PGY-5 Resigning from CAP fellowship?

[inveggar]

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Hello all,
I'm a PGY5 2nd yr child fellow and am board eligible. I matched at my home CAP program (where I did my residency). There have been a lot of disruptions in our rotations and faculty that have left. I feel like my colleagues and I have had a difficult time compared to those that have graduated before us. I also am not too keen on dealing with obnoxius parents and unfortunately situations for children which have absolutely nothing to do with me (i.e. foster care placements, abuse). The workload has increased and I am getting burned out. I would much rather see adults and have a salary so I can provide for my family (we are a family of 5 and my spouse is not working). In spite of everything, I have a good relationship with the attendings we have left but their hands are tied due to system issues.

I am considering giving my 30 day notice to terminate my employment as I don't know if I can manage 11 more months of this and take a hit in my income. I know the program director will not be happy but I wonder if this will effect me from a future employment perspective, if I decide to just do private practice? Also, seeing as though this is my home program (can the Adult program withdraw my training credit, eventhough I completed it)?

I truly love working with the children and some families (emphasis on some) but I am absolutely fed up with the system of care for children. I feel like half the pathology is due to situations which I cannot have any power to change over and this frustrates me. Also, it is rather frustrating that I don't get additional time for follow ups with C&A patients (I am essentially seeing two patients, I think that warrants more time especially if I see the parent and the child individually). I didn't realize these problems when I was applying. I'm also taken aback by the expectations of parents/therapists/teachers to demand a Psychiatrist medicate every single thing (even normal behavior) and when I refuse it turns into an argument where they fire me.

I have been feeling this way for a while but was hoping things would change. I didn't have these issues with adult population for some reason.

Does anyone have any advice for me?

 

[dl2dp2]

Happens all the time. People routinely drop out. In and of itself carries no stigma.

 

[inveggar]

Happens all the time. People routinely drop out. In and of itself carries no stigma.

Can the program revoke my residency (i.e. say that I did not complete the requirements) as a retaliation? I am already board eligible but I just don't want the program/hospital to cause problems for me later on (with state board licensing, etc.).

 

[Attending1985]

In the short time I agreed to work with teens (I’m and adult psych) I had the same sentiments. Especially the therapists overdiagnosing and demanding medications when inappropriate. That’s why I stopped.

 

[dl2dp2]

Can the program revoke my residency (i.e. say that I did not complete the requirements) as a retaliation? I am already board eligible but I just don't want the program/hospital to cause problems for me later on (with state board licensing, etc.).

I mean, they can always do that, but I don't see why they would. Discuss the situation with the program director and negotiate a win-win outcome. This is so common as to be not very remarkable an occurrence.

 

[downwithDTB]

I imagine that they could try to say that you did not complete your requirements, but assuming that there is evidence in a computer somewhere that you've completed your CSVs and have completed clinical rotations, and there is not a paper trail of multiple citations against you and warnings of dismissal, it would be very, very hard for them to have this stand up upon appeal to any licensing board and would look absolutely horrendous for their program. I might go to a program that someone resigned from. I wouldn't go to a program that was embroiled in a controversy over failing to graduate someone who had been in good standing because they didn't wanna finish child fellowship.

 

[Merovinge]

I would not be worried about having your residency revoked. If you were able to fast-track that means you met the requirements needed, so them accepting you into the fellowship acknowledges that they agreed you were in good standing implicitly.

That said, I would strongly consider completing the fellowship. It opens up more doors for future career work, particularly as someone who likes working with kids. Really sucks that your program is going down in flames, but honestly it happens to good programs from time to time and does not have to set you terribly off track, particularly since you like your remaining faculty.

Some CAP work is really tough, dealing with complex trauma, kids in the system or abject poverty who can't get standard of care treatment or just normal life things (like clean clothes or not getting assaulted). BUT some of these cases can be absolutely amazing. Ever see a kid serially abused get into a better home and then make the honor role or get accepted into college?. That look of pride in themselves they thought they would never have is not easy to forget. You ever see the kid Rxed Zyprexa by the NP because he was aggressive once come back 6 months later down 50 pounds and grades up a letter grade that you hardly even recognize? How about the socially anxious kid who got a date to prom after working hard on his exposures?

Bad families are the worst, but everywhere I've worked there have been more good then bad, and far more grateful than ungrateful, particularly once I stopped forgetting about the good and only focusing on the bad. You can't tell me you havent had your share of non-compliant adults, malingering adults, or perpetually broken adults. Both populations have difficult populations but I actually find CAP to be less than adult on a per pt/family basis.

There are certainly financial implications to consider but given that you choose the fellowship knowing full-well about this then, unless something has changed significantly in the past 18 months with the family (and hey, is so, fair enough), I wouldn't let that be the decider now.

 

[heysexylady]

Can the program revoke my residency (i.e. say that I did not complete the requirements) as a retaliation? I am already board eligible but I just don't want the program/hospital to cause problems for me later on (with state board licensing, etc.).

They can't. You completed 4 years. You really don't even need to give them 30 days notice. I've seen somone give 5 days. You have a contract with them that says you are pgy 5.....so they can't say you did not successfully complete 4 years. This will not affect.

 

[NickNaylor]

Did you fast track? The reason I ask is if you're a PGY-5, it may be worthwhile to suck it up for the year so that you can get your certification if you've already persevered for a year.

Have you talked to your program director or other program leadership about your concerns?

I'm not saying that you shouldn't drop out of your training, but it seems like a fairly drastic step if you feel that the main problems are related to the program and you haven't given the program a chance to try and address them. I can't quite tell if your misgivings are about your program specifically or about some of the aspects of CAP practice generally.

 

[inveggar]

I would not be worried about having your residency revoked. If you were able to fast-track that means you met the requirements needed, so them accepting you into the fellowship acknowledges that they agreed you were in good standing implicitly.

That said, I would strongly consider completing the fellowship. It opens up more doors for future career work, particularly as someone who likes working with kids. Really sucks that your program is going down in flames, but honestly it happens to good programs from time to time and does not have to set you terribly off track, particularly since you like your remaining faculty.

Some CAP work is really tough, dealing with complex trauma, kids in the system or abject poverty who can't get standard of care treatment or just normal life things (like clean clothes or not getting assaulted). BUT some of these cases can be absolutely amazing. Ever see a kid serially abused get into a better home and then make the honor role or get accepted into college?. That look of pride in themselves they thought they would never have is not easy to forget. You ever see the kid Rxed Zyprexa by the NP because he was aggressive once come back 6 months later down 50 pounds and grades up a letter grade that you hardly even recognize? How about the socially anxious kid who got a date to prom after working hard on his exposures?

Bad families are the worst, but everywhere I've worked there have been more good then bad, and far more grateful than ungrateful, particularly once I stopped forgetting about the good and only focusing on the bad. You can't tell me you havent had your share of non-compliant adults, malingering adults, or perpetually broken adults. Both populations have difficult populations but I actually find CAP to be less than adult on a per pt/family basis.

There are certainly financial implications to consider but given that you choose the fellowship knowing full-well about this then, unless something has changed significantly in the past 18 months with the family (and hey, is so, fair enough), I wouldn't let that be the decider now.

There are some personal reasons that have arouse (i.e. my spouse is not able to work and one of our kids has had some health issues). But these are not the true determining factor. I hate how in our system of care the attendings just take a back seat to therapists and social workers. As a result, I feel they medicate children based on the therapist and parent's urge, as opposed to thinking objectively at times. This irritates me. I treat patient's the way I would want my own children treated. When I see a 8 year old on 4 different medications when honestly all they need is a caring, loving parent, it really irks me. My attendings support me on this, but then they back down when the therapist tries to make a case to prescribe.

My colleagues are sucking it up but I'm having a hard time working in this system of care. It just really sucks and is incredibly disappointing that even small requests take a back seat. I have some of my own health issues and requesting minor accommodations (i.e. to have a comfortable seat) is refused because "it's not in the budget." But again, I'm willing to compromise on my own comfort/happiness, but I hate being told by a therapist to prescribe medications to a child when I don't think it is warranted.

I'm still on the fence. I like some my colleagues and I don't want them to have a bad experience if I leave. We are already busy enough.

 

[Merovinge]

There are some personal reasons that have arouse (i.e. my spouse is not able to work and one of our kids has had some health issues). But these are not the true determining factor. I hate how in our system of care the attendings just take a back seat to therapists and social workers. As a result, I feel they medicate children based on the therapist and parent's urge, as opposed to thinking objectively at times. This irritates me. I treat patient's the way I would want my own children treated. When I see a 8 year old on 4 different medications when honestly all they need is a caring, loving parent, it really irks me. My attendings support me on this, but then they back down when the therapist tries to make a case to prescribe.

My colleagues are sucking it up but I'm having a hard time working in this system of care. It just really sucks and is incredibly disappointing that even small requests take a back seat. I have some of my own health issues and requesting minor accommodations (i.e. to have a comfortable seat) is refused because "it's not in the budget." But again, I'm willing to compromise on my own comfort/happiness, but I hate being told by a therapist to prescribe medications to a child when I don't think it is warranted.

I'm still on the fence. I like some my colleagues and I don't want them to have a ****ty experience if I leave. We are already busy enough.

If that's your biggest concern, I would really not expect that to be a huge issue going forward. I haven't meet any therapists or psychologists who are brazen enough to recommend prescribing practices and honestly most don't have the time to be tracking you down to try and medicate their patients We are unquestionably the top of the hierarchy of deciding on the prescribing of psychotropics to children and that will always be your decision to make as an attending. Parents can argue for things, but my experience has been that when you give a rationale and reasonable description of your plan of care they almost always back down. It's a lot easier to find a FPNP to prescribe adult dosages of controlled drugs or antipsychotics to 6 year olds then argue with you.