PGY1 Non-Renewal – Better to Leave at 12 Months or Stay to 15?

[nala97]

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Hi everyone,

I’m a US IMG PGY1 in Family Medicine I was placed on probation and informed of non promotion back in March due to clinical performance issues mostly with documentation and applying knowledge under pressure. I’ve since been diagnosed with ADHD, started treatment, and requested accommodations, but my program recently told me I won’t be promoted to PGY2. They also said it’s very unlikely I’ll meet the milestones for PGY1 completion, even if I stay through the extension they offered until October.

So I’m torn between:
• Leaving on June 30 with 12 months and a training verification letter (no PGY1 certificate)
• Staying until October for 15 months, but still not being signed off

I want to try restarting PGY1 elsewhere if possible, and I’m worried about how GME funding works if I go past 12 months without credit.

Would really appreciate any advice on what would leave me with the best shot at starting over.

Thanks

 

[ThoracicGuy]

Hi everyone,

I’m a US IMG PGY1 in Family Medicine I was placed on probation and informed of non promotion back in March due to clinical performance issues mostly with documentation and applying knowledge under pressure. I’ve since been diagnosed with ADHD, started treatment, and requested accommodations, but my program recently told me I won’t be promoted to PGY2. They also said it’s very unlikely I’ll meet the milestones for PGY1 completion, even if I stay through the extension they offered until October.

So I’m torn between:
• Leaving on June 30 with 12 months and a training verification letter (no PGY1 certificate)
• Staying until October for 15 months, but still not being signed off

I want to try restarting PGY1 elsewhere if possible, and I’m worried about how GME funding works if I go past 12 months without credit.

Would really appreciate any advice on what would leave me with the best shot at starting over.

Thanks

Have you investigated any programs that would take a chance on you? If so, those programs will likely start in July so you'd need to be available by that time. I'll be honest, though, the odds are stacked against you here. If you have the chance of getting PGY1 full credit, then you could look into Preventative Medicine or Occupational Medicine training.

Good luck.

 

[tacobellforlife]

Hi everyone,

I’m a US IMG PGY1 in Family Medicine I was placed on probation and informed of non promotion back in March due to clinical performance issues mostly with documentation and applying knowledge under pressure. I’ve since been diagnosed with ADHD, started treatment, and requested accommodations, but my program recently told me I won’t be promoted to PGY2. They also said it’s very unlikely I’ll meet the milestones for PGY1 completion, even if I stay through the extension they offered until October.

So I’m torn between:
• Leaving on June 30 with 12 months and a training verification letter (no PGY1 certificate)
• Staying until October for 15 months, but still not being signed off

I want to try restarting PGY1 elsewhere if possible, and I’m worried about how GME funding works if I go past 12 months without credit.

Would really appreciate any advice on what would leave me with the best shot at starting over.

Thanks

100% get 1-year funding. It will just be an easier transition. I would definitely check ResidentSwap as there have been a plethora of new FM programs which have been opening up for the next academic year.

 

[AlbinoHawk DO]

This is definitely a terrible position to be in. Without getting a PGY-1 certificate, you effectively will be unable to get license anywhere. The chances to get a second residency after this are probably close to none. Ultimately, I don't think either scenario makes a difference given that they won't give you the opportunity to "graduate" from PGY-1. I would do everything in your power to convince the PD to allow you to remediate until you meet milestones to get your PGY-1 certificate.

Are you sure this is all entirely academic? I mention this because the PD probably knows they are ending your medical career by not giving you a chance to complete at least PGY-1

 

[tacobellforlife]

This is definitely a terrible position to be in. Without getting a PGY-1 certificate, you effectively will be unable to get license anywhere. The chances to get a second residency after this are probably close to none. Ultimately, I don't think either scenario makes a difference given that they won't give you the opportunity to "graduate" from PGY-1. I would do everything in your power to convince the PD to allow you to remediate until you meet milestones to get your PGY-1 certificate.

Are you sure this is all entirely academic? I mention this because the PD probably knows they are ending your medical career by not giving you a chance to complete at least PGY-1

This is truly the worst thing to read. Knowing that a PD is ending your medical career after the countless hours and time put in to get to the training level. Some programs will literally pick a resident every year to make their life hell.

 

[nala97]

This is truly the worst thing to read. Knowing that a PD is ending your medical career after the countless hours and time put in to get to the training level. Some programs will literally pick a resident every year to make their life hell.

Yeah it’s my Orgina

This is definitely a terrible position to be in. Without getting a PGY-1 certificate, you effectively will be unable to get license anywhere. The chances to get a second residency after this are probably close to none. Ultimately, I don't think either scenario makes a difference given that they won't give you the opportunity to "graduate" from PGY-1. I would do everything in your power to convince the PD to allow you to remediate until you meet milestones to get your PGY-1 certificate.

Are you sure this is all entirely academic? I mention this because the PD probably knows they are ending your medical career by not giving you a chance to complete at least PGY-1

Yeah, al

This is definitely a terrible position to be in. Without getting a PGY-1 certificate, you effectively will be unable to get license anywhere. The chances to get a second residency after this are probably close to none. Ultimately, I don't think either scenario makes a difference given that they won't give you the opportunity to "graduate" from PGY-1. I would do everything in your power to convince the PD to allow you to remediate until you meet milestones to get your PGY-1 certificate.

Are you sure this is all entirely academic? I mention this because the PD probably knows they are ending your medical career by not giving you a chance to complete at least PGY-1

Yeah, I’ve been trying to process that exact fear. My main struggle has been staying organized under pressure which really affects my inpatient rotations and my organizational skills and that’s made me seem weaker than I actually am. My OB and ED attendings thought I was solid, and even in clinic, my plans were usually sound. I recently started ADHD treatment and requested accommodations, and I’m asking for one last chance to work under structure to meet the PGY1 milestones.
I really don’t want to walk away without at least knowing I tried everything. Appreciate your honesty. It’s painful, but it’s helping me stay clear-eyed.

 

[tacobellforlife]

Wait, @nala97 why can't you get a PGY1 certificate if you're ending on June 30th?

 

[nala97]

Wait, @nala97 why can't you get a PGY1 certificate if you're ending on June 30th?

They say because I haven’t met all pgy1 milestones

 

[tacobellforlife]

They say because I haven’t met all pgy1 milestones

****, this is a very tough situation. I have never heard of somebody being forced out after PGY1 level. I think you really really need to grind and demonstrate that you're capable of working under the pressure.

If you leave now, I'm not sure whether you'll be able to get back into medicine.

Atleast staying until October could potentially be a saving life line. You 100% need to have periodic meetings with your preceptors to make sure you're doing well and show them that you're improving.

 

[Crayola227]

Yeah it’s my Orgina

Yeah, al

Yeah, I’ve been trying to process that exact fear. My main struggle has been staying organized under pressure which really affects my inpatient rotations and my organizational skills and that’s made me seem weaker than I actually am. My OB and ED attendings thought I was solid, and even in clinic, my plans were usually sound. I recently started ADHD treatment and requested accommodations, and I’m asking for one last chance to work under structure to meet the PGY1 milestones.
I really don’t want to walk away without at least knowing I tried everything. Appreciate your honesty. It’s painful, but it’s helping me stay clear-eyed.

What does orgina mean?

 

[Crayola227]

What's the thread consensus? Are the odds really better ending in June for the coming year?

Isn't the advice usually that funding is less the issue than other considerations such as how much a program needs to fill a spot, etc?

I ask because, if it were me and less advantage to that, I would cling to the hope and tough it out. Is this about their wanting coverage or a true chance to at least get the PGY1 certificate? Because I can't otherwise understand why the program would offer. Unless some of it is, give them more work and they return some good will helping you move on.

It's a shame because I suspect in principle there is an ADA issue here, but lawyering up and those cases are impossible unless you're just trying to negotiate a termination into a better resignation. But this is non-renewal so nothing to do there.

This seems like a throw yourself on the mercy situation. I wonder if sticking it out and busting ass, even with no PGY1 certificate, will more favorably dispose them to helping you move on.

A frank conversation where you try to find out if there is some field they could see you in, with appropriate treatment of your ADHD, and if they might be willing to help you get there. You are willing to work hard and do anything for that, and are willing to work until October if they think it will make a difference in some way for continuing or getting help moving on. (Other posters might be right, I'm trying to square this, because it seems like additional program support might be more important if it's on offer?)

Sometimes it's just about, they don't think they can get you where you need to be, and they have to think about the program and coverage. Ending your career permanently not being the goal, just an unfortunate side effect. If this is indeed the case, showing some understanding of that here, and sympathy to the program for the hassle here and the offer to work more (I know this seems ridiculous given what is happening here) shows some maturity and that can only help. It's awful to feel like you have to make nice and be a friend to them here, but the one destroying you is also your only lifeline.

Good character and work ethic counts for a lot here though if anyone helps you in any way. Don't forget that for a minute even if you're getting washed out.

I see what other people are saying here that it seems odd, but it does happen that way. Obviously up to OP to realize if there are other things going on, because the offer to stay makes little sense if it's not going to make a difference at a real chance, or not in exchange for good will and help to move on.

 

[NotAProgDirector]

regarding the funding, you'll have a total of 36 months of full funding. Since your PGY-1 is going to be extended / repeated you'll go beyond 36 months. At that point, you have decreased funding which usually comes out to 75-80% of your total funding. So it's not like you have no funding beyond 36 months. Read this for more details: Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know

So from a funding perspective, whether you resign in June or October makes little difference.

Programs certify successful completion of a PGY-1 year -- which means gaining the skills we would expect during a PGY-1. Just completing 12 months isn't sufficient. OP - it sounds like your program is willing to extend you for 3 months -- if so, perhaps if you improve in those three months, they then would certify you. They may be concerned that you won't gain the skills you need, given your current level of functioning.

@Crayola227 mentioned a possible ADA issue. There isn't one here. The ADA requires that employers provide reasonable accommodations for employees with chronic disabilities. It requires that the employee request the accommodation (unless the disability is obvious). Now that you're diagnosed with ADHD and on medication, if you need a reasonable accommodation you could certainly ask for it. But you can't excuse prior poor performance on something that was unknown and/or untreated (per the ADA). If you have not told your program about your ADHD treatment you could choose to do so, and perhaps that will make them more inclined to give you more time to see if that improves your performance.

Getting a new PGY-1 spot will not be easy. Programs will ask "Please explain why you won't run into the same problems again?". Hopefully your treatment will help -- if so, perhaps staying another 3 months and getting documentation of your improvement would help.

 

[AlbinoHawk DO]

Upon reflection, I agree that the 15 months at least give you an opportunity to prove yourself. Perhaps you can negotiate with the PD that if you meet some milestones by then, they give you another 3 months to meet the milestones to get the PGY1 certificate. Makes it clear that's your main goal as you might end up with no medical care without that certificate

 

[Gonio5]

They say because I haven’t met all pgy1 milestones

This is troubling because the milestones are so subjective. The milestones are sort of like EMR, lots of words but says very little.

Example of one of the milestone for another program but likely similar if they copied it from another source for their ACGME review.
Medical Knowledge
a. House Officer has demonstrated an understanding of the
pathophysiology relevant to encountered clinical conditions.
i. Evaluated Through Direct Observation? Yes or No.
ii. Evaluated Through Chart Audit/s? Yes or No.
iii. In-Training Exam has been taken? Yes or No.
iv. Evaluated Through Multi-Source Evaluation? Yes or No.
v. Evaluated Through Self-Reflection? Yes or No.

Is the program going to document when you did and didn't meet this for every or many patients? No? The chart audit doesn't really do this because the chart is not supposed to be an essay. The in-service exam is very important but has already taken place.

 

[Crayola227]

regarding the funding, you'll have a total of 36 months of full funding. Since your PGY-1 is going to be extended / repeated you'll go beyond 36 months. At that point, you have decreased funding which usually comes out to 75-80% of your total funding. So it's not like you have no funding beyond 36 months. Read this for more details: Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know

So from a funding perspective, whether you resign in June or October makes little difference.

Programs certify successful completion of a PGY-1 year -- which means gaining the skills we would expect during a PGY-1. Just completing 12 months isn't sufficient. OP - it sounds like your program is willing to extend you for 3 months -- if so, perhaps if you improve in those three months, they then would certify you. They may be concerned that you won't gain the skills you need, given your current level of functioning.

@Crayola227 mentioned a possible ADA issue. There isn't one here. The ADA requires that employers provide reasonable accommodations for employees with chronic disabilities. It requires that the employee request the accommodation (unless the disability is obvious). Now that you're diagnosed with ADHD and on medication, if you need a reasonable accommodation you could certainly ask for it. But you can't excuse prior poor performance on something that was unknown and/or untreated (per the ADA). If you have not told your program about your ADHD treatment you could choose to do so, and perhaps that will make them more inclined to give you more time to see if that improves your performance.

Getting a new PGY-1 spot will not be easy. Programs will ask "Please explain why you won't run into the same problems again?". Hopefully your treatment will help -- if so, perhaps staying another 3 months and getting documentation of your improvement would help.

The ADA issue would be if the program became aware of the issue, the resident requested accommodations, and the program moved to non-renewal which is what the resident says, if the non-renewal wasn't in good faith. Even though a non-renewal can be for any reason essentially, it cannot be for that reason. Of course you'd have to show the non-renewal was to avoid having to accommodate. On its face it sounds bad, so I question intention. Often what looks like a duck is a duck. Besides, I don't think I'm giving good advice to residents who admit to medical issues and employers issues, if I don't earnestly consider if they have any case at all. I think based on what little said here, maybe there were not good intentions, but not to a point to be helpful.

We can argue this of course, which is precisely why we can say there is no case here without a smoking gun level of evidence the program is letting the resident go because of disability. This is assuming that the resident is now up to snuff or will be but the program doesn't want to accommodate/risk moving forward, and of course we don't know that and you could argue they probably aren't.

But every day employers decide it's not worth it to them and violate the law in spirit and in reality even if there is no proving it. So I agree there is no case, but for a different reason than you. I think going by the rest of what you said, there might still be a case to be made in theory. I don't otherwise disagree with how you laid out "how it works" it's accurate enough. I don't think either of us could say if this is what happened or not though.

All you have to do is witness employers break the law with impunity while an attorney and other experts tell you it's flat out illegal, while also telling you that despite this they do it anyway because you just don't have bulletproof proof to take it to court and win, that they have seen this from others not only in employment but medicine, while the employers in so many words says it's what they're doing but it's not recorded, to know this happens. And I even understand why employers especially in medicine will do this. Doesn't change the fact it happens and it wasn't supposed to.

The issue is people want to say because it's never happened to them or they never did it, it doesn't exist. That's like proving a negative. If you are someone or know someone this happened to, then it should be enough to say, well, it happens.

 

[Crayola227]

So maybe there was an ADA violation, maybe there wasn't, in either case I doubt there is anything to be done, if that was something the OP wondered. Which all residents with medical conditions should consider in asking accommodations or being let go, how to handle their disability with their employer and if anything was amiss.