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[DrBobSmith]

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I originally took this down, but here is what I originally posted:

- Due to various reasons I will have to reveal on ERAS that I've been treated for alcohol dependence (two medical leaves during 1st year)
- I have been in a monitoring program and active in my recovery for the past 3 years through school
- Other than that red flag I would be a very competitive candidate for most if not all psych programs in the country
- I was hoping for some insight from others on how candidates or colleagues like me with substance abuse issues or other mental health problems have been treated in the past

Thanks for all the input so far... feel free to PM me if you want clarification and can offer more insight

Thanks

 

[splik]

The general advice is not to disclose any illness and least of all a mental disorder or substance abuse problem in your application. It is one way of cutting down on applications and it does raise eyebrows about one's reliability and performance as a resident. Also discussing such things suggests poor judgment on the part of the applicant.

You mention you *have* to mention substance abuse which means there is some red flag in your application be it criminal, a minor misdemeanor or having taking time out of medical school. Red flags can be the death knell of an application.

If you have a good application i suspect you will get interviews, but this will unquestionably hurt your application, how much will depend on what your red flag is. You especially need good letters of recommendation, and a few people who support you and will champion your cause by calling PDs/department chairs and vouching for you.

It will be a big deal and overshadow whatever achievements you have in that this is what everyone will focus on and want reassurance that this is not going to be a problem in the future and that is not reassurance you can really provide.

In short all is not lost but you cant expect this not to hurt you. Psychiatry is probably the medical specialty most intolerant to mental illness within its ranks.

 

[digitlnoize]

Psychiatry is probably the medical specialty most intolerant to mental illness within its ranks.

Does no one else find this ironic? It's a like a surgery resident getting rejected for being s/p appendectomy. Or an IM resident getting rejected because he has GERD.

We tout these disorders as biological illnesses to our patients, but to ourselves seem to want to claim that you are unclean if you've ever taken an SSRI.

On the contrary, I think psychiatry residency could be a great thing for a high-functioning psychologically minded person. They could be come educated to the highest level possible about their disease, and using that information become even more healthy. Or, they may be driven to produce more and better research than others.

If a candidate with mental illness has managed to make it through undergrad, into medschool, and then complete medical school, then I think it's likely they either don't have a mental illness (or if they do, it helps them, like OCPD), or their illness is so well controlled that it hasn't affected their medical school career, so give them the benefit of the doubt and say it won't affect their residency either.

It is extremely common for applicants to want to enter a chosen specialty due to their personal experience with disease. (I have heart problems so I did cards, or my mom died of cancer, so I'm doing Heme-Onc). Of all the medical specialties, psychiatry seems to me to be the only one which looks down on this fact, especially for mild illness.

This seems, to me, to be a huge mistake. What kind of message are we, as a profession, sending to budding psychiatrists? Mental illness means there is something wrong with you, and that you are inferior, and that you should just cover it up, hide it, lie about it, and make sure NO ONE ever finds out. And, for God's sake, don't TALK about it.

Is anyone surprised that there is still a social stigma against mental illness?

I understand the counterargument that sick people miss more work days, blah blah blah, but I think there is a difference between a 64yo candidate with full blown CHF and COPD vs one who had a heart arrhythmia ablated at age 20 with no sequelae. By the same token, there's a difference in a psych patient who is chronically schizophrenic, multiple hospitalizations per year, non-compliant...and someone who gets mildly depressed a couple times a year and takes an SSRI, or takes a stimulant for ADHD. If they're well controlled, and functional I see no problem with it, and they might even be the better candidate.

Sorry. Rant over.

 

[OldPsychDoc]

Every medical student and health professional should make themselves aware of the existence of their state's HPSP--Health Professionals Service Program. It will provide confidential referrals to treatment and a support and accountability structure to validate your recovery and hopeful lack of impairment. In some states you are allowed to check "No" for the question regarding treatment for substance abuse if you are under the auspices of an HPSP for that treatment. The HPSP will serve as an intermediary with your state licensing agency and help you to keep your license AND get treatment for mental health and substance abuse issues.

 

[2000 Man]

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[whopper]

Does no one else find this ironic?

I find it hypocritical on several levels for and against the applicant and the program, and I'm not talking Hippocrates-like. I wrote about this before in another thread. It's a very difficult situation for the applicant because they will likely fear being judged against in an unfair manner and rightfully so. It's also difficult for the program because if they kick out a resident who can't deliver, they could have a lawsuit on their hands. Residents that are fired aren't a happy bunch. This is not like any other job where if you leave the job, you just get another. Being fired can leave a permanent black mark and in effect end up being on a blacklist.

When you're a PD and you got a guy who openly says he's mentally ill, and there's hundreds of applicants, what I believe is going on is the program would simply just take someone else. They don't want to take the risk. Is it wrong? IMHO yes, though at the same time, it puts the program in a difficult situation because of the non-fluid nature of hiring and firing residents.

Another problem is if an applicant is mentally ill, and it's stated on the application, even despite good credentials (grades, USMLE scores, LORs), medical schools have a tendency to want to sell their students for the same reasons mentioned above, they're trying to avoid an unhappy student who's threatening to sue if they get a bad review, and they figure they'll just let the next rung handle the problem. This has occurred actually several times in the medical profession. There's several known cases where doctors and nurses were actually intentionally killing patients, and the hospital didn't want a public relations nightmare and simply just told the doctor or nurse to leave and didn't report the event to the authorities on the notion that they'll wash their hands and let the next place deal with it. (No I'm not joking on this).

This type of shady denial of hiring occurs all the time in the corporate world. Guy comes in with dreadlocks, a bible for the Church of Satan, and says he's a member of political organization the boss doesn't like during a job interview, he's not going to be hired and they won't say it's the dreads, his religious affiliation or his politics even though that's what's really going on because that's discrimination. They'll just tell the guy they got a better applicant whether or not it's true.

There was a case of a paraplegic on Oprah years ago and no residency would take him despite having stellar grades, USMLE scores, and LORs significantly better than the people who actually got in. It was transparent a program didn't want someone that needed a wheelchair, but they won't openly state it. They'll just give the letter politely saying sorry.

IMHO someone with a mental illness shouldn't have that held against them during the application process unless it's been found that they could not perform their duties as well due to that illness. E.g. if a guy is on an antidepressant, still has good grades, USMLE scores, and LORs, it shouldn't have an impact (my opinion...of course I believe it would have an impact in some programs--against the applicant). On the other hand if an applicant was known to fly-off-the handle, yell at patients, write poor reports, and the mental illness was playing some role in it, yes I do think it needs to be held against the applicant unless the problem was known to be corrected.

 

[F0nzie]

What happened to the original post? 😕 I don't agree with discrimination, but the reality is that it exists everywhere in multiple different forms as whopper elucidated. It doesn't matter what job you're applying for, you're going to need to put your best foot foward. If you want to move up in ranks, you have to play the politics. Most employer's bottom line is money. Profits are what keep businesses afloat, not empathy and understanding. In the case of residency, the cash equivalent is keeping all the residents that are accepted. I'm sure a lot of professionals especially in the mental health field may have a bias towards conceptualizing severe mental illnesses as a whole as chronic conditions that are relapsing and remitting...because alot of them can be. Also, despite how far we've come along in pharmacology and therapy, the mentally ill population is at a much higher risk for significant impact on social and occupational functioning. The general population may conceptualize the mentally ill as lazy. See how many ways this recent article can be interpreted where it was estimated that only 22% of severely mentally ill people were working. http://www.chicagotribune.com/news/local/ct-met-holiday-giving-pillars-20111211,0,5023386.story. Whatever the biases, stimga, or research suggests, either way the risks may cuts into an institution's bottom line. I'm not trying to promote false self here- I just believe we live in a world of "survival of the fittest" and going out of your way to let an employer know you have a mental illness is probably not going to get you the empathic approval and validation you may receive from your therapist. We are not that sophisticated yet.

 

[peppy]

I feel the issue of whether mental illness should be a factor to residency definitely depends on the severity of the mental illness. I do agree that conditions like a history of mild depression that is well treated and stable should not be a factor in someone's residency performance. However, it's undeniable that some mental health conditions are 1) worsened by stress and sleep deprivation, which is rampant in residency and 2) impair a person's insight and judgment, which can be dangerous or harmful in a physician who is responsible for others' well-being.

I have met psychiatrists (and other mental health workers) who, in my opinion, were allowing their own psychiatric issues to cause them to behave in ways that were not helpful to the patients or that made it hard for the rest of us to work with them.

I think that can be very destructive and it can give the general public a very negative image of mental health care ( "They can't help anyone else get better. Look at how crazy they all are" is a sentiment that I've heard about psychiatrists before - and with some of the psychiatrists I know, I TOTALLY UNDERSTAND why people think that way about us).

 

[digitlnoize]

I feel the issue of whether mental illness should be a factor to residency definitely depends on the severity of the mental illness. I do agree that conditions like a history of mild depression that is well treated and stable should not be a factor in someone's residency performance. However, it's undeniable that some mental health conditions are 1) worsened by stress and sleep deprivation, which is rampant in residency and 2) impair a person's insight and judgment, which can be dangerous or harmful in a physician who is responsible for others' well-being.

I have met psychiatrists (and other mental health workers) who, in my opinion, were allowing their own psychiatric issues to cause them to behave in ways that were not helpful to the patients or that made it hard for the rest of us to work with them.

I think that can be very destructive and it can give the general public a very negative image of mental health care ( "They can't help anyone else get better. Look at how crazy they all are" is a sentiment that I've heard about psychiatrists before - and with some of the psychiatrists I know, I TOTALLY UNDERSTAND why people think that way about us).

I agree 100% that severity matters, and that we should put our best foot forward, but if someone is successful in medical school, and had a mild depressive episode during high school, or ADHD, or a parent with "Diagnosis X" I don't think that should preclude them from a spot, and the general consensus has seemed to be that it probably does.

I certainly don't think we should completely overlook mental (or even physical illness, as non-PC as that may be), if someone's illness makes them unable to perform, then they shouldn't be a doctor. However, if the disease is well-controlled, and they have performed well in the past (good test scores, no interruptions in medical education, etc), then I see no reason why a mental health diagnosis should bar anyone from a residency position.

Disclaimer: I do NOT have any psychiatric diagnoses myself (although you're all free to debate that fact amongst yourselves, hahaha 😀 ). I'm just trying to take up for the underdog.

If we can't eradicate the stigma against mental illness from within our own ranks, how can we expect to eradicate it from the rest of the world?

 

[atsai3]

Is anyone surprised that there is still a social stigma against mental illness?

I understand the counterargument that sick people miss more work days, blah blah blah, but I think there is a difference between a 64yo candidate with full blown CHF and COPD vs one who had a heart arrhythmia ablated at age 20 with no sequelae. By the same token, there's a difference in a psych patient who is chronically schizophrenic, multiple hospitalizations per year, non-compliant...and someone who gets mildly depressed a couple times a year and takes an SSRI, or takes a stimulant for ADHD. If they're well controlled, and functional I see no problem with it, and they might even be the better candidate.

Sorry. Rant over.

I don't know if the differences are as minimal as your post seems to imply. In the NCS-R, major depressive disorder was associated with 9 days of absence & 18 lost days of productivity annually. Bipolar disorder, 28 days of absence & 35 lost days of productivity. One might expect these means to be even greater among employees experiencing above-average job-related stressors (i.e., residents).

 

[digitlnoize]

I don't know if the differences are as minimal as your post seems to imply. In the NCS-R, major depressive disorder was associated with 9 days of absence & 18 lost days of productivity annually. Bipolar disorder, 28 days of absence & 35 lost days of productivity. One might expect these means to be even greater among employees experiencing above-average job-related stressors (i.e., residents).

Again, there's a difference in active severe (or even moderate) recurrent MDD and having one depressive episode 10-20 years ago.

My point is that if the person has managed to make it through 4 years of medical school without falling behind due to absence, they'll most likely survive just fine in residency, and if they want to mention that they were sad once in their life, it shouldn't preclude someone from succeeding. Sure, if they've had 2 or 3 psych hospitalizations per year for the last 10 years, they're probably a risk.

I think we need to ask ourselves why it is not ok for a doctor to have a disease? That's the more pertinent question. Do we really want physicians who have no idea what it means to be sick? Why do we set such unrealistic expectations for ourselves, that we must work superhuman hours without a break, to the point of legal intoxication, or without a sickness or vacation day?

 

[whopper]

Are the mentally ill more likely to have more days missed from work or do a worse job? Yes--as a demographic. To hold that against an individual is prejudiced and would fit the legal definition of discrimination, just like studies show that young men of specific ethnic minorities are more likely, as a demographic, to do worse in multiple choice tests. Any argument pushing that the problems showed by a demographic are to be held against an individual is discrimination, racism, sexism, what have you.

Another factor that makes this more difficult is that going into residency has parallels with being in the military. You have to be committed, you will be worked tremendously hard, and lives will be in your hands. The military will not accept someone with specific forms of mental illness. Should the medical field? I'm not saying for or against. I'm merely just posing that as a question for everyone to think about.

I think a reason why this issue was never actually confronted in a manner where residency programs made a kosher policy on them is because it's not open/public enough and there's not enough applicants or programs causing enough of a hoopla for a open dialogue and debate to start. The most open display I've ever seen was the guy on the Oprah show and that was years ago and I never heard anyone else ever bring it up since other than on these forums.

 

[cleareyedguy]

If someone goes out twice on medical leave as a first year student, he/she isn't required to announce the specific problem 3 years later. If asked, and he/she probably won't be, he/she can just say, "I was sick and got better and now I'm fine." Th interview is not the time to use one of your AA steps.

On the other side of the fence, programs are looking for low risk high achievers. They are using minimal info to make big decisions. If someone gives a hint of unreliability, impulsivity, sociopathy, stupidity, low resilience, character rigidity, etc, etc, the program will likely ding him or her. Yes, the ADA exists for a reason, but programs are still going to (and should) try to pick the people who stand the best chance of becoming great docs. Because of the ADA, this applicant needn't mention his problem (assuming, again, his medical leave was voluntary and not disciplinary--and if it was disciplinary, then it indicates that at least some point in the past he was NOT forthcoming and quick to get treatment and he therefore foregoes some of the ADA protection--then he needn't and shouldnt give the details.

 

[whopper]

They are using minimal info to make big decisions.

And programs have to go through hundreds if not thousands of applications in a relatively small amount of time. The old stereotype of an evil program making piles and judging people based simply on a score and not the true worth of the person is not so evil when you consider how little time and info the program has, what's at stake, and that a prudent program will not kick out a resident until several obstacles have been crossed due to the fear of a lawsuit and the risk of blackmarking the resident.

It's not a fair process, but I can't think of a way to make it better.

A buddy of mine who was a chief resident, when going through applications, would specifically see if anyone was kicked out and tried to give their applications extra attention because he too was kicked out of a program, unfairly, and the program was malignant making him work 100 hours a week. He wanted to make sure these applicants were given a fair chance because he too was put through the process where he knew it would be held against him when applying to new programs.