Please Help - I want to leave my fellowship!

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DocThatRocks

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DocThatRocks said:
I am a PGY 4 in my first year of fellowship. I love my field, but I hate my fellowship program. I want to leave and need advice.

My program is horrible. I am the only U.S. grad in my program. The IMGs in my program do not seem to care about patient care issues. They constantly take short cuts and falsify documentation. There are numerous omissions in H&Ps, and what is worse is that the attendings will sign off on this documentation. Everything is so disorganized here and there is poor communication among the physicians and staff. There are no standards in this program. Residents don't answer their pagers, and there are no consequences. The fellows in my program try to push their work off on me.

There is no teaching in this program. The attendings do not teach on rounds and the fellows do not teach the residents or medical students, which is strange for a program associated with a medical school. Didactics are not protected time at all. They are supposed to be protected, yet we constantly have to miss lectures to admit patients or see consults in the ED.

I feel like I am unable to provide the level of care that I wish to give to my patients because the attending wants to round quickly and leave. He gets aggravated if things are not done quickly so he can sign the notes and leave. I feel like the patient care I want to give should be the standard of care and is not anything exceptional, yet compared to the other doctors here, it does seem exceptional.

I came from a residency program where didactics were protected time. Teaching was highly emphasized and we were required to teach the medical students. The fellows here acted surprised when I brought up the subject of teaching medical students. They have since tried to push all of their medical students on me since I have been trying to teach them. Patient care was very important in my residency program. If you were not doing your job, you would be disciplined and there were consequences.

I have talked to my program director about these issues, and it is evident that things will not change. He really did not seem to care. I feel like if I stay in this program, I will not become a competent physician in my field. I am already stressed out in this program. I don't want to be stressed out by something that I love doing. I am passionate about my field and am prepared to work hard, but I do not feel like I am getting anything out of my program except for knowing what kind of physician I don't want to be. Everyone in my program can see that I am miserable. I am unable to just go with the flow of things. I feel that if I do go with the flow of things to fit in with the fellows here, I will just be a bad physician. I cannot settle for not learning and giving poor patient care. The other fellows already do not like me because I have brought up issues with the program director and want this to be a better program.

I want to leave this program. The program coordinator and staff do not want me to leave, but they have been sensing that I am quite ready to do so. I have not told the program director that I want to leave. I need advice please.
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Whats your speciality. Fellowship is little different from residency, because you are board certified doctor and you are suppose to read by yourself and lesrn/train yourself. You will not get those kind of training/guidance which you did as student or resident especialy if you are in a non procedural speciality because you are equellent to attending/board certified
 
I would say to finish at least the 1 year of additional training that u need so that u are board elegible. At that point, you can start applying for other fellowships. Once you get a spot somewhere else you can go ahead and quit at your current program. In any case, you should make certain that your fellowship PD is the last person to know this. Once you have all the cards in place you can give him the finger...
 
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DocThatRocks said:
I do not want to say what field I am in for the sake of anonymity. My residency was 4 years long. I left after 3 since I knew that I wanted to do fellowship. It should be somewhat easy to figure that out from this information. So since I did not finish my 4 years of residency, I am not eligible for board certification. I would be eligible after completing my first year of fellowship, which would be equivalent to completing 4 years of residency.

I do not have a problem with reading and teaching myself. But I definitely have a problem with all of the other things I mentioned.
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One word "suck it out" for this year. Once you are board eligible, you will be in better position to make decisions. Secondly first year of fellowship is usually scuttwork/buzy schedule....In your second yr things may get better
 
gutonc said:
Also, you're confusing two different idiomatic phrases..."suck it up" and "stick it out." "Suck it out" sounds like a porn stage direction.
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LMAO... You guys are terrible! :laugh:
 
You need one more year of training. The program you are in sounds like a disaster.

Options:

1. Contact your first program. Given your field, some residents stay for the PGY-4, some move on to fellowships. There is a reasonable chance that your prior program may have an open slot for you. I would bet they would be happy to have you back as a PGY-4 if a slot is open. If so, you leave your current program and move back to your first program. There is some chance that you'd need to complete 12 months of training there, but an extra 3 months sounds much better than 9 more months of the pain of your current program.

2. Stick it out, as others have mentioned.

3. I would bet that other programs in your field have open slots for PGY-4's. You could certainly hunt around. This would be worth doing if your new fellowship is in a different location than your prior program -- perhaps there is another program in your current location where you could finish a PGY-4. However, your "fastest" exit will be back to your original program.
 
Though I'm speculating from my own field, this sounds like child psych (4 year residency, fast track in 3). If that's so if you really think about leaving, ascertain whether the rotations you've completed will qualify you for at least adult requirements for boarding, since you're double-using rotations to qualify for both child and adult. Don't leave until you're at least board-eligible in adult.
 
I'll ask what everybody's wondering: What program is this?

Future applicants might want to avoid this place if they knew the name of the program.
 
Knicks said:
I'll ask what everybody's wondering: What program is this?

Future applicants might want to avoid this place if they knew the name of the program.
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You're joking, right?

The OP already stated that s/he doesn't even want to spill what specialty it is (although I'm pretty sure it's been guessed correctly in the thread). What are the chances that s/he's going to say where it is?
 
latinman said:
I would say to finish at least the 1 year of additional training that u need so that u are board elegible. At that point, you can start applying for other fellowships. Once you get a spot somewhere else you can go ahead and quit at your current program. In any case, you should make certain that your fellowship PD is the last person to know this. Once you have all the cards in place you can give him the finger...
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Won't other fellowship programs want a letter from the current PD?

Scary description of the program by the OP.
 
No matter what you decide to do your attitude (or at least the outward appearances) needs to change. You absolutely do not want to be telegraphing your discontent to anyone and everyone. This will cause you nothing but pain no matter how justified it may be.

Look happy, do your work with a smile, never complain...and be working privately to transfer. Key word is PRIVATELY. These people can ruin your career.
 
DocThatRocks said:
Oh okay, I will start walking around like I am so excited to be there. I will bring my cheerleader pom poms too! Yay, I am so excited you guys document physical exams that you did not actually do! Yay!
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Or you could just quit.

Don't ask questions you don't want the answer to.
 
DocThatRocks said:
Oh okay, I will start walking around like I am so excited to be there. I will bring my cheerleader pom poms too! Yay, I am so excited you guys document physical exams that you did not actually do! Yay!
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OP....Thats mean. People trying to help you and you are behaving this way....

I wonder if all a-z in that program is wrong or If you have some problem too.....something is fishy.......
 
I believe you misinterpreted the advice. Your inward feelings are your own. The point was simply that if you outwardly transmit that you are unhappy, or that you think other people are doing a bad job / providing poor care, then somewhere along the line you will find yourself being "remediated" for your "deficiencies". And your program holds all the cards. At a minimum, your outward projection needs to be neutral -- get your job done, don't complain to others, don't complain about other's care unless you have a willing administration to listen to you. Else, you will be seen as the problem.

I would note that there is another "option". You could become a whistleblower. Billing insurance / medicare documenting exams that weren't done is fraud. If you can prove systematic fraud, Medicare will investigate and then claw back whatever fraudulent billing was found, plus fines and interest. As the whistleblower, you would get a percentage. Needless to say, 10% of a multimillion dollar fine is a nice chunk of change.

Of course, getting a job after being a whistleblower can be a real pain. But, you could collect evidence during the next year. Keep it all in a nice file, well documented. Make certain you don't violate HIPAA or other laws. Then, when you finish your year, you submit your evidence. The whole process is likely to take 1-2 years to process. Medicare might not go after the money -- but it might, and if it does, you could get a nice payout in the future AND know that you helped clean up a mess (since this would certainly lead to multiple firings and restructuring. Plus, it would be much easier to project a good attitude while doing this in the background.

Did I mention that if someone figures out that this is what you are doing, you are likely to be fired immediately, regardless of what whistleblower protections there might be?
 
aPD gives great options.

I'd advocate the motto -- "Be the change you want to see in the world." (M.Gandhi)

If you believe whistleblowers should risk it for the greater good, go for it. If you want to show what quality should be by modeling it, in the hope that others follow suit by your example, I think that's valid too.
 
The best thing you can do, is get through this year. Transfer to a pgy5 spot that has an opening beginning in July. There are a lot of them out there and you can still learn a lot as a pgy5. You really have no other choice, unless you want to try and transfer back to a pgy4 spot (which is not all that simple a task to accomplish, at all).
 
nitemagi said:
aPD gives great options.

I'd advocate the motto -- "Be the change you want to see in the world." (M.Gandhi)

If you believe whistleblowers should risk it for the greater good, go for it. If you want to show what quality should be by modeling it, in the hope that others follow suit by your example, I think that's valid too.
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I love that quote. I especially love that Gandhi never actually said or wrote it.

http://www.nytimes.com/2011/08/30/opinion/falser-words-were-never-spoken.html?_r=3

It does make for a catchy bumper sticker though.
 
HondoCrouch said:
No matter what you decide to do your attitude (or at least the outward appearances) needs to change. You absolutely do not want to be telegraphing your discontent to anyone and everyone. This will cause you nothing but pain no matter how justified it may be.

Look happy, do your work with a smile, never complain...and be working privately to transfer. Key word is PRIVATELY. These people can ruin your career.
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this guy makes a very very valid point. this is an important lesson in any type of job. you cannot ever show that you are unhappy. in this economy... you are out the door so easy. work at will states, you can get fired for anything.

people wanna see someone smiling and all that garbage. don't be the nail sticking out.

DocThatRocks said:
Oh okay, I will start walking around like I am so excited to be there. I will bring my cheerleader pom poms too! Yay, I am so excited you guys document physical exams that you did not actually do! Yay!
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i hate to say it, but you have to. if you don't you will jeopardize yourself. get on stimulants, do a line of cocaine. show up like charlie sheen..... fact is you cannot go around and look unhappy, people pick up on this.
 
PharmaTope said:
i hate to say it, but you have to. if you don't you will jeopardize yourself. get on stimulants, do a line of cocaine. show up like charlie sheen..... fact is you cannot go around and look unhappy, people pick up on this.
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Pass on the drugs. Thanks though. Hahahaha.
 
What did you do DocThatRocks? Has it gotten any better?
 
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