Prior LOA-- effects on future

[fluffy2b]

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Hi guys,

I am a first year medical student who was originally in the c/o 2010. Last year during the 2nd semester I had to take a leave of absence for psychiatric reasons. My question is, how is this going to affect me come residency time? Assuming that I do well on boards and third year rotations, am I going to be able to match as well as those who didn't have a psychiatric leave? I would ideally like to match at a New England program (Longwood, Cambridge, Brown, Dartmouth, etc) in psych. Oldpsychdoc, I would really love your opinion in particular if you don't mind commenting.

My other question is regarding licensure. I know that I have to check off the box that asks whether or not I have any condition that might impair my judgment as a physician-- how much of a pain is this going to be if I provide the board of medicine with information explaining my situation, and a letter from my treating psychiatrist stating that I have successfully been in treatment, compliant with that treatment, and plan to be in treatment and monitored throughout my professional career?

I'm really worried about this-- am I doomed to some community based program? Is all of my hard work going to be for nothing?

 

[OldPsychDoc]

Hi guys,

I am a first year medical student who was originally in the c/o 2010. Last year during the 2nd semester I had to take a leave of absence for psychiatric reasons. My question is, how is this going to affect me come residency time? Assuming that I do well on boards and third year rotations, am I going to be able to match as well as those who didn't have a psychiatric leave? I would ideally like to match at a New England program (Longwood, Cambridge, Brown, Dartmouth, etc) in psych. Oldpsychdoc, I would really love your opinion in particular if you don't mind commenting.

My other question is regarding licensure. I know that I have to check off the box that asks whether or not I have any condition that might impair my judgment as a physician-- how much of a pain is this going to be if I provide the board of medicine with information explaining my situation, and a letter from my treating psychiatrist stating that I have successfully been in treatment, compliant with that treatment, and plan to be in treatment and monitored throughout my professional career?

I'm really worried about this-- am I doomed to some community based program? Is all of my hard work going to be for nothing?

You've got some time ahead of you before you have to worry too much about this affecting your career. For right now, make sure you're doing what YOU need to do to keep yourself healthy.

Personally, I don't know New England--perhaps you're confusing me with Doc Samson? (Don't feel bad...even Senior Mods have been known to make that mistake! For future reference, DS is the smart one from New England, OPD is the cranky one from the Great Midwest 😀)

As far as impaired judgment goes, the exact wordings will vary by state of licensure, but you usually don't have to reveal past treatment in detail--and even if treatment is more recent, if you work with an HPSP program, you will usually be fine as far as licensure goes. For example, in my state the questions read:
1-"Is your cognitive, communicative, or physical capability to engage in the practice of medicine or surgery with reasonable skill and safety impaired or limited in any way?" and
2-"Have you within the past five years been advised by your treating physician that you have a mental, physical, or emotional condition, which, if untreated, would be likely to impair your ability to practice medicine with reasonable skill and safety? If you answer this question ‘yes", please answer the following:
3-With regard to any condition referenced above, are you being treated so that such impairment is avoided?
4-With regard to any condition referenced above, are you in compliance with the recommended treatment? "

So basically, as long as you are being treated and complying with treatment in a responsible way, you can be licensed to practice medicine. (You would presumably be answering No, Yes, Yes, and Yes.)

As far as being "doomed" to a community program (--hey, it's not that bad! You actually see and treat REAL patients!!) you might actually find that more academic programs are well, more tolerant of quirks. (I mean, when have you met a "normal" professor? 😀) OTOH, you might prefer the more laid back atmosphere of a small community program, and find the environment healthier for you.

 

[Chrismander]

For what it's worth, i had to take a short leave (~2 mo) of absence my first year for depression. i came back stronger, did good in my basic science years, did well on step 1, got a few publications under my belt, and got excellent clinical evals--even in the rotations I didn't honor, I got a lot of positive comments on my record about my ability to work on a team, take care of patients, etc., which is what PD's are going to be concerned about in someone who's taken time off for mental illness.

In the ERAS LOA section all I put was that I took time off to deal with depression, and figured that anyone who wanted to know more could just ask. It'll be up to you to figure out what and how much to disclose on your application, but that'll be 3 years from now so no need to worry about it now.

I was very worried as the application season started about how this would affect me. Basically, it hasn't. It seems like a handful of programs didn't offer me an interview on account of this, but these weren't even the best programs I applied to. Dartmouth (the only one on your list that I applied to) was one of the first that offered me an interview, and the program director made a point in his interview invitation to mention how he believed experience with depression in oneself or family can improve a physician's empathy. No one at Dartmouth even mentioned it on the interviews.

I just finished my 5th interview. only 2 have even asked about it. No doubt partially because no one reads my friggin application until i'm in the room, but that's another story. One that did was a 3rd or 4th tier program that's my safety. The interviewer started by asking what happened in my first year, i gave my spiel, then he asked me if i had a h/o mania and if i was taking meds currently (illegal). Even being illegal and whatnot, this exchange lasted all of 30 seconds, wasn't harsh in tone, and concluded with the interviewer telling me that they'd love to have me but that he knew I'd end up somewhere else (they're a mostly IMG program). The other place that asked was a very biologically oriented program, and all they asked was "are your symptoms under control", no further questions. That seems like a pretty fair question to me (something i'd really want to know about a candidate with a h/o depression), and i'm really surprised no one else has asked about it. A few places might be gauging it through their other, generic questions like "what's the hardest thing you anticipate about being a psychiatrist? Tell me about the patient who evoked the strongest emotional response in you?--followed by What about this patient made the response so strong?". Most places seemed to re-ask the question "what influenced you to become a psychiatrist" a few different times in different ways, which made me think they were trying to get me to connect my experiences first year with my career decision. I was honest and kept telling them I didn't have the faintest interest in the field until my 3rd year clerkship, and that seemed to satisfy them.

In the end, i think it didn't affect me so much because 1) it was a really long time ago, 2) the rest of my application was good, and specifically my LOR's and narrative eval feedback mollified their concerns that I was running around with a poorly treated mental illness that would interfere with my ability to take care of patients, work on a team, and learn, and 3) psych isn't the most competitive field out there. If I was appying to integrated plastics or derm, I might have been more thoroughly interviewed/reamed, and it might have shut some doors. But who knows.

I agree strongly with OPD's advice above--don't worry about what's going to happen 4 years from now; spend the next 4 years doing whatever's necessary to stay healthy and functional so you can do well in school. If you're still off from school, don't come back until you are 100% ready, the absence is an absence, and it's much better to wait longer to come back rather than having a second LOA or academic troubles if you weren't at 100%. Stay very close to your shrink and psychologist/SW if you have one, keep seeing your therapist at least monthly even when you're better so that someone is watching for early signs of depression in you. Beyond that, just do the best you can and don't let worries about matching (which everyone has) and concerns about weak points of your application (which everyone has to some degree) sabatoge your mental health.

Maybe some of the PD's on here could chime in and give their perspective, and correct anything wrong that I've said?

Feel free to PM me.

The Chrismander

 

[OldPsychDoc]

..A few places might be gauging it through their other, generic questions like "what's the hardest thing you anticipate about being a psychiatrist? Tell me about the patient who evoked the strongest emotional response in you?--followed by What about this patient made the response so strong?". Most places seemed to re-ask the question "what influenced you to become a psychiatrist" a few different times in different ways, which made me think they were trying to get me to connect my experiences first year with my career decision. I was honest and kept telling them I didn't have the faintest interest in the field until my 3rd year clerkship, and that seemed to satisfy them. ...

FWIW, questions like those above are questions I use a lot in interviews to try to get at the applicant's motivations and experience in psychiatry*, so I wouldn't attribute them to an interviewer's oblique approach to your depression experience.

(*We interview a fair number of IMGs who might be seeing psych as their path to a US residency. We love IMGs--we just want them to REALLY want to do psychiatry!)

 

[beezley]

This is all interesting to me. Though I've never had to take time off I have had issues with GAD. Ironically it can both make me miserable with anxiety but I think it also is part of why I have been so successful as a medical student (nervous about grades so I am anal about studying and knowing what I have to do). A double edged sword as it were. Although I think my various interactions with psychiatry as a patient and my experience with the disorder will make me a much more empathetic psychiatrist, I never have thought about whether I am going to put in on my application or not. I guess I don't know. To me that is deeply personal info that makes me feel vulnerable, not sure I would share it in a non-anonymous situation. I might just keep it vague, "I have a family of highly functioning anxious people". Since I'm far from the only in my family.

It just goes to show though...the stigma still could be there. I have contemplated the field of radiology in the past and I would not hesitate to put on my app. my experiences with radiologists as a result of 2 brain MRIs for migraines (yes I actually got to interact with a radiologist). Hmmm.

 

[fluffy2b]

You've got some time ahead of you before you have to worry too much about this affecting your career. For right now, make sure you're doing what YOU need to do to keep yourself healthy.

Personally, I don't know New England--perhaps you're confusing me with Doc Samson? (Don't feel bad...even Senior Mods have been known to make that mistake! For future reference, DS is the smart one from New England, OPD is the cranky one from the Great Midwest 😀)

As far as impaired judgment goes, the exact wordings will vary by state of licensure, but you usually don't have to reveal past treatment in detail--and even if treatment is more recent, if you work with an HPSP program, you will usually be fine as far as licensure goes. For example, in my state the questions read:
1-“Is your cognitive, communicative, or physical capability to engage in the practice of medicine or surgery with reasonable skill and safety impaired or limited in any way?” and
2-“Have you within the past five years been advised by your treating physician that you have a mental, physical, or emotional condition, which, if untreated, would be likely to impair your ability to practice medicine with reasonable skill and safety? If you answer this question ‘yes”, please answer the following:
3-With regard to any condition referenced above, are you being treated so that such impairment is avoided?
4-With regard to any condition referenced above, are you in compliance with the recommended treatment? ”

So basically, as long as you are being treated and complying with treatment in a responsible way, you can be licensed to practice medicine. (You would presumably be answering No, Yes, Yes, and Yes.)

As far as being "doomed" to a community program (--hey, it's not that bad! You actually see and treat REAL patients!!) you might actually find that more academic programs are well, more tolerant of quirks. (I mean, when have you met a "normal" professor? 😀) OTOH, you might prefer the more laid back atmosphere of a small community program, and find the environment healthier for you.

Thanks for your comment. Yeah, I guess I got you and OldPsychDoc confused. I would definitely like his opinion, although yours was greatly appreciated.

 

[manwhoisthursdy]

Thanks for your comment. Yeah, I guess I got you and OldPsychDoc confused. I would definitely like his opinion, although yours was greatly appreciated.

I think you just did it again...

 

[fluffy2b]

I think you just did it again...

Crap. I meant Doc Samson. God, I hope I'm right this time.

 

[manwhoisthursdy]

Crap. I meant Doc Samson. God, I hope I'm right this time.

My question is, what's the significance of the parapraxis...

 

[fluffy2b]

My question is, what's the significance of the parapraxis...

You shrinks, you have to make something out of nothing all the time, don't you? Sicko's, all of you. Any way, Doc Samson, want to comment on my original problem?

 

[manwhoisthursdy]

You shrinks, you have to make something out of nothing all the time, don't you? Sicko's, all of you. Any way, Doc Samson, want to comment on my original problem?

I'm still just a wannabe shrink, but thanks!

As to your original problem ... not that my opinion means much, but I don't think you have any reason to worry. Do what Chrismander did, and you will be in excellent shape to match where you want ... in better shape than most applicants perhaps.

 

[fluffy2b]

You've got some time ahead of you before you have to worry too much about this affecting your career. For right now, make sure you're doing what YOU need to do to keep yourself healthy.

Personally, I don't know New England--perhaps you're confusing me with Doc Samson? (Don't feel bad...even Senior Mods have been known to make that mistake! For future reference, DS is the smart one from New England, OPD is the cranky one from the Great Midwest 😀)

As far as impaired judgment goes, the exact wordings will vary by state of licensure, but you usually don't have to reveal past treatment in detail--and even if treatment is more recent, if you work with an HPSP program, you will usually be fine as far as licensure goes. For example, in my state the questions read:
1-“Is your cognitive, communicative, or physical capability to engage in the practice of medicine or surgery with reasonable skill and safety impaired or limited in any way?” and
2-“Have you within the past five years been advised by your treating physician that you have a mental, physical, or emotional condition, which, if untreated, would be likely to impair your ability to practice medicine with reasonable skill and safety? If you answer this question ‘yes”, please answer the following:
3-With regard to any condition referenced above, are you being treated so that such impairment is avoided?
4-With regard to any condition referenced above, are you in compliance with the recommended treatment? ”

So basically, as long as you are being treated and complying with treatment in a responsible way, you can be licensed to practice medicine. (You would presumably be answering No, Yes, Yes, and Yes.)

As far as being "doomed" to a community program (--hey, it's not that bad! You actually see and treat REAL patients!!) you might actually find that more academic programs are well, more tolerant of quirks. (I mean, when have you met a "normal" professor? 😀) OTOH, you might prefer the more laid back atmosphere of a small community program, and find the environment healthier for you.

I guess I'm bumping my own thread. One of the things that concerns me about the bolded statements is a horror story that was told on grand rounds that was focused on physician depression and suicide. One of the cases involved a doctor who had disclosed on his licensing application that he had a history of mental illness; the state subsequently made it hell for him to gain licensure and it was a battle of lawsuits and countersuits before he was able to attain it. I am so worried that this is going to be me.

So I definitely think that mentally ill med students and physicians can and definitely are treated as second class colleagues. The question still remains: can we be as competitive as other applicants if our resumes are more attractive subtract the axis I pathology?

 

[Shalom77]

I think you need to distinguish between what's required on applications and what's required by various state liscensing boards.

Personally, if I had taken a LOA for depression - which I haven't - I would have just put "medical reasons" or something vague but reasonable on my ERAS application. Now I'm not applying to psychiatry but I do think there's still considerable stigma against those with mental illness in the medical profession and I just wouldn't put it in an application.

If you did well after coming back and do well in third year and on various board exams - there should be no question that you have recovered sufficiently from whatever illness/medical condition to perform up to standard.

In that sense yes you can be as attractive as other candidates.

You'll be long accepted into residency before you have to fill out any licensing applications - which is a different issue and varies by state. I am familiar with the case you mention and I do think the state (MN) might have eventually changed the wording/documentation requirements as a result of some of those legal battles.

 

[whopper]

So I definitely think that mentally ill med students and physicians can and definitely are treated as second class colleagues. The question still remains: can we be as competitive as other applicants if our resumes are more attractive subtract the axis I pathology?

This is an issue I don't think several programs will answer honestly.

I took a LOA. Why? Had nothing to do with an Axis I pathology. The reality was that as a guy in my mid 20s, I felt very insecure & frustrated about not earning any money, and not having dated a woman in a long time due to medschool. I wanted to just live a normal life for about a year. I think it was a good idea, even in hindsight. It gave me time to study for USMLE Step I, & I got some curiosities of life out of the way. It also improved my investing skills which I plan will make more money for me in the future than being an attending.

Anyways, during my interviews for residency, several programs asked me if I had a psychiatric illness solely based on my LOA. I didn't know if it was ethical or within their rights to ask. I never did the legal research, though I have heard several in noteworthy positions say it is not appropriate for that question to be asked. I got interviews to about 10 programs (forgot the exact number now). About 5 asked if I had an Axis I pathology. 4 out of those 5 asked in a manner where I felt it was appropriately asked. I didn't feel uncomfortable and I do think a program deserves to know why I took a year off.

1 program in particular interogated me on that aspect and even went as far as to say that "we don't want to hire some psycho". That really ticked me off because I figure if we're in the psychiatric healing business, last thing I want was to be in a program where an attending would brand someone with a psyche disorder as a "psycho". The guy apparently was giving me an intentional pressure interview, so his belligerance may have been an act. Still, that knocked this program down quite a bit. I didn't even care to put the program on my Match list.

Some of the programs I applied to, I specifically remember them asking me if I had any medical problems. I don't know the specific state's regulations concerning this.

I also felt comfortable explaining I didn't have an Axis I because I didn't have one. I think the situation would be different to someone who has an Axis I DO (even if it is in remission & successfully treated). I did get an impression, even from the programs where I felt comfortable, that they weren't exactly wanting someone with a psyche history. No, they didn't knock psychiatric patients down, but why ask if its not an issue?

I also have heard several stories from attendings with an Axis I DO where they were treated, as you mentioned, as 2nd class citizens in this field. I attended a NJ-Psychiatric Association meeting where a lecturer mentioned her experiences of discrimination because she had bipolar. She was told by several during her education to stop. I forgot her name but if someone would like to, I could look it up.

I know this isn't exactly good news, however I wanted to give you my honest interpretation of things I've seen. This is also an issue where programs I don't think will answer this question honestly. No program above the table is going to say they're going to discriminate based on a medical or psyche illness, but under the table, yes they may.

Just like in the workplace, you put 2 candidates for the same spot, one has long hair, the other doesn't, but otherwise the same, the workplace may hold the long hair against the person even though in some states that is considered illegal discrimination. Some people call it the "glass shield" or "glass ceiling". The workplace could say whatever reason that is legitimate but the real reason could've been the hair.

http://en.wikipedia.org/wiki/Glass_ceiling

Can you be as competitive? I wish I could give you a definitive answer. I do believe at least a few will respect an applicant admitting to past history with an illness, even give them points for it on the "personal statement" aspect of the application if the candidate explained it well. It may even prove sincerity to go into the field. However I do also believe some will hold it against the candidate but do so under the table (the glass ceiling coming into play). Overall though, I believe most will not hold it against you so long as everything else on the application looks good. If however there's issues on the application that will show possible reason to believe the applicant may compromise their responsibilities, I do think the program will make it an issue. In what way they're going to handle it? Don't know.

 

[Doc Samson]

Personally, I don't know New England--perhaps you're confusing me with Doc Samson? (Don't feel bad...even Senior Mods have been known to make that mistake! For future reference, DS is the smart one from New England, OPD is the cranky one from the Great Midwest 😀)

Are you saying that I'm not cranky? I have a lot of consultees who'd vehemently disagree.