Program Director's letter when leaving a residency

[Nemo70]

I would greatly appreciate any advise on how to best handle my situation.

I entered a residency which I thought I would like but am unhappy with. I would like to apply to a PGY II position in another residency.

My fears are as follows:
If I try and leave my residency which is located in a small community, my program director will give me a poor letter of rec and my new program will not want to take me. My old program will be angry that I tried to leave and replace me and I will be left with no job.

I am doing a great job as a resident, but lets just say my PD is not a warm and fuzzy guy. Our program has a reputation for "strong arming" residents.

What should I do? I do not want to be stuck in a field I am not happy in. I know that most programs I apply to will want a PD letter early on, and I really dont want to tell my PD I am leaving until April or so.

Please advise me as best I can.

I want to leave but I cant afford to be unemployed!

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[PlutoBoy]

Don´t quit. Finish your residency and make sure you are going to be able to make a living and then try to switch if you still want that. Don´t leave what you have at hand for something uncertain. 👍

 

[turquoiseblue]

I think first off, you need to get accepted to your PGY2 position--then you can safely leave your program, otherwise you lose both. Also, that way, your PD letter won't matter any more. As the old addage says: "A bird in hand is worth 2 in the bush"

If you really want to leave that badly, just finish your PGY1 and get a PD letter after you leave. I don't know about advanced notice in this case.....it could hurt you if you don't tell them in advance--it may make the program upset, because they have to change schedules and hire a new PGY2. If you completed it, he should write you a fair objective letter. But it doesn't guarantee you'll find a PGY2. You probably will find a PGY2 if you are AMG though, (if yo'ure FMG this may work if your USMLE scores are good), so if that is the case, your plans won't fail.

 

[atsai3]

I think first off, you need to get accepted to your PGY2 position--then you can safely leave your program, otherwise you lose both. Also, that way, your PD letter won't matter any more. As the old addage says: "A bird in hand is worth 2 in the bush"

If you really want to leave that badly, just finish your PGY1 and get a PD letter after you leave. I don't know about advanced notice in this case.....it could hurt you if you don't tell them in advance--it may make the program upset, because they have to change schedules and hire a new PGY2. If you completed it, he should write you a fair objective letter. But it doesn't guarantee you'll find a PGY2. You probably will find a PGY2 if you are AMG though, (if yo'ure FMG this may work if your USMLE scores are good), so if that is the case, your plans won't fail.

Bad advice. Transfers do not work this way.

The OP should do a search of the SDN forums. There has been plenty written about the transfer process (much of it written by myself) in the forums. In brief: if you want start as a PGY2 in another specialty in July 2011, you need to tell your current program director ASAP that you intend to apply. The programs to which you apply for a transfer position will require a letter of good standing from your current program director. There is no way around this. You can't wait until April because by then all of the PGY2 transfer spots will have been taken.

Consider a monkey that swings from branch to branch but does not let go of one branch until it has grabbed ahold of the next one. You can't do that here. To carry the analogy further, you need to let go of one branch and hope that you are able to grab on to the next one. Some people do this successfully; others do not (and fall out of the trees).

Transferring programs is a risky process, and you need to assume some risk. If your primary goal is to minimize your exposure to risk, then don't transfer.

-AT.

 

[turquoiseblue]

atsai3, do you have first hand experience in the transfer process? Did this method work for you? I haven't transferred, but I've seen many examples just as you have.

To the OP--I would not tell your PD about anything unless you're sure you will have the PGY2. Test your waters and see how much you are wanted out there among PGY2 spots. If you tell the PD prematurely, then you could set yourself up for a fall--there is a risk that the PD may favor you less because of your intent to transfer, thinking you're going to leave the program, unless you are that stellar they would do anything to keep you. You most likely do eventually need a PD letter to get the PGY2 spot though, so you'd have to tell him/her about your intent at some point. Of course you want to start looking now and try to have the spot in hand asap, but it may or may not happen depending on your USMLE scores, AMG status, etc.

At best, I would just apply for PGY2, see if you get anything, and if you do, then tell your PD so you can get a PD letter, so that you can continue your program in case you don't get anything at all--just in case the PD decides to not renew your contract--and they can do such things so be careful!! Do not tell them so far in advance and be overconfident that you will get a PGY2!! because it is tough to get things in the postscramble scramble, as the competition is fierce for only a select few spots.

If you want to apply for PGY2, try ERAS/NRMP or SFMATCH--those will give you the highest likelyhood of getting a PGY2 spot, although the spot will start the year after you apply in most cases.

 

[Doctor Bob]

To the OP--I would not tell your PD about anything unless you're sure you will have the PGY2. Test your waters and see how much you are wanted out there among PGY2 spots. If you tell the PD prematurely, then you could set yourself up for a fall--there is a risk that the PD may favor you less because of your intent to transfer, thinking you're going to leave the program, unless you are that stellar they would do anything to keep you. You most likely do eventually need a PD letter to get the PGY2 spot though, so you'd have to tell him/her about your intent at some point. Of course you want to start looking now and try to have the spot in hand asap, but it may or may not happen depending on your USMLE scores, AMG status, etc.

At best, I would just apply for PGY2, see if you get anything, and if you do, then tell your PD so you can get a PD letter, so that you can continue your program in case you don't get anything at all--just in case the PD decides to not renew your contract--and they can do such things so be careful!! Do not tell them so far in advance and be overconfident that you will get a PGY2!! because it is tough to get things in the postscramble scramble, as the competition is fierce for only a select few spots.

I... uhh...
Yea, I'm going to have to disagree with this.

In brief: if you want start as a PGY2 in another specialty in July 2011, you need to tell your current program director ASAP that you intend to apply. The programs to which you apply for a transfer position will require a letter of good standing from your current program director. There is no way around this. You can't wait until April because by then all of the PGY2 transfer spots will have been taken.

This is much more sensible. Trying to pull a fait accompli can be very dangerous.

Really doing it either way has it's potential drawbacks. I just think the second way is the more professional way to do it. But that's just my opinion and carries no weight whatsoever.

 

[gutonc]

I... uhh...
Yea, I'm going to have to disagree with this.



This is much more sensible. Trying to pull a fait accompli can be very dangerous.

Really doing it either way has it's potential drawbacks. I just think the second way is the more professional way to do it. But that's just my opinion and carries no weight whatsoever.

Really? You think agreeing with a Fellow finishing his training is a better idea than agreeing with the advice given by someone who has been fired from/quit 2 different intern years (without finishing either of them)?

Me too.

OP, there is no easy way to do this but the only sure thing is that nobody is going to offer you a PGY2 spot without a letter from your current PD stating that you are in good standing in the program and guaranteeing that you'll be allowed to complete your intern year. The sooner you bring this up, the better. Sure, your current PD may be a vindictive douchebag but there's nothing you can do about this. Tell him/her that you have every intention of working as hard as any of your colleagues through the remainder of the year (then do it).

Without the letter from your current PD, you might as well start over in ERAS and get a letter or two from an attending you've worked with this year and hope for the best. You're not getting a PGY2 contract without that letter.

 

[turquoiseblue]

by the way i was never fired...i even got a letter stating that i had nothing bad in my records....i left due to medical reasons...maybe they didn't want me to still work while still ill..who knows...and at this point i could care less..and i think it is no one's business at that to belittle me for it.

and honestly, i think my plan especially works if you're FMG and have one of those malignant PD's, from what i've seen. if you're AMG with a nice PD you're probably more than welcome to discuss with your PD and all will be fine. it's really unfair but that is the trend i've seen.

i think aProgDirector or any program director would be the best person to answer this question.

 

[snowbank]

Interesting posts. Dr. Bob - would you please go 1 step ahead and tell us the advantages and disadvantages of each option also?

Coming from someone who has (and is still) swinging from tree to tree, has let go and has fallen, (to use atsai's example) - take it from me - DO NOT quit/resign. Sounds like you're a good resident and they like you. Getting a letter from the PD AFTER you leave them stranded and hanging (in that they need to quickly find and hire someone after you leave) will not bode well for you. They may even refuse. Suck it up and continue if you can, graduate, so you at least have something, and a job, and earning potential should you decide to continue in that field. If not, then you can think of a second residency. I personally know many people - including a faculty member in my dept - who did 2 residencies after being in practice for some years. The faculty I refer to was actually vice chair for 20 y in a univ program in his dept, had a mid life crisis, and went back to a residency in a totally unrelated field. Hardest thing he ever did in his life (as he told me) but he's happier now.

THat brings us to wanting out and switching. I personally cant say which option is best, as Im still going through the process myself. What I think will be important is how you tell or mention to the PD that you want out. I mean, can you say family issues (spouse, kids, fiancee, parents etc) for switching vs. i dont like the program or I dont like the specialty?
Like you said, you will need a letter from the PD, and your telling him first before he finds out from another PD at the place you interviewed at will likely be much more benign.

Finding spots - I only know of residentswap.org and findaresident.com. I also recently came across openspots.org or similar. That, and word of mouth from friends.

Good luck.......

 

[DrJosephKim]

I'd also encourage you to complete your residency.

 

[atsai3]

atsai3, do you have first hand experience in the transfer process? Did this method work for you? I haven't transferred, but I've seen many examples just as you have.

To the OP--I would not tell your PD about anything unless you're sure you will have the PGY2. Test your waters and see how much you are wanted out there among PGY2 spots. If you tell the PD prematurely, then you could set yourself up for a fall--there is a risk that the PD may favor you less because of your intent to transfer, thinking you're going to leave the program, unless you are that stellar they would do anything to keep you. You most likely do eventually need a PD letter to get the PGY2 spot though, so you'd have to tell him/her about your intent at some point. Of course you want to start looking now and try to have the spot in hand asap, but it may or may not happen depending on your USMLE scores, AMG status, etc.

At best, I would just apply for PGY2, see if you get anything, and if you do, then tell your PD so you can get a PD letter, so that you can continue your program in case you don't get anything at all--just in case the PD decides to not renew your contract--and they can do such things so be careful!! Do not tell them so far in advance and be overconfident that you will get a PGY2!! because it is tough to get things in the postscramble scramble, as the competition is fierce for only a select few spots.

If you want to apply for PGY2, try ERAS/NRMP or SFMATCH--those will give you the highest likelyhood of getting a PGY2 spot, although the spot will start the year after you apply in most cases.

Strongly, strongly disagree. turquoiseblue is giving really bad advice. You cannot apply to transfer without that letter. Perhaps turquoiseblue is proposing some creative solution around this that I do not know about. But there is no way around this. Of course Nemo70 may be in for a (potential) fall. Then again, Nemo70 might transfer into a dream program. That's the risk. I assume that Nemo70's current situation is bad enough that s/he is willing to assume the risk.

Nemo70, this is how your conversation will go when you contact another program about an open PGY2 spot:

Nemo70: Hi. I'm Nemo70, I heard you will have a PGY2 spot open next year, and I'd like to submit an application for it.

Program Coordinator X: Great! Here's a copy of the application form (or he may direct you to the web site to download it directly). We'll need three letters of recommendation, including one from an attending that you have worked with at your current program as well as a letter of good standing from your program director.

Nemo70: But my program director is sketchy. I don't want to tell him about this until you actually give me a legally binding offer for the open PGY2 position.

Program Coordinator X: Sorry. We need that letter. Without it, we have no way of knowing that you are leaving your current program in good standing.​

 

[NotAProgDirector]

This is always a tricky situation. As a resident, you don't want to give up your spot until you have another one lined up. New programs are going to want to check with your current PD to make sure that your performance is acceptable, or if not where the problems lie. Your program will want to refill your position, and might find someone prior to you finding a spot.

Much of what to do depends on whether you've got a reasonable PD, and how competitive you are for new spots. Here's what I do:

1. If I'm contacted by a resident in a different program, I'm happy to talk to them about an open PGY-2/3 spot if I have one. We review the program's structure and expectations. That way, they can get a sense of whether this is something they want.

2. If they want to proceed, I will only formally review an application with permission to speak with their PD, and I insist that they tell their PD about the request for transfer. I am very clear that I am not guaranteeing them a spot, that there may be other contenders for the position, or that I might not fill it at all.

3. Once I have reviewed the situation with their PD and their app, we arrange an interview (assuming I'm still interested). This then can lead to an offer.

ON THE OTHER SIDE:

1. A resident tells me they want to leave. I review it with them, help them decide what makes sense for them going forward.

2. I help that resident interview in other programs / fields. Often this involves some schedule swapping / coverage. I stress that it remains this resident's professional responsibility to "pay back" any colleagues which cover for him/her.

3. I stress that my ongoing support hinges on their ongoing full effort at their job.

4. If a resident decides to leave early, I need 3 months notice. That's the same notice I need to give them if I decide not to promote them, so it only seems fair. If there are extenuating circumstances, I'm happy to discuss them.

5. If I find a person to fill the outgoing resident's spot before they find a spot, I bring this to their attention and give them a last chance to keep their spot. This often happens when a resident re-enters the match. They apply in Nov and I start looking for a replacement. I find a replacement in mid January, but the match isn't until March. I can't save the spot, as a good applicant will go elsewhere. Usually by then the resident knows how many interviews they have and thus has some sense of how likely they are to get a new spot, so the decision is not made blindly. But, some faith is required to let go of one position to find another.

 

[glade]

Much of what to do depends on whether you've got a reasonable PD

This is the only part of the post you had to read. The most pathetic thing about residency is that you're in a position where your ability to change your career path is largely dependent on whether or not someone is a douchebag. Because if they are, then it doesn't matter what steps you follow or how tactful you are or whether you're a good resident. And that's pathetic.

 

[atsai3]

The most pathetic thing about residency is that you're in a position where your ability to change your career path is largely dependent on whether or not someone is a douchebag.

From the way you phrased it, it makes it seem like you think this is somehow different from other professions or career paths.

-AT.

 

[glade]

While that is true for all professions, it is indisputably not to the extent as the medical field. Residency is almost like indentured servitude in many ways, not the least of which is the degree to which you are unable to break away it (without forever having to leave the profession).

 

[Luv2Cut]

I'm wondering why exactly do you want to leave. Your only a quarter of the way through the year. Maybe it is something that is correctable?

I encourage you to just man up and go talk to your PD. If he's a malignant personality, he may not be that way one on one. You have to remember PDs have to deal with personnel issues with residents every year. They have to deal with the lazy ones that are always incognito or always dumping work on their classmates. Personally, I don't blame PDs for being a hardass sometimes. And if your the one on the receiving end of it, well its probably good for you. So go talk to your PD and level with them. If your doing a good job as a resident then you have no fears. Tell him/her your concerns and see if you can get a solution.

Look being a PGY-1 just sucks. You do most of the work because your supposed to. That's how you learn to become a doctor. You can't learn from the sidelines. I remember what it was like to get the crap kicked out of you. It sounds like your just getting fed up with being a PGY-1. If so, then just suck it up and plow through. You'll be glad you did.

 

[chocomorsel]

This is always a tricky situation. As a resident, you don't want to give up your spot until you have another one lined up. New programs are going to want to check with your current PD to make sure that your performance is acceptable, or if not where the problems lie. Your program will want to refill your position, and might find someone prior to you finding a spot.

Much of what to do depends on whether you've got a reasonable PD, and how competitive you are for new spots. Here's what I do:

1. If I'm contacted by a resident in a different program, I'm happy to talk to them about an open PGY-2/3 spot if I have one. We review the program's structure and expectations. That way, they can get a sense of whether this is something they want.

2. If they want to proceed, I will only formally review an application with permission to speak with their PD, and I insist that they tell their PD about the request for transfer. I am very clear that I am not guaranteeing them a spot, that there may be other contenders for the position, or that I might not fill it at all.

3. Once I have reviewed the situation with their PD and their app, we arrange an interview (assuming I'm still interested). This then can lead to an offer.

ON THE OTHER SIDE:

1. A resident tells me they want to leave. I review it with them, help them decide what makes sense for them going forward.

2. I help that resident interview in other programs / fields. Often this involves some schedule swapping / coverage. I stress that it remains this resident's professional responsibility to "pay back" any colleagues which cover for him/her.

3. I stress that my ongoing support hinges on their ongoing full effort at their job.

4. If a resident decides to leave early, I need 3 months notice. That's the same notice I need to give them if I decide not to promote them, so it only seems fair. If there are extenuating circumstances, I'm happy to discuss them.

5. If I find a person to fill the outgoing resident's spot before they find a spot, I bring this to their attention and give them a last chance to keep their spot. This often happens when a resident re-enters the match. They apply in Nov and I start looking for a replacement. I find a replacement in mid January, but the match isn't until March. I can't save the spot, as a good applicant will go elsewhere. Usually by then the resident knows how many interviews they have and thus has some sense of how likely they are to get a new spot, so the decision is not made blindly. But, some faith is required to let go of one position to find another.

As always APD, good advice. I am currently thinking of leaving my program as I have run into problems lately with new management whom I feel is treating me unfairly. I just started contacting programs but I am honestly not too keen on telling my new PD as I feel she would not necessarily be that helpful in helping me find a spot. I most certainly could stay and bite the bullet but the past few months for me have been quite difficult and my personality has changed. I am angry and bitter and would love to to leave. I am quite unhappy and trust very very few people. Don't really know what to do as I am currently a senior resident with less than 2 years to go. Of course I take some responsibility for what has happened, but I believe other things are getting blown way out of proportion.

 

[chocomorsel]

This is the only part of the post you had to read. The most pathetic thing about residency is that you're in a position where your ability to change your career path is largely dependent on whether or not someone is a douchebag. Because if they are, then it doesn't matter what steps you follow or how tactful you are or whether you're a good resident. And that's pathetic.

Very sad but very very true. And BTW, what did he do to get banned?

 

[saanjana]

Hi,
I had to switch programs after my first year due to a family emergency. It was critical that I came home but my PD was very supportive. In my situation I went to him asking for a year off, and he suggested transferring.

From what I gathered during the process, it is very important to have a good letter from your PD. Also, most PD's won't try to negate your chances if you are a strong resident. The key is to speak with them openly that you ARE going to leave, in which case they know you will do so regardless. If you give them some time, they can find another resident to replace you.

I do think its a good idea to be as discreet as possible. When I was in this position, my PD was supportive but I did go to him at the very last minute because of my situation. I did feel that the rest of the faculty became somewhat hostile towards me once they knew I was leaving.

Speak to the program you are interested in first to make sure they indeed have an open position. It is unlikely that a program will offer you a position without your PD's letter because they want to make sure you did a good job your intern year (especially if you are transferring to a program in the same field).

Hope this helps 🙂

 

[Law2Doc]

...
From what I gathered during the process, it is very important to have a good letter from your PD...

Agree with this. Although turquiseblue means well, being discrete simply isn't the way it works, at least not at any place worth transferring to. You either transfer with the blessing of your PD, or no other reputable program is going to touch you.

 

[saanjana]

Agree with this. Although turquiseblue means well, being discrete simply isn't the way it works, at least not at any place worth transferring to. You either transfer with the blessing of your PD, or no other reputable program is going to touch you.

Very true indeed.

However, it is a good idea to keep the conversation between the PD and yourself, and not discuss with other faculty, residents, etc, till you know what your position is.

 

[shojimoji]

Old post. But if u have a malignant pd, Is there anyway to go around this?