Quiting internship after 6 months, am I entitled to a letter?

[Lightbender]

I'm thinking about quitting internship 6 months into it. What I need is a letter from my PD that I have completed 6 months of internship and was in satisfactory standing. Nothing fancy, doesn't have to be glorifying, just doesn't say I suck.

I think my PD is a reasonable person, although I have never heard of him dealing with this kind of situation. There is no mention of events like this on my contact, but do you think I am entitled to a letter?

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[MDtoUSMLE]

I have seen program directors with different mentalities. Some are always positive by nature and respect your decision and some are just strict about their rights. It also depends on the circumstances and how badly your PD needs you. You signed a contract for 1 year and the program trusted you. If resigning means your colleagues will suffer by covering your shifts then I don't think it will be an easy task for you. I would approach the chiefs first before taking the big decision because your entire future, trust me, entire future will stand on this letter if you want to apply to any ACGME residency program in the future. If I was you I would think 100 times about it, unless you have something secured already in your pocket. Try to weight the reasons forcing your to leave vs the attractions pulling you out.

 

[shopsteward]

It is likely to be difficult to get another internship even with a letter, if you quit half way through. If you are ever going to want to practice medicine, you would be best off sticking this one out.

What is the advantage to you of leaving now? Is there someone you can talk to about whatever your problem is (union rep, residents' adviser, chief resident, welfare adviser, counsellor, residency adviser at your old medical school)?

If you have to go, have you explored options such as a temporary leave of absence, family leave (paid or unpaid) or medical leave?

Are you planning to re-enter the Match? Sad to say, it's usually easier to get a job if you already have a job.

 

[meerkat111]

I hate listening to this "oh you signed a contract". I did quit and got another spot- best thing I ever did. Sometimes, when/if you see no hope of your situation ever improving, it is best to quit dot period. People did tell me not to quit but I wish I had quit sooner. Ppl in medicine are so far removed from reality, it is unbelievable.

 

[Lightbender]

I’m thinking about not practicing medicine all together or getting a residency spot in another country, so I only need a letter that says I have completed 6 months of internship and fulfilled the BASIC requirements. As long as the letter doesn’t have MAJOR redflags like lack of professionalism, sexual harassment etc. I’m happy.

I’m not saying I was accused of the above, but just heard horror stories of unreasonable PDs making up stories like that. Do I at least have the right to have a letter as such?

 

[ThoracicGuy]

I’m thinking about not practicing medicine all together or getting a residency spot in another country, so I only need a letter that says I have completed 6 months of internship and fulfilled the BASIC requirements. As long as the letter doesn’t have MAJOR redflags like lack of professionalism, sexual harassment etc. I’m happy.

I’m not saying I was accused of the above, but just heard horror stories of unreasonable PDs making up stories like that. Do I at least have the right to have a letter as such?

I think you don't really have a good understanding of everything... Have you looked into what USLME equivalent test will be needed in Europe? Have you looked into requirements to get that ortho training you want? I've read some countries you may stay on a wait list for several years before you can specialize. You end up doing general medicine until then, just what you don't like now. Also you will be competing with students from that country and EU with med school done there. I am sure that they would have questions on why you quit your US training after six months. This is a bad idea.

 

[Elisabeth Kate]

I'm thinking about quitting internship 6 months into it. What I need is a letter from my PD that I have completed 6 months of internship and was in satisfactory standing. Nothing fancy, doesn't have to be glorifying, just doesn't say I suck.

I think my PD is a reasonable person, although I have never heard of him dealing with this kind of situation. There is no mention of events like this on my contact, but do you think I am entitled to a letter?

Sorry, I don't think you're "entitled" to anything. You made a commitment for one year and you're breaking that commitment. Your entitlement disappears with it. The only thing you are entitled to or have a right to is confirmation of employment at the hospital from HR. Future employers usually get that by calling.

 

[cabinbuilder]

Just don't do it. You are better off taking a break once internship is finished. That way you will keep your future options open.

 

[smq123]

I'm confused. Were you (way) off-cycle? Or just anticipating that you're going to be quitting 5 months from now?

 

[SouthernSurgeon]

Your previous posts (which you deleted after not getting the responses you've hoped for) indicate that you've, to sum it up, screwed up pretty badly.

Don't make a rash decision to quit based on mistaken assumptions about the ease of getting training in the field you want in another country. You don't seem to have an understanding of the hurdles involved in securing one of these positions. Also don't forget that this would likely limit your ability to ever come back to the US to practice.

In other words, you've got one foot in the grave right now. Put the shovel down.

 

[Lightbender]

Your previous posts (which you deleted after not getting the responses you've hoped for) indicate that you've, to sum it up, screwed up pretty badly.

Don't make a rash decision to quit based on mistaken assumptions about the ease of getting training in the field you want in another country. You don't seem to have an understanding of the hurdles involved in securing one of these positions. Also don't forget that this would likely limit your ability to ever come back to the US to practice.

In other words, you've got one foot in the grave right now. Put the shovel down.

I deleted my previous posts because I got the response I wanted and was merely trying to protect my identity. I fully understand that once I take the step there is no coming back, and I really don't have a problem with that. I have a detailed understanding of how things work in the country I am planning to apply for and have attendings in the inner circle for guidance, so that's not the main issue here.

What I needed was an affirmation that I have completed 6 months of internship (out of the 12 months) to fulfill the minimum requirement for advancement to PYG2 level. I really don't need a "recommendation letter" from my PD, so I guess an confirmation of employment from HR will do.

Thanks for the above suggestions. I'll likely talk to an union rep / residency adviser also.

 

[BlondeDocteur]

You need 12 months to advance to PGY-2. Not 11 months and 29 days, and definitely not 6. You can certainly get a generic letter saying you completed 6 months in good standing (although I didn't read what you deleted so maybe that can't be said about you), but it won't do much for you. There are tons of successful stories of people resigning and successfully finding another position, but it makes an already uphill battle all the more steep, and the best possible thing is to finish a year out.

 

[Lightbender]

I have a 6 months of surgical internship lined up for me already after I finish 6 months here. If anyone is interested in knowing about how it works overseas send me a PM and I may consider explaining further.

I decide to not complete the full year in my current position because I won't be getting any surgical exp during my PGY1 year, the hours is not great, I'm doing something I don't enjoy doing etc etc.

 

[BlondeDocteur]

Yeah I know how it works in the UK (as others noted, you will be consigning yourself to lifelong training in their system as it's not recognized here). But are you 4 weeks in, and talking about a theoretical resignation 5 months from now?

 

[Winged Scapula]

I also know how training works abroad and am concerned that you are committing yourself to the possibility of never working as a surgeon here in the US. However, you say you know what you are getting yourself in to. At this point in time, there are no surgical specialties I am aware of that allow foreign trained physicians to work in that specialty in this country without additional US training; the "fellowship back door" is closing soon so that will no longer be an option.

What you can't know is what the future holds; there may be some reason you need to come back to the US and you may need to be employable. By at least finishing your IM year, you would be eligible for a US medical license and could potentially work if you needed to come back. I know it seems miserable but you are closing a lot of doors by failing to finish the entire year.

Just my 2 cents.

 

[Promethean]

You are being extremely foolish not to finish your commitment, but it sounds like you aren't going to listen to that no matter how many people try to tell you.

So, I don't expect you to listen to this either: You aren't entitled to anything. You may request a letter, and your PD may oblige you, but they aren't under any obligation to give you what you want. With your attitude, I wouldn't be surprised to find that they might be happy to see you go.

Why even bother going to the internet to ask this, instead of talking to your PD directly? Is your relationship with your program already so bad that you need to be assured that some external force will require them to cooperate with you?

 

[DermViser]

I have seen program directors with different mentalities. Some are always positive by nature and respect your decision and some are just strict about their rights. It also depends on the circumstances and how badly your PD needs you. You signed a contract for 1 year and the program trusted you. If resigning means your colleagues will suffer by covering your shifts then I don't think it will be an easy task for you. I would approach the chiefs first before taking the big decision because your entire future, trust me, entire future will stand on this letter if you want to apply to any ACGME residency program in the future. If I was you I would think 100 times about it, unless you have something secured already in your pocket. Try to weight the reasons forcing your to leave vs the attractions pulling you out.

 

[ThoracicGuy]

I have a 6 months of surgical internship lined up for me already after I finish 6 months here. If anyone is interested in knowing about how it works overseas send me a PM and I may consider explaining further.

I decide to not complete the full year in my current position because I won't be getting any surgical exp during my PGY1 year, the hours is not great, I'm doing something I don't enjoy doing etc etc.

Let's play the what if game... What if you get into your training in the EU country and don't get a spot in Ortho that you are wanting and instead are stuck in general surgery. Would you be ok with that? Do you have any desire to practice in the US in the future? Are you ok with never coming back to work? What if you get there and get into the surgery side and realize that you really aren't enjoying it. Will you try to get a residency back in the US in something else?

You claim to have some 'inner circle' that supposedly wants you for their position. Do you honestly think that they will want some foreign grad over their own graduates for these positions?

Just a few things to think about. I'm sure you feel like you know what to do and don't care or believe what people here have said, but if you don't want to totally ruin your US medical career, think about it a bit. An extra six months of surgery internship isn't going to change anything in the long run, but having a completed PGY1 year in the US will mean alot compared to this 6 month training that you are proposing...

 

[Winged Scapula]

The issue of whether or not you can reasonably get into foreign training and get a employed position afterwards is one that should be taken seriously. Many governments (and I have personal experience with one) require that foreign nationals can only be hired if there is no suitable citizen for the position. This is the case for training and employment. So while the "inner circle" may seem certain you would have no problem getting in, there may be governmental regulations which impact that.

Do you have PR in the country you're thinking of moving to?

 

[nlax30]

Yea it's hard to say with knowing more to the story but that's none of our business.

Bottom line, you may or may not get what you want from your PD, but you already know that. I would think they would at least give a letter just stating the facts like you were there from this date to that, and what rotations you successfully completed/passed. If that's all you need and you already supposedly have a spot lined up then I don't see any reason the wouldn't give you at least that.

But you're obviously set on this so God speed and I hope it works out. I also hope you've sought wise counsel from knowledgeable people in your life there.

 

[IM2GI]

You already think you are smarter than everyone else here, but I will echo what everyone else has said: Intern year sucks, a lot of people want to quit. You are ****ing up your life by doing so at worst, and limiting future options at best.

Finish the year and re-evaluate.

 

[NotAProgDirector]

The answer is "sort of". In some ways, you're asking the wrong question.

You need documentation of 6 months of completed training -- either for your international training, or for a medical license, or for whatever. Usually, for this type of purpose, all you need is a statement that "Lightbender worked at XYZ program from Date A to Date B and resigned in good standing". Usually, rather than a letter (which could be easily forged), any new program / licensing body will contact the program directly to confirm your dates and training. So, most PD's would not be vindictive and lie -- they will simply state that you completed training. Often this would be done by the GME office, who could confirm your dates.

When we talk about a "letter", we're usually talking about an LOR -- will your PD state that you did good work and that they support you in your quest for a new spot. That's a more complicated question.

So, in general, an employer does have a requirement to report what dates you worked, and whether your work was satisfactory. Your PD does not have any requirement to write an LOR (although I think that any decent PD shoulc write an honest letter of a resident's performance).

On the topic of your overall plan, I think you're taking a leap of faith -- and that can be a good thing. As you can see from the comments, you're going down the road less traveled. This could end with great career for you, or great regrets. But, you could have regrets not following your dream also. So, best of luck and I hope it works out.

 

[mercaptovizadeh]

I hope you truly know what you are doing, because if you don't (and the odds are you don't), there will be a lot of tears at the end of this road.

If you're set on doing this, I would approach it as concentric circles of suboptimal scenarios around your very unlikely hoped-for outcome of securing an orthopedics positions.

You could end up failing out of medicine altogether. Are you ready for this possibility? Do you have alternative employment lined up? Are you prepared for the psychological/financial consequences of quitting medicine after making the 4+ year investment so far?

You could end up failing to match into ortho (in fact, very likely). Your alternatives are medical specialties and surgical specialties, which given the competitiveness of surgical specialties could very well land you into general surgery - or ob/gyn. Are you OK with being a general surgeon or ob/gyn? Are you OK with being an internist, pediatrician, psychiatrist, pathologist, etc.? It seems you have a lot of contempt for anything but surgery, so...

You very likely will fail to match in the US. Are you OK with leaving the US permanently and living instead in Europe? We tend to see most physician immigration coming from Asia and Europe and Africa into the US, not doctors leaving the US to go abroad. There's a reason for this. Are you content with the differences in training, career advancement opportunities, limited resources, and much less income that you would have as a doctor in Europe?

Anyway, just some things to think about as/before you destroy your US medical career.

Good luck!

PS: don't talk to the chiefs or any one at your program, not even fellow interns/residents, about your thoughts before you make the actual decision.

 

[mercaptovizadeh]

You already think you are smarter than everyone else here, but I will echo what everyone else has said: Intern year sucks, a lot of people want to quit. You are ******* up your life by doing so at worst, and limiting future options at best.

Finish the year and re-evaluate.

Agreed. Lots of us think about quitting intern year or medicine altogether or what have you. I remember thinking of quitting graduate school dozens of times. I'm glad I didn't, because it's all the difference between having a PhD vs. having wasted several years of my life in lab with nothing to show for it and feeling crappy about failing at something I had set out to do.

 

[Top Gun]

I’m thinking about not practicing medicine all together or getting a residency spot in another country, so I only need a letter that says I have completed 6 months of internship and fulfilled the BASIC requirements. As long as the letter doesn’t have MAJOR redflags like lack of professionalism, sexual harassment etc. I’m happy.

I’m not saying I was accused of the above, but just heard horror stories of unreasonable PDs making up stories like that. Do I at least have the right to have a letter as such?

I'm not sure why you need a letter if you're not planning to practice medicine ever again. And no, you're not entitled to one. You're basically screwing your program over by leaving after 6 months. So if you do want one, you need to adopt a humble attitude when asking your PD for one.

 

[Law2Doc]

The answer is "sort of". In some ways, you're asking the wrong question.

You need documentation of 6 months of completed training -- either for your international training, or for a medical license, or for whatever. Usually, for this type of purpose, all you need is a statement that "Lightbender worked at XYZ program from Date A to Date B and resigned in good standing". Usually, rather than a letter (which could be easily forged), any new program / licensing body will contact the program directly to confirm your dates and training. So, most PD's would not be vindictive and lie -- they will simply state that you completed training. Often this would be done by the GME office, who could confirm your dates.

When we talk about a "letter", we're usually talking about an LOR -- will your PD state that you did good work and that they support you in your quest for a new spot. That's a more complicated question.

So, in general, an employer does have a requirement to report what dates you worked, and whether your work was satisfactory. Your PD does not have any requirement to write an LOR (although I think that any decent PD shoulc write an honest letter of a resident's performance).

On the topic of your overall plan, I think you're taking a leap of faith -- and that can be a good thing. As you can see from the comments, you're going down the road less traveled. This could end with great career for you, or great regrets. But, you could have regrets not following your dream also. So, best of luck and I hope it works out.

Its july. OP isn't even a month into intern year. No "satisfactory" track record yet. All interns are stuggling at this stage. And OP is presumably about to spring this on the PD who knows when. Isn't it putting the cart before the horse to assume the OP is going to be regarded as having performed satisfactorily over the next five months? Even if he objectively does well, wounds will still be raw. And there's a chance he won't be given as many benefits of the doubt by his attendings and peers once he reveals his plans - every error that would probably have been ignored if he were staying may loom larger and get tucked away into his file. Your evaluation in early intern year is 90% subjective (perception/attitude) and 10% performance -- its a steep learning curve, you are expected to screw up, and learn from it, but more importantly you have to be perceived as a worthy investment of their time. So the difference between satisfactory and not has a lot to do with subjective evaluation, which doesn't turn on your performance. Announcing in early internship that you are leaving might be setting yourself up for failure. Wouldn't expect anything more positive than the dates of residency -- even the word "satisfactory" might be hard to get-- and there's actually lots of opportunity for negative things to creep into such a letter. You are an intern in your first 6 months -- you are very early in the learning curve and not yet a good doctor, and will have made many mistakes, and so there's ample opportunity for a letter to honestly reflect that. Your PD can be completely honest and say that over the course of the time with his residency you screwed up X, Y and Z and didn't yet learn A, B and C. He doesn't have to say that was satisfactory or comparable to other interns over the years. In fact he can infer that you still have a lot of training to go before he would consider you satisfactory, and that's probably true, and nothing you can dispute.

I probably would hold off on asking for any sort of letter until a future employer asks for one.

 

[DarknightX]

I have a 6 months of surgical internship lined up for me already after I finish 6 months here. If anyone is interested in knowing about how it works overseas send me a PM and I may consider explaining further.

I decide to not complete the full year in my current position because I won't be getting any surgical exp during my PGY1 year, the hours is not great, I'm doing something I don't enjoy doing etc etc.

Awww, no surgical experienced during your PGY-1 year? Hours not great?

What the F did you expect? It's a surgery residency!

Most interns don't operate (at least they shouldn't have that expectation) and you're basically a glorified secretary. Intern year sucks. Get over it.

My advice to you would be to man up, finish up the 6 months and then re-evaluate your options. Like so many others have told you, leaving in the middle of the year could be a career ending move. I can't believe you have the stones to even think about asking for a letter.

 

[SouthernSurgeon]

Awww, no surgical experienced during your PGY-1 year? Hours not great?

What the F did you expect? It's a surgery residency!

Most interns don't operate (at least they shouldn't have that expectation) and you're basically a glorified secretary. Intern year sucks. Get over it.

My advice to you would be to man up, finish up the 6 months and then re-evaluate your options. Like so many others have told you, leaving in the middle of the year could be a career ending move. I can't believe you have the stones to even think about asking for a letter.

They're in a medicine residency

 

[mercaptovizadeh]

They're in a medicine residency

Even bigger duh.

 

[ThoracicGuy]

Awww, no surgical experienced during your PGY-1 year? Hours not great?

What the F did you expect? It's a surgery residency!

Most interns don't operate (at least they shouldn't have that expectation) and you're basically a glorified secretary. Intern year sucks. Get over it.

My advice to you would be to man up, finish up the 6 months and then re-evaluate your options. Like so many others have told you, leaving in the middle of the year could be a career ending move. I can't believe you have the stones to even think about asking for a letter.

This guy wanted to do Ortho originally but due to personal/family concerns ended up interviewing and matching for IM. Now he's having second thoughts and wants to jump back to Ortho. He believes that an IM year will make him look bad for ortho. He also doesn't want to do general surgery at all. Now his idea is that he will go somewhere in Europe where he's apparently a dual citizen and will just slide into a residency there, assuming it will be ortho.

So basically he's willing to quit and go to Europe to try that, I suppose not caring what the consequences might be to his US training.

You'd have been able to see that, but he decided he wanted to go back and reedit that out of previous posts in another thread...

 

[DarknightX]

They're in a medicine residency

I assumed he was in a surgery residency because he was complaining about the lack of OR time. Yeah, even bigger DUH, what did you expect?

This guy wanted to do Ortho originally but due to personal/family concerns ended up interviewing and matching for IM. Now he's having second thoughts and wants to jump back to Ortho. He believes that an IM year will make him look bad for ortho. He also doesn't want to do general surgery at all. Now his idea is that he will go somewhere in Europe where he's apparently a dual citizen and will just slide into a residency there, assuming it will be ortho.

So basically he's willing to quit and go to Europe to try that, I suppose not caring what the consequences might be to his US training.

You'd have been able to see that, but he decided he wanted to go back and reedit that out of previous posts in another thread...

Yeah I didn't catch that at all. A year of IM won't make you necessarily look bad for Ortho, but quitting in the middle of the year will make you look horrible.

Good luck dude.

 

[Lightbender]

I want to extend any appreciation for the valuable advice provided especially from nlax30, aPD and Law2Doc. I understand that this is not a rash decision to be made and I have to ask myself a lot of the questions proposed on this thread, including whether I am OK with not being able to practice medicine in the US. Unfortunately, I cannot answer any of those questions without unveiling my identity so I would have to discuss it with some close trusted friends.

I try to keep an open mind as much as I can for the next 3 months, at which time I should be able to reach a final decision. I would, as said above, obviously not approach my chief and PD about my thoughts before that.

In regard to Europe, I know someone who finished an EM residency in the US and moved back to EU to work. She told me the perks are there is a lot less paperwork, no more hassles with insurance or worrying about patients not paying, a lot better hours and flexibility, less stringent recertification requirements and you’re essentially immune to malpractice lawsuits and do not have to practice defensive medicine (read: OB/GYN is actually not an undesirable specialty under this condition). Enough though the taxes are high, they do go to somewhere useful, like better infrastructure, safer neighborhoods, culture, education, healthcare etc, and there is always a way to make money if I wishes to (the hourly wages are not too far off). I probably don’t understand the full intricacy of working in Europe yet but there should be a way around it.

I think the thread is becoming a little too inflammatory and I do not plan on defending myself any further. I have all my questions answered, so I would appreciate if the moderator could close the thread.

 

[Law2Doc]

...I probably don’t understand the full intricacy of working in Europe yet ....

Understatement of the week. The grass is always greener, but I think anyone working in the EU who is being honest with you would tell you that no health system is perfect and for every one thing that seems objectively better there are probably two things that are worse.