NotAProgDirector

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Oct 11, 2006
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  1. Attending Physician
I am an American medical school graduate from a top medical school, didn't graduate AOA but close to it. I have research experience and publications, very good board scores, lots of awards. The specialty I chose is my passion (non-surgical), and I was recruited highly for residency. Intern year was fine, however during my PGY 2 year I started developing clinical depression and burnout. Many devastating personal events happened all at the same time. Of importance, my performance was highly regarded during residency, I had an excellent reputation, and patient care was never a concern until the PD was told by a fellow resident I was depressed and possibly suicidal. I never took a sick day. No substance abuse involved. I got along fine with everybody, even the tough attendings. I was just a few weeks away from my PGY 3 year. After he was told, I was immediately hospitalized and have been treated over the last four years for "MDD, severe, recurrent." My contract was cancelled for "business reasons" several months after my treatment began and I did not return to work. I was told that my spot in the program was secure prior to my termination (I have this in writing), but nobody thought it would be this long. I really crashed after I was terminated and I made a serious suicide attempt. My insurance would not pay for the cost of my entire treatment which forced me into bankruptcy. I have no family support. One bad event cascaded to another, but I have a really strong will. I am better now, and in remission, but in a worse situation than when this all began. Over the last few months, I have taken steps to reclaim my life and career. I approached the department with a well-researched, well-devised proposal to return; the door was not closed, but I was told all the spots were filled for the upcoming year, which I have reason to believe was not true. The next move was left to me, but I don't know what to do. I am currently trying to find a fellowship in this field, but no success so far (this is not the largest institution). To make matters more difficult, for several strong reasons (including financial) I cannot afford to move from this city. I can't wrap my head around changing to family medicine, when I had such a promising career and potential in this field, which is still my passion. I don't know if contacting my former advisor from medical school would be worth the embarrassment. I am taking steps to turn my experience with serious depression into something positive by contacting some well-known researchers dealing with similar cases. I don't know where this will lead yet, but if anything good comes of this, maybe at least it can help other residents. Regardless, it doesn't affect my immediate situation. Is my career over? I'm having trouble accepting that all of my successes and talents, my credibility, everything I've worked for my entire adult life towards something so meaningful and fulfilling as medicine, can be ruined because I was diagnosed and treated for major depressive disorder, albeit severe. I strongly believe this experience will only make me a better doctor.

This situation is beyond my experience to know what to do next. This forum is one of the only resources I know of that I have left. Please, somebody give me some advice.

First: Wow, that's quite a story. Sounds like you've been through quite a bit.

Thoughts:

1. Four years is a long time. Your skills will have atrophied. You should assume that you will need to start as a PGY-2 again. You might even need some PGY-1 time, but see below.

2. Depression, especially severe depression like yours, makes PD's nervous. It's not a disease that's curable. It is treatable, but tends to worsen with stress, long hours, and sleep deprivation -- all common in residency training. There are two big worries: 1) that you'll reflare and require another extended leave, or 2) that you'll claim ADA issues / accommodations. Both will make PD's very gunshy about an extended commitment.

Ideas:

1. Your first step is your original program, as you have done. I would try to have a "straight talk" with your PD. Basically say: "Look, I know this is a really complex and difficult position for all of us. But I need to know: would you be willing to restart my training at the (insert PGY level here) level if you had a spot, or is it basically not going to happen. Tell it to me straight, so I can plan my life -- since if you won't continue my training, then I'm going to look elsewhere". Because of your history of severe depression, your ex-PD may simply not want to tell you for fear of "depressing" you.

Make sure you ask for the right thing. If a full PGY year is not available, ask for 2-3 months of training to start. Anything you can get at this point will help your next position.

2. You should seriously consider applying for a medical license in your state. Hopefully you can get one with only a single year of GME. Hopefully your health issues will not get in the way -- for certain the board of medicine is going to review your application closely.

3. If you can get a medical license, then you can work -- now you could try to finagle a "rotation" without being in a GME program (since you woudn't need a training license). Perhaps someone who knows you from that institution would be willing to have you work with them, shadow, something.

4. If a position at your original program is not an option, then you need to start looking elsewhere. Sounds like you're not all that flexible about location -- not unreasonable, as likely much of your psych resources are based there and moving away from those to do a residency is probably a bad idea. You'll have to consider different fields, potentially.
 
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