Quoted: Options after being fired from residency

[Doodledog]

Sent to me by PM. I have no further ideas, but perhaps others do.

My contract was not renewed in the PGY-2 specialty year. I begged my PD to take me back, took everyone's advice, listened to senior residents who thought that I could make it. No reason was given at all. This happened in the fall. I figured it was because of some slow work and lateness (I was acutely depressed due to a family problem). No patient care danger. May have been short with some hospital staff due to depression and stress because they started me on call/wards the first day, although I had been away from hospitals for a whole year and I asked them to start me on consults or something easier. Months later, the PD said I could take a leave of absence, but not with any mention of whether I would be promoted. I figured it would be an income-less delay of the inevitable, and I was doing so much better at work that I though no problem staying. Nothing but positive feedback. Meanwhile I was seeing a therapist. Then in April, a very callous senior started asking if I had started looking for jobs at pharma companies. I went back to the PD and he stared blankly and said I was not coming back. I had previously told him about the devastating things that had happened in my life (after the non renewal because I was trying to bottle it up and not "complain" at work, it's not a friendly or supportive environment). I then found out my salary had already been allocated to hire a fellow for the next year. They actually reduced the size of the residency class after not renewing me. Then they hired a PGY-4 a year later.

I frantically looked for spots for the next full academic year, living on unemployment, pretending to drive to work everyday so that my landlord and neighbors wouldn't figure it out. I got lots of phone calls and interest, but the minute they insisted on calling the PD and did so, the offered interviews disappeared. I pressed some PDs to tell me what my old PD had said, and NO ONE would tell me like it was some kind of state secret. I don't know if he is lying or not.
I filed an EEOC complaint (still processing) and hired a lawyer who wouldn't try the case, just got a 'neutral letter'-two liner- from the program director to be sent to new programs.
How do I find out what he was saying?

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[dragonfly99]

Wow, this is tough.
Clinical medicine may be out for you, particularly if you graduated from a foreign school. Did you get credit for the entire intern year? If so, you might have a shot at some other types of residencies...maybe you could do pathology or occupational med, for example. Maybe you could do psychiatry if you went through depression and learned something from that.

You might need to look for another job, such as a research job, while you figure out what to do.

It seems like you might have screwed yourself over with this EEOC complaint. It sounds like your attorney didn't think you had a case in terms of unfair termination. This type of thing (discrimination complaints and lawsuits) definitely makes program directors mad. Now he's not likely to give you a decent reference, without which I think it will be hard for you to get another residency in the US.

If you graduated from a foreign school and have citizenship in another country, it might be much easier to start anew in another country. If you don't want to go to your country, I guess you could try for Australia, other countries, etc. Maybe you could not tell them that you did an intern year here, but I don't know exactly how you'd go about that, since they'll likely ask what you've been up to the past couple of years.

 

[pathologic]

It might be a good idea to seek treatment for your depression and document it heavily. There are physician groups that you could attend and again document attendence. The main goal would be to identify exactly what went wrong as far as how you delt with the stress of residency and build a support system to avoid it happening again. With documented treatement and a solid plan of action you can overcome this!

 

[NotAProgDirector]

So, this is an anonymous forum for a reason. Some of the advice/analysis below might be difficult for the OP to read. But perhaps some stark truth might help here. I write this not to hurt you, but to show how it looks from the other side.

Some of this story doesn't quite hold together:

My contract was not renewed in the PGY-2 specialty year. I begged my PD to take me back, took everyone's advice, listened to senior residents who thought that I could make it. No reason was given at all.

There are plenty of stories of callous or vindictive PD's out there. I'd like to think that most PD's are actually trying to do a good job. Regardless, I highly doubt that a PD let you go and really gave you no reason. Perhaps you didn't agree with their reasoning, or were unwilling to hear it, but I find it likely that you were warned/told.

I figured it was because of some slow work and lateness (I was acutely depressed due to a family problem). No patient care danger. May have been short with some hospital staff due to depression and stress because they started me on call/wards the first day, although I had been away from hospitals for a whole year and I asked them to start me on consults or something easier.

These are all possible reasons for not being renewed, if they were severe enough, recurrent, or you were unwilling to accept responsibility for them. So, it sounds like you were warned/told about this.

Being depressed is no excuse. You are responsible for your own behavior and performance. If you are ill, then you need to be treated for that illness. If the illness makes you unable to do your job, then you need a leave of absence until it has been treated sufficiently.

Your PD is under no requirement to start you on an easy rotation. You were hired to do a job. Others may have had equally good reasons to request easier rotations first. This is not an acceptable excuse for unsatisfactory performance

Months later, the PD said I could take a leave of absence, but not with any mention of whether I would be promoted. I figured it would be an income-less delay of the inevitable, and I was doing so much better at work that I though no problem staying. Nothing but positive feedback.

Let me get this straight. You were doing better at work, so your PD suggested you take a leave of absence? This makes no sense at all. You were asked to take a leave of absence because your performance was not adequate. Perhaps it had improved, but clearly not to the level to satisfy your PD that you were able to perform. The fact that you don't seem to see this, even in retrospect, is highly concerning. Being asked to take an LOA is a huge red flag, in any field/career.

I went back to the PD and he stared blankly and said I was not coming back. I had previously told him about the devastating things that had happened in my life (after the non renewal because I was trying to bottle it up and not "complain" at work, it's not a friendly or supportive environment).

I'm sorry for the devastating things happening in your life. Still, your PD has a responsibility to run the program and make sure that everyone in it is performing at a satisfactory level. If your outside life interferes with your ability to perform satisfactorily, then you need a leave of absence. If that does not fix the problem, then you will end up terminated.

It is unfortunate that your program was not a friendly environment where you would feel safe sharing these types of things. This is a failing of your program.

I frantically looked for spots for the next full academic year, living on unemployment, pretending to drive to work everyday so that my landlord and neighbors wouldn't figure it out.

I am worried that this type of behavior is exactly the thing that got you into trouble in the first place. Your landlord and neighbors should be the least of your issues. Sitting at home and doing nothing would be a complete waste, and I applaud your efforts at finding a new spot.

I got lots of phone calls and interest, but the minute they insisted on calling the PD and did so, the offered interviews disappeared. I pressed some PDs to tell me what my old PD had said, and NO ONE would tell me like it was some kind of state secret. I don't know if he is lying or not.
I filed an EEOC complaint (still processing) and hired a lawyer who wouldn't try the case, just got a 'neutral letter'-two liner- from the program director to be sent to new programs.
How do I find out what he was saying?

An EEOC complaint is going nowhere. DO you have any evidence that you were fired based on your sex, or race? Sounds like, by your own admission, you were fired because of your performance and your lack of recognition that there was a problem.

Personally, in situations like this, I think the PD should be required to write a detailed letter about the resident's performance. This letter should be viewable by the resident, and if they feel the contents are unfair should be appealable through the usual channels. This would not stop any future PD asking to speak with your prior PD, and it would be possible for your old PD to say anything, but at least such a letter would form a starting spot for a discussion.

If you received lots of phone calls and interest, it's possibly because you misrepresnted what happened at your old program. If I'm contacted by a potential resident who tells me one story, and then I contact the program and get a completely different story, that's usually the end of it. I can't tell where the truth lies, I expect it is with both, and it's a huge red flag that there are plenty of unresolved issues. It might not be what your PD is saying, but simply that his/her story doesn't jive with yours.

If I were reviewing your application, my major concern is as stated in my comments above: I see you blaming the system and others without accepting any responsibility for your own problems. I see you missing clear clues that there was a serious problem which you failed to heed. I am concerned that your psych issues remain very active.

 

[Doodledog]

A separate poster with a similar problem

I was dismissed in first year after 4.5 months. I went thru a terrible time. Now I am applying again, have a few interviews. Everyone asks what happened. From my point of view there were unfamiliarity as I am a FMG and everything was new to me (the system) so I was less efficient than my american graduate counterparts. Secondly I had few logistical issues, didnt have a car, had to move twice, used public transport and that took up time and energy. Long story short, my knowledge was pretty good, no personality clashes but reduced efficiency. I believe it would have gotten a lot better with time. I have done observerships after that and worked very hard.

Any interview advise on how to handle situation

Please respond in this thread

 

[NotAProgDirector]

New PD's are going to want to know what happened the last time, and how you plan to fix it. It sounds like you've already gotten your answer. You're now more acclimitized to the US health care system. You have a car, and you'll be sure to get an apartment and get settled before starting. You'll do some observation at their program before getting started, so you learn the lay of the land. You've already done some observerships to work on this.

 

[moveon]

Sad to hear that. Similar story here. However i did get credit for the whole year. I did not file any law suits but emailed / spoke with ACGME a couple of times. The PD gave me a 2 liner letter stating which rotations i did and that he felt i needed more time in ICU so i was put thru an extra month after which i passed the rotation and the year successfully and i think its pretty justified on his part to do that. (I have other 3 strong letters from faculty and over all my evals are avg-above avg and in svc results were satisfactory) He does have a larger responsibility to the program and I do respect his decisions. and I think its unfair for him to lie on a letter or to a new PD, i understand that. I am an FMG have been out of training for 3 months now, thought of taking a break / spending some time with my family before resuming.

I am trying to get into some research / some masters program meanwhile to keep my CV going. I am open to applying to less competitive specialties like FP and Peds (was in IM earlier). I have been getting calls too in past and it all stopped when they spoke with the PD. However i have been candid with new PD's about what happened and that I have an insight into my problems and my outlook has matured and that I will do my best not to repeat my mistakes. Thats the only honest answer I could give them.

The program has terminated residents in the past and some of them were taking legal action however i dont see the wisdom in that, it will only further screw up things. Besides my goal is to get back into training and not go thru more stress and end up spending money where nothing might be guaranteed.

What do you guys think ? What are my chances of resuming residency training ? i appreciate your candid opinion and help. This forum has been very supportive, thanks a bunch !!

Sent to me by PM. I have no further ideas, but perhaps others do.

My contract was not renewed in the PGY-2 specialty year. I begged my PD to take me back, took everyone's advice, listened to senior residents who thought that I could make it. No reason was given at all. This happened in the fall. I figured it was because of some slow work and lateness (I was acutely depressed due to a family problem). No patient care danger. May have been short with some hospital staff due to depression and stress because they started me on call/wards the first day, although I had been away from hospitals for a whole year and I asked them to start me on consults or something easier. Months later, the PD said I could take a leave of absence, but not with any mention of whether I would be promoted. I figured it would be an income-less delay of the inevitable, and I was doing so much better at work that I though no problem staying. Nothing but positive feedback. Meanwhile I was seeing a therapist. Then in April, a very callous senior started asking if I had started looking for jobs at pharma companies. I went back to the PD and he stared blankly and said I was not coming back. I had previously told him about the devastating things that had happened in my life (after the non renewal because I was trying to bottle it up and not "complain" at work, it's not a friendly or supportive environment). I then found out my salary had already been allocated to hire a fellow for the next year. They actually reduced the size of the residency class after not renewing me. Then they hired a PGY-4 a year later.

I frantically looked for spots for the next full academic year, living on unemployment, pretending to drive to work everyday so that my landlord and neighbors wouldn't figure it out. I got lots of phone calls and interest, but the minute they insisted on calling the PD and did so, the offered interviews disappeared. I pressed some PDs to tell me what my old PD had said, and NO ONE would tell me like it was some kind of state secret. I don't know if he is lying or not.
I filed an EEOC complaint (still processing) and hired a lawyer who wouldn't try the case, just got a 'neutral letter'-two liner- from the program director to be sent to new programs.
How do I find out what he was saying?

 

[Sehkmet]

I'm in the same boat..For me I resigned before I actually got fired. To make the story more interesting I had to resign from 2 residencies. The reason for both was 'failure to progress.' I was on academic probation for several months because I was not at the same level as my peers who progressed. My attendings noticed it, but more importantly I noticed it. Many people tell me it was because I was not interested in what I was doing really .I had wanted surgery but had to do internal medicine. But there are probably a lot of people who hate their job, are still able to get through it do very well.

Was it a knowledge problem? Perhaps..I think I had trouble retaining what I learned but in hindsight, I think I needed a lot more hands on and was too afraid to seek it (not very good quality for someone who wants to do surgery!). I think you really need to understand how you learn and be almost ruthless in trying to obtain what you need to progress and I was not (and likely subconsciously unwilling) to do what it takes to get to where you need to go.

Was it because my father passed away a few months into my 1st residency? Once again perhaps it contributed, but many people get through residency with deaths in the family. So this one is no excuse either.

I am lucky and very grateful to have a job now, especially with the economy the way it is--there is not much an MD without a residency who resigned from 2 residencies can do! I've learned quite a few lessons from having to endure 2 huge failures. I still read many of my medical books trying to keep current. But its been about a year now and you definitely lose knowledge when you are not actively using it.

I have no illusions about the future. Most people tell me that 2 failed residences are 2 huge signs that I was not meant to be a physician. But then I probably would not have graduated from medical school if I believed most people. Perhaps they are correct. But I am just stupid (or stubborn) enough to believe otherwise. It'll be and is an uphill battle, but there isn't a day that goes by where I am not thinking about being a physician. I am willing to put the work into it, but its difficult knowing how to go about getting what you want when the only template seems to be 'give up, forget about being a physician and just stay in your office job--better fit for you anyway.' As I am typing this I am thinking that there is probably not any good advice anyone can give other than what most people have told me. I really think I am really on my own in this. As one physician told me..be realistic and good luck!

As I have said I am willing to put the time and work into it..do I somehow need to repeat clerkships, do an observorship (can I even do these things without being in med school).

If anyone has any suggestions I would love to hear from you!

 

[Shinken]

As I have said I am willing to put the time and work into it..do I somehow need to repeat clerkships, do an observorship (can I even do these things without being in med school).

If anyone has any suggestions I would love to hear from you!

Be very careful of how much time has passed since you graduated from med school. Many residency programs have limits on how much time they allow after med school graduation (five years seems to be an average, I believe). If you've graduated several years ago they won't consider you for residency.

My advice is to start researching this right away before you lose more time and become completely ineligible to apply for residencies in most places.

 

[rysa4]

Well more info would be useful. I do not think a lawsuit or complaint process will be helpful at all so I would move onto other avenues of thinking.

1. English - It is somewhat important ( in my opinion) to be fairly competent in the English language. If this is not an issue for you that would be a good thing, because it removes certain communication barriers that might otherwise arise in future attempts at getting back in.

2. The line about wanting to be on consults first because you had not been on hospital wards in awhile is concerning. I am not sure how to say this other than when you start an internship or residency you just have to be ready to go. I suspect this was the problem.

3. In general, there are three issues: Competency, attendance, and fit. You need the first two to stay in a program and the last one to be offered a job where you train if that is a goal at all. You have problems in the last two areas for sure.

4. With my attempt at identifying issues from afar, my recommendation is to self-examine whether or not you feel you are capable of performing an internship. If the answer is yes, then go get one; there are unfilled spots every year. Freakin get a community family practice spot; there are many unfilled every year, and you will definitely have a job waiting at the end of the tunnel--but if you do this you have to be at work every single day you are supposed to and have your little medicine books at all times with you.

5. As far as the getting in the car and pretending to go to work - you have issues. truth is - nobody cares and you are focused on the wrong things. Exercise, meditate, get on anti-depressants- whatever - but get that sludge off your back as best as you are able and decide what you want to do.

6. You're main decision is to decide whether to re-apply or not- you can't worry about what will happen with those applications - you have no control over the outcome other than your own effort - so make one or don't. You don't have much time either.

 

[eagleskickbutt]

I have to preface this by saying that my suggestion is based solely from my engineering background. I have been on a lot of interviewing committees of interns and graduate engineers. In one instance, we hired a guy who told us he was fired because he failed a drug test because he was smoking pot at night. None of us cared because he had a set of skills that were desirable to our company and we believed he would never do that again.

1. Take ownership- I think if you make some mistakes, you have to take ownership so you can gain control of the situation. It should not matter what this PD is saying about you if you admit mistakes like being late and having a poor attitude. When you interview with possible residencies tell them the worst of the worst so that they are not surprised when they make their follow up call.
2. Change your behavior- When you apply to other residencies; explain how you have changed. The key is to learn from your mistakes and own them and never do them again. On our committees we never held it against a candidate to if they were fired in the past if they made a believable statement of having changed.
3. Write a letter of apology- I don’t think it would hurt to write a letter of apology to your PD. This is not for them or you but as a way to prove to your future residency that you are through with that behavior. It may also balance out the EEOC complaint that you filed.
4. Educate yourself- Sometimes people don't know they are rude or have a bad tone. Read books on communication so that you don’t loose your cool with anyone at work. That is unprofessional and nobody wants to work with a loose cannon.
5. Balance- Take some time for yourself to exercise and eat right, take your vitamins and take care of your emotional needs.
6. Socialize- Get out and join a church or community organization and practice your skills.
7. Think of the positives- There are many positives that could come out of this. It seems better to learn these things now, than after your residency doesn't it?

Good luck and think of how many obstacles you have overcome already. You have the strength to overcome this you just have to believe in yourself.