Re-Applying to Residency following Dismissal as Intern

[kazdan]

Hi everyone,
I was hoping to get some feedback regarding a current situation that is particularly distressing to me as I move forward to (hopefully) recontinue my career in medicine

I recently was dismissed from my residency shortly into my intern (PGY-1) year after a few episodes of being late. At the time, I honestly thought I was being as proactive, honest, and apologetic as possible when explaining what I thought the problem was, which I really thought were simply problems related to sleep hygiene and having trouble adjusting to intern year. I was sent for a fit for duty evaluation, which was positive for marijuana. Again, right after I took this drug test before the results came back, the possibility of the test turning positive hit me so suddenly, and I knew that I had a slim chance to continue at this program. I had smoked about 3 weeks prior during vacation (given to me one week into residency) and that was it, but given the circumstances, I understand how skeptical they (and you guys) must be when I say that. I was as transparent as possible with the faculty and PD, telling all of them that I was extremely concerned that this test might be positive, and that I would be fully cooperative in anything they saw fit.

Unfortunately, I was dismissed, which I fully understand. I am about two days away from entering an inpatient drug and alcohol rehabilitation program which I really believe will help me get over the problems I may have had and neglected as an intern. After that program ends, I hope to either get a job or volunteer in either a research position or at an addiction center in a full-time role, ideally so that when I'm reapplying through ERAS this year, I'll be able to have someone (ie my boss) who can attest to me not having any of the same problems I dealt with in residency.

I've been concerned over my chances for this upcoming year through the Match system and ERAS. Last year, I applied in Internal Medicine to about 40-50 programs, and got about 20+ interviews. My step 1 score is 222, step 2 is 232. I have been fully on board with considering applying additionally to family medicine, in part because of the better odds I might have for this upcoming year, as well as my interest in primary care.

I know I made some big mistakes, as I'm sure all of you reading this fully realize. I'm sure many of you don't believe I deserve a second shot... Given how much this has really dug tunnels into my psyche, I would appreciate it if anyone who responds can be as honest as they can be, but also hold back on re-emphasizing the degree to which I screwed up.

If anyone could help give me some advice on some of the biggest questions/concerns I have, namely a) who my best resources should be when it comes to re-applying through ERAS and making my application complete [with the obvious addendum for this current year], and b) if anyone can give advice as to a position I can perhaps look for after I complete my time in the inpatient setting ... I have kept a good relationship with my prior PD regarding this whole scenario, as bad as it was ... And although I haven't mentioned anything to her about moving forward regarding next year, I hope that when the time comes and if i'm lucky enough to be granted interviews for next year, when future PDs reach out to her, she will be able to have some favorable things to say about me, if that's even possible. All she knows now is that I am entering this inpatient facility now and am both extremely regretful of how I handled things, but also appreciative for how much of a help she was during that stressful period.

Sorry for the convoluted post - Thanks everybody

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[Crayola227]

It sounds like you are getting the help you need regarding substance abuse, and I want to applaud you for that

Hopefully this time away from training you can work on strategies for self care and sleep hygiene that can contribute to your success, as well as some introspection. Psycheducation.org has a lot of info that I like on sleep and light hygeine that is backed up with a lot of citations. It's more directed to BPAD but there's plenty of pearls for anyone that struggles with sleep, circadian rhythm disorders and the like. Take it from a night owl.

Check out my post history for tips on "self care" "mental health" and seeking care with an eye towards how that affects your career.

This is something that will continue to follow you with any state medical board license applications, so keep that in mind where you apply and interview.

Not to belabor this further, hopefully others reading this thread will understand that as soon as you start medical school, the best thing you can do for your career is to never touch any drugs that can be seen on a UDS, marijuana included. You can't always foresee in the course of your career when you might have to pee in a cup. You just never know when you might get that needle stick and get sent to Student/Employee Health for a UDS as part of a worker's compensation ass-covering thing that isn't even your idea, so that whatever insurance carrier can make a case that they shouldn't cover your care. Of course, anything found on your UDS can be a cause for causing you further trouble. It's just not that worth it, and it's just one of many sacrifices, some one might argue, aren't fair, that we make for this career.

I know a PA IRL who had to shave their entire body because of one of those drug hair tests.

1) You definitely need communication with your school, as they will be helping you with ERAS - from your transcript to Dean's letter to photo upload to uploading LORs.
-They may be able to help you with mentorship, or pulling any sort of strings to help you get back on your feet.
-They might be able to help you figure out some research or an observership.
-They might not be any help beyond ERAS.
2) You definitely should plan on potentially needing to SOAP, and look for positions outside the Match or off-cycle. Programs that didn't fill, are new, on probation.
3) Any help your prior PD would be willing to give, would be a Godsend.
-Definitely talk to them that you will be reapplying, and ask for their support.
-You will need their LOR and any program that might consider you will want to talk to them. Whether you sink or float will depend on your PD.
4) Contact any attendings that you worked with in your prior program that might be supportive of you, that could write an LOR or put in any good words for you anywhere.
5) Apply broadly, as in, to every program you can afford that might take a chance on you.
-Consider adding psychiatry or path to your list. Maybe that's not what you want, but at this point if you can even complete the sort of intern year that would let you get a license somewhere, that would be better for your goals.
-You might need to complete a residency, even in a field you don't want, as a way to step stone to what you do want. It would be easier after you have successfully completed some residency training to try to transfer, or to complete it and then try to get a second residency. Programs will be more willing to look past this after you have some successful clinical training time under your belt.
6) Anything you can do that will keep you clinically relevant, or get you MD LORs, would be best but can be a challenge.
7) I'm not saying this is a saving grace, but you should take Step 3 and try to ace it. Doing poorly can only do more to hurt you, but passing it and doing well will at least remove that as any issue of concern for a PD.
8) Engage in some sort of CME or other learning strats (journals, reviews, etc) that will help you retain your knowledge base AND keep you up to date with advances. Not being in training makes it easy to lose.
9) Consider everything personal (like rehab) and professional (like research, observerships) that will go into recrafting a PS. It would likely be a good idea to have one for any MDs you work with to try to rebuild your app, and for your LOR writers, including your PD. Even if it isn't the final one, I would write one and keep working on it. If you want people in your corner, the best you can do is let them know why you're doing this, trying to get back in and reinvent yourself.

I don't know what your chances are, so I hate to encourage or discourage you. I know it's an uphill climb. Be prepared to burn tons of cash or take out loans if you can get them, to apply to everywhere including Hades and Hell. Be prepared to figure out how to talk about all this dirty laundry, and how to field all the uncomfortable questions, and spin it to talk about some hardcore believable growth and introspection that I hope you will make.

I won't lie, it's possible that you can't fix this. However, there is a lot of reasonable steps you can do to try to make this dream possible again, even if it doesn't work. I certainly wouldn't blame you for trying.

Best of luck to you.

 

[ThoracicGuy]

Hi everyone,
I was hoping to get some feedback regarding a current situation that is particularly distressing to me as I move forward to (hopefully) recontinue my career in medicine

I recently was dismissed from my residency shortly into my intern (PGY-1) year after a few episodes of being late. At the time, I honestly thought I was being as proactive, honest, and apologetic as possible when explaining what I thought the problem was, which I really thought were simply problems related to sleep hygiene and having trouble adjusting to intern year. I was sent for a fit for duty evaluation, which was positive for marijuana. Again, right after I took this drug test before the results came back, the possibility of the test turning positive hit me so suddenly, and I knew that I had a slim chance to continue at this program. I had smoked about 3 weeks prior during vacation (given to me one week into residency) and that was it, but given the circumstances, I understand how skeptical they (and you guys) must be when I say that. I was as transparent as possible with the faculty and PD, telling all of them that I was extremely concerned that this test might be positive, and that I would be fully cooperative in anything they saw fit.

Unfortunately, I was dismissed, which I fully understand. I am about two days away from entering an inpatient drug and alcohol rehabilitation program which I really believe will help me get over the problems I may have had and neglected as an intern. After that program ends, I hope to either get a job or volunteer in either a research position or at an addiction center in a full-time role, ideally so that when I'm reapplying through ERAS this year, I'll be able to have someone (ie my boss) who can attest to me not having any of the same problems I dealt with in residency.

I've been concerned over my chances for this upcoming year through the Match system and ERAS. Last year, I applied in Internal Medicine to about 40-50 programs, and got about 20+ interviews. My step 1 score is 222, step 2 is 232. I have been fully on board with considering applying additionally to family medicine, in part because of the better odds I might have for this upcoming year, as well as my interest in primary care.

I know I made some big mistakes, as I'm sure all of you reading this fully realize. I'm sure many of you don't believe I deserve a second shot... Given how much this has really dug tunnels into my psyche, I would appreciate it if anyone who responds can be as honest as they can be, but also hold back on re-emphasizing the degree to which I screwed up.

If anyone could help give me some advice on some of the biggest questions/concerns I have, namely a) who my best resources should be when it comes to re-applying through ERAS and making my application complete [with the obvious addendum for this current year], and b) if anyone can give advice as to a position I can perhaps look for after I complete my time in the inpatient setting ... I have kept a good relationship with my prior PD regarding this whole scenario, as bad as it was ... And although I haven't mentioned anything to her about moving forward regarding next year, I hope that when the time comes and if i'm lucky enough to be granted interviews for next year, when future PDs reach out to her, she will be able to have some favorable things to say about me, if that's even possible. All she knows now is that I am entering this inpatient facility now and am both extremely regretful of how I handled things, but also appreciative for how much of a help she was during that stressful period.

Sorry for the convoluted post - Thanks everybody

You need to have a conversation with your former PD. Without their support for you to get a new position, you will not have much of a chance for success. As it is, this will be hard to come back from, but it could be possible.

 

[MedicineZ0Z]

You need to have a conversation with your former PD. Without their support for you to get a new position, you will not have much of a chance for success. As it is, this will be hard to come back from, but it could be possible.

Even if OP applies to 100+ family med residencies, including low-tier ones, you don't think he has a shot?

 

[Crayola227]

Even if OP applies to 100+ family med residencies, including low-tier ones, you don't think he has a shot?

No.

ERAS has all sorts of ways of filtering thousands of apps for a program to review. One checkbox is if your med school grad date is more than 5 years past. Many programs have that filter on so such apps are never even received. They go in the digital garbage before anyone ever even sees them. I was told this in person by a PD.

Also there is a section where an applicant checkboxes if they have had any prior residency training. That's fine for advanced positions but for cat PGY1 spots... I don't know if programs can autofilter those (somewhere on SDN aPD answers this for me I forget).

No matter what, if you have prior residency experience, a new PD will want to talk to your old PD. They can sink you. No amount of programs applied to can overcome this simple fact.

 

[ThoracicGuy]

Even if OP applies to 100+ family med residencies, including low-tier ones, you don't think he has a shot?

Is there a chance? Probably not a great one, but it's not zero. His best bet is through personal connections.

 

[Bobblehead]

I recently was dismissed from my residency shortly into my intern (PGY-1) year after a few episodes of being late. At the time, I honestly thought I was being as proactive, honest, and apologetic as possible when explaining what I thought the problem was, which I really thought were simply problems related to sleep hygiene and having trouble adjusting to intern year.
...
I am about two days away from entering an inpatient drug and alcohol rehabilitation program which I really believe will help me get over the problems I may have had and neglected as an intern.
...
I would appreciate it if anyone who responds can be as honest as they can be, but also hold back on re-emphasizing the degree to which I screwed up.

You are not being honest in an anonymous internet forum. If you come across this way in your personal statement, which should extensively, openly and brutally honestly discuss this situation, let alone at a face to face interview assuming you make it that far you will not like the outcome.