Resigned from FM residency, do I have options to reapply in another specialty?

[shaggybill]

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I don't really want to get into the details, but in 2018 I resigned (voluntarily) from my FM residency after 21 months. I'll just say I picked a terrible specialty that left a terrible taste in my mouth for medicine in general. I did leave on good terms with my PD, and she filled my spot pretty quickly. Recently I've started having some regrets that I'm not using my degree (DO) and I really wish I would have picked something more focused and far less broad.

For the most part, I was a hard worker but bottom-halfer in medical school and probably even in residency. I failed COMLEX 1 the first time, did reasonable well on the retake and on subsequent board exams (level 2, PE, and level 3). I'm currently applying for my state medical license to work as a general practitioner, but I really hate not being board certified in anything. I can't imagine ever doing family medicine again. I'd really like to do something heavy in procedures since that's what I'm really good at, but given my history, I'm certain that my chances of successfully applying to and/or starting as a PGY2 at procedure-heavy specialties or something like diagnostic radiology is slim to none.

All that being said, what, if any, specialties out there would I have the best (albeit slim, I know) chance of getting into on reapplying or starting as a PGY2 where there are unexpected open slots?

Please no roasting. I know the best thing I could have done was stayed in residency, but that didn't happen so here I am.

 

[ThoracicGuy]

Being a DO in FM (you didn't say if it was an AOA or ACGME program), would tend to not allow you to use any credits towards another program. You will need to be looking at PGY1 spots in whichever field you wish to try for.

Your chances in procedural fields is low.

 

[shaggybill]

Whoops, meant to include that. It was an ACGME program. Can you clarify why my PGY1 year might not be counted?

 

[GoSpursGo]

Whoops, meant to include that. It was an ACGME program. Can you clarify why my PGY1 year might not be counted?

Because each specialty is different and the experience in intern year generally does not overlap. A prospective program could examine your rotations and give you some subset of credit if some of your rotations were, say, analogous to an IM intern year and you're applying to IM specifically. But EM months won't overlap. L&D months won't overlap. Outpatient clinic months probably won't overlap. Etc. I think it's going to be extremely difficult to find a program where you'd be able to cobble together a full intern year's amount of credit. I'm not trying to be mean, but honestly I don't think trying to fill a PGY-2 spot is realistic.

PGY-1 positions will be difficult as well. If I'm doing the math right, your YOG was 2016, you have a COMLEX failure, and I think the fact that at some point you voluntarily resigned because you thought you didn't want to do medicine anymore is very problematic--you're going to have to convince a prospective program that you're for sure not going to do that again. Honestly, your best bet is probably hoping to find another FM PGY-2 spot. That may still be tough, but you stand a much better chance of getting credit for your prior time, and if you were a decent resident previously and can get good letters that may help. I know you didn't love it, but if you want to be board certified in something that's your best route.

Another important question, regardless of which direction you go--what have you been doing since you resigned?

 

[shaggybill]

Because each specialty is different and the experience in intern year generally does not overlap. A prospective program could examine your rotations and give you some subset of credit if some of your rotations were, say, analogous to an IM intern year and you're applying to IM specifically. But EM months won't overlap. L&D months won't overlap. Outpatient clinic months probably won't overlap. Etc. I think it's going to be extremely difficult to find a program where you'd be able to cobble together a full intern year's amount of credit. I'm not trying to be mean, but honestly I don't think trying to fill a PGY-2 spot is realistic.

PGY-1 positions will be difficult as well. If I'm doing the math right, your YOG was 2016, you have a COMLEX failure, and I think the fact that at some point you voluntarily resigned because you thought you didn't want to do medicine anymore is very problematic--you're going to have to convince a prospective program that you're for sure not going to do that again. Honestly, your best bet is probably hoping to find another FM PGY-2 spot. That may still be tough, but you stand a much better chance of getting credit for your prior time, and if you were a decent resident previously and can get good letters that may help. I know you didn't love it, but if you want to be board certified in something that's your best route.

Another important question, regardless of which direction you go--what have you been doing since you resigned?

Ok, thats the answer I was probably needing to hear. I have been involved in some work completely unrelated to medicine for the past 18 months. I've always had a huge interest in business and owning my own company one day. Probably the best thing for me to do is get my medical license and try to do some odd job (medicare assessments, etc) that I see pop up on Indeed/MDSearch until something a little more permanent comes along. I've seen some wound care positions that will train and don't require BC. I do like a good wound. Later on down the road I can look at medical business opportunities such as a med spa where I could do some non-invasive procedures that don't require extensive training.

 

[ThoracicGuy]

Ok, thats the answer I was probably needing to hear. I have been involved in some work completely unrelated to medicine for the past 18 months. I've always had a huge interest in business and owning my own company one day. Probably the best thing for me to do is get my medical license and try to do some odd job (medicare assessments, etc) that I see pop up on Indeed until something a little more permanent comes along. I've seen some wound care positions that will train and don't require BC. I do like a good wound. Later on down the road I can look at medical business opportunities such as a med spa where I could do some non-invasive procedures that don't require extensive training.

Just be aware that if you go that route you will likey shut the door on any chance of completing training. The further out you get, they harder it will be for you.

Would your program consider taking you back as a pgy2?

 

[Piebaldi]

I don't really want to get into the details, but in 2018 I resigned (voluntarily) from my FM residency after 21 months. I'll just say I picked a terrible specialty that left a terrible taste in my mouth for medicine in general. I did leave on good terms with my PD, and she filled my spot pretty quickly. Recently I've started having some regrets that I'm not using my degree (DO) and I really wish I would have picked something more focused and far less broad.

For the most part, I was a hard worker but bottom-halfer in medical school and probably even in residency. I failed COMLEX 1 the first time, did reasonable well on the retake and on subsequent board exams (level 2, PE, and level 3). I'm currently applying for my state medical license to work as a general practitioner, but I really hate not being board certified in anything. I can't imagine ever doing family medicine again. I'd really like to do something heavy in procedures since that's what I'm really good at, but given my history, I'm certain that my chances of successfully applying to and/or starting as a PGY2 at procedure-heavy specialties or something like diagnostic radiology is slim to none.

All that being said, what, if any, specialties out there would I have the best (albeit slim, I know) chance of getting into on reapplying or starting as a PGY2 where there are unexpected open slots?

Please no roasting. I know the best thing I could have done was stayed in residency, but that didn't happen so here I am.

Im sure you know it would have been best to finish residency particularly with less than 1,5 years remaining but alas that didn't happen so no point in discussing that.
It will be likely difficult to reapply as a PGY-2. Most likely you'll have to start over again.
Procedural fields are competitive since they make more $$$.
You can always do what some people do and set up cosmetic type shop/open some sort of medical type business if you have $$. No board certification truly needed since it's all cash based.

You can temporarily do things like medical exams for one of those companies that hire people with no BC also. Ive heard of some people doing wound care - but that's plus or minus and depends on the state and how desperate they are.

With a step failure, resignation from residency, it will be tough. Good luck

 

[shaggybill]

I'm admittedly a little conflicted about finishing FM residency, even at my old program. And I'm still debating in my head WHY I want to be board certified. What do I hope to get out of it? I have little to no desire to do much in the way of complex disease management. I'd prefer to procedures, but that's already been discussed and ruled out. I wouldn't mind doing very limited and less complex medicine like managing someone's BP or diabetes, health maintenance, wellness exams etc, but I have no desire to do all the other stuff that comes with being a family doc. One thing I hated about FM was you never know what's going to be waiting for you in the room. Is it one complaint or five, is it a psych patient with a 30 minute story, and in addition will you have to address the 8 health issues the EMR is flagging to avoid getting a nastygram from the chart nazis downstairs? No thank you.

I've thought about hanging a shingle and having a basic care clinic where I do things like wellness exams, health maintenance, and some VERY basic clinical things itemized so that people know what I do and don't provide. By myself, all cash, low overhead, and for a low price. Not sure if there is much demand for something like that, but I'm not looking to make a million from it either. I suppose thats not entirely different than the Minute Clinic at Target, but hey, I'm not opposed to owning something like that if there's demand. Coming up with the capital to start it would definitely be a challenge.

BC would definitely give me more job security and job options, make my feel like I've reached a goal, and admittedly satisfy my ego. But I think I could also be happy with a permanent job doing something like wound care that is super focused and where I get to see patients without being responsible for managing all their issues.

I'm not sure that I would be able to get my old PGY2 position back. While I left on good terms with my PD, and she just wrote me a letter of recommendation for my medical license, the conversations I had with her before leaving I'm pretty sure left her convinced that I hated everything about medicine and taking me back would be too big of a risk. That in combination with the fact that I was far from the strongest resident in my class might put the final nail in the coffin. My program was involved in a free clinic in town and I worked several shifts there with one my program's founders. I may get it touch with him about volunteering there under his supervision just so I do something good with my degree and training. Maybe he can give me some guidance about where to go next.

 

[ThoracicGuy]

The biggest benefit with board certification is insurance coverage. You may not be eligible to take certain insurances without it.

Also to be on medical staff usually requires it.

 

[NecFasc92]

I'm admittedly a little conflicted about finishing FM residency, even at my old program. And I'm still debating in my head WHY I want to be board certified. What do I hope to get out of it? I have little to no desire to do much in the way of complex disease management. I'd prefer to procedures, but that's already been discussed and ruled out. I wouldn't mind doing very limited and less complex medicine like managing someone's BP or diabetes, health maintenance, wellness exams etc, but I have no desire to do all the other stuff that comes with being a family doc. One thing I hated about FM was you never know what's going to be waiting for you in the room. Is it one complaint or five, is it a psych patient with a 30 minute story, and in addition will you have to address the 8 health issues the EMR is flagging to avoid getting a nastygram from the chart nazis downstairs? No thank you.

I've thought about hanging a shingle and having a basic care clinic where I do things like wellness exams, health maintenance, and some VERY basic clinical things itemized so that people know what I do and don't provide. By myself, all cash, low overhead, and for a low price. Not sure if there is much demand for something like that, but I'm not looking to make a million from it either. I suppose thats not entirely different than the Minute Clinic at Target, but hey, I'm not opposed to owning something like that if there's demand. Coming up with the capital to start it would definitely be a challenge.

BC would definitely give me more job security and job options, make my feel like I've reached a goal, and admittedly satisfy my ego. But I think I could also be happy with a permanent job doing something like wound care that is super focused and where I get to see patients without being responsible for managing all their issues.

I'm not sure that I would be able to get my old PGY2 position back. While I left on good terms with my PD, and she just wrote me a letter of recommendation for my medical license, the conversations I had with her before leaving I'm pretty sure left her convinced that I hated everything about medicine and taking me back would be too big of a risk. That in combination with the fact that I was far from the strongest resident in my class might put the final nail in the coffin. My program was involved in a free clinic in town and I worked several shifts there with one my program's founders. I may get it touch with him about volunteering there under his supervision just so I do something good with my degree and training. Maybe he can give me some guidance about where to go next.

Finish your residency
Do sports
Do procedures all day long
Profit

 

[evilbooyaa]

Finish your residency
Do sports
Do procedures all day long
Profit

Sports is a relatively competitive fellowship after FM. OP is not going to just walk into a sports fellowship with their history.

 

[NecFasc92]

Sports is a relatively competitive fellowship after FM. OP is not going to just walk into a sports fellowship with their history.

Very true. Was just trying to bring some hope! That is all 🙂

 

[Sushirolls]

Cash only OMM/OMT practice, is realistically your best and possibly your only option. Positively, could even be more lucrative then had you actually finished FM and done a routine job.

Or set up an on call business for smaller private practice FM/Psych offices when they need phone call coverage for vacation.

 

[aafisahar]

what school did you go to so I can learn how to turn gold into ****?

you had multiple red flags on your application, still matched, then walked away after getting more than halfway through?

no easy way about it, you need divine intervention to match again. you might be able to find a program needing a warm body to fill a pgy-1/pgy-2 spot but it's very unlikely you'll land a program better than the one you left. definitely would rule out any other specialty (eg IM, psych, etc) as you will look like toxic waste on paper.

otherwise, try to get a license and practice in a state that will let you.

 

[hallowmann]

Surprised no one mentioned Occ Med or Preventative Medicine training. Your intern year could count, and generally they're not super competitive. I would consider it if you could see yourself doing what they do.

A lot of what you already described is also possible. It sounds like you like some types of encounters, but just don't like the uncertainty and longterm care. Preventative, Occ, OMT, boutique, or even your own specialized "simple medical stuff" clinic could function that way. I think you need to better evaluate what you like in medicine outside of the suck of residency. I honestly think your best bet is to volunteer at that free clinic like you mentioned. You might be able to narrow stuff down and find what you like. Plus you'll keep your clinical skills sharp and you might make some connections with other docs volunteering there, who may know of jobs or different opportunities in the area.

 

[anonperson]

Ok, thats the answer I was probably needing to hear. I have been involved in some work completely unrelated to medicine for the past 18 months. I've always had a huge interest in business and owning my own company one day. Probably the best thing for me to do is get my medical license and try to do some odd job (medicare assessments, etc) that I see pop up on Indeed/MDSearch until something a little more permanent comes along. I've seen some wound care positions that will train and don't require BC. I do like a good wound. Later on down the road I can look at medical business opportunities such as a med spa where I could do some non-invasive procedures that don't require extensive training.

There was a poster who quit general surgery after some back injury and then became a wound doc. He seemed to indicate it was very lucrative. You could try searching for that.

 

[NotAProgDirector]

If you're interested in wound care, read this: Re: CA license, but no board cert. How to get life back on track with a baby?

 

[Splenda88]

Since you completed 21 months of residency, you can get a medical license and work for the feds (eg., Indian Health Services etc...)

My friend is doing that right now after completing a year internship and he is making a good living. M-F, 8am-5p, federal holidays off, 200k/yr with plenty benefits.

 

[Piebaldi]

I'm admittedly a little conflicted about finishing FM residency, even at my old program. And I'm still debating in my head WHY I want to be board certified. What do I hope to get out of it? I have little to no desire to do much in the way of complex disease management. I'd prefer to procedures, but that's already been discussed and ruled out. I wouldn't mind doing very limited and less complex medicine like managing someone's BP or diabetes, health maintenance, wellness exams etc, but I have no desire to do all the other stuff that comes with being a family doc. One thing I hated about FM was you never know what's going to be waiting for you in the room. Is it one complaint or five, is it a psych patient with a 30 minute story, and in addition will you have to address the 8 health issues the EMR is flagging to avoid getting a nastygram from the chart nazis downstairs? No thank you.

I've thought about hanging a shingle and having a basic care clinic where I do things like wellness exams, health maintenance, and some VERY basic clinical things itemized so that people know what I do and don't provide. By myself, all cash, low overhead, and for a low price. Not sure if there is much demand for something like that, but I'm not looking to make a million from it either. I suppose thats not entirely different than the Minute Clinic at Target, but hey, I'm not opposed to owning something like that if there's demand. Coming up with the capital to start it would definitely be a challenge.

BC would definitely give me more job security and job options, make my feel like I've reached a goal, and admittedly satisfy my ego. But I think I could also be happy with a permanent job doing something like wound care that is super focused and where I get to see patients without being responsible for managing all their issues.

I'm not sure that I would be able to get my old PGY2 position back. While I left on good terms with my PD, and she just wrote me a letter of recommendation for my medical license, the conversations I had with her before leaving I'm pretty sure left her convinced that I hated everything about medicine and taking me back would be too big of a risk. That in combination with the fact that I was far from the strongest resident in my class might put the final nail in the coffin. My program was involved in a free clinic in town and I worked several shifts there with one my program's founders. I may get it touch with him about volunteering there under his supervision just so I do something good with my degree and training. Maybe he can give me some guidance about where to go next.

Well BC is needed for many jobs/insurance. Setting up shop is something that you can do, but given the large number of physicians who have finished residency and are BC, it might be difficult for you to set up shop without having either. AGain owning medical type stuff - urgent cares, PT practices, cosmetic type stuff is certainly a possibility but all requires $$$.

If I were you, I'd try to get my old spot back - even if you don't like it, it's only 1.5years and opens up a lot of opportunities - even if you end up doing something limited on your own, working for insurance companies, etc. I think this is a. good example of also always thinking things through all the way before making a decision - most of us have at one point or another thought about quitting residency as it sucks at various points - but without residency unfortunatley the degree is useless.

 

[Piebaldi]

Finish your residency
Do sports
Do procedures all day long
Profit

Sports is not that profitable - most sports doc work under orthos, rarely become partners, and end up doing peripheral injections which don't pay that much sadly. sports is not hwere the money is. not to mention they have to cover all sorts of games. and US reimbursement is in the toilet.

 

[AdmiralChz]

Didn’t you just post in the anesthesia sub-forum asking if you’d be competitive for that (the answer was a resounding no)?

The answer hasn’t changed really for any field. You’ve got some huge red flags - COMLEX failure, quitting a residency, and doing no clinical work for 18 months. Competitive specialties are out the window for you (as most will require USMLE anyways, like Anesthesia). Anything but FM or maybe rural IM. Preventative medicine is a good out-of-the-box idea, but you won’t be getting the “procedures” you’d like to do. I am not sure how you’d get them being a GP either...

If you are really dead-set on this, I guess you could consider applying for a surgical prelim at a non competitive place that rarely fills. This may possibly turn into a dead-end for you and would be one tough year full scut and busy work, but could conceivably get one foot inside the door for you.

For others reading this, the story here is unfortunately a case study of why to be very careful prior to leaving a training program voluntarily. The odds are against this poster making it successfully back into clinical medicine (outside of FM especially which you hated).

 

[intern_for_life]

Didn’t you just post in the anesthesia sub-forum asking if you’d be competitive for that (the answer was a resounding no)?

The answer hasn’t changed really for any field. You’ve got some huge red flags - COMLEX failure, quitting a residency, and doing no clinical work for 18 months. Competitive specialties are out the window for you (as most will require USMLE anyways, like Anesthesia). Anything but FM or maybe rural IM. Preventative medicine is a good out-of-the-box idea, but you won’t be getting the “procedures” you’d like to do. I am not sure how you’d get them being a GP either...

If you are really dead-set on this, I guess you could consider applying for a surgical prelim at a non competitive place that rarely fills. This may possibly turn into a dead-end for you and would be one tough year full scut and busy work, but could conceivably get one foot inside the door for you.

For others reading this, the story here is unfortunately a case study of why to be very careful prior to leaving a training program voluntarily. The odds are against this poster making it successfully back into clinical medicine (outside of FM especially which you hated).

This is an old thread I know, but what do you mean "outside of FM". He could still apply and get into FM again after those red flags?

 

[shaggybill]

Just an update from me, the OP. I obtained my medical license from a neighboring east coast state and am working at concierge clinic. While the job itself is pretty cush and I make good money for non-BC doc, the clinic does have its problems that make me question its longevity. I'm hoping to transition into a job that involves more primary care (community health clinic or something similar) and plan to apply to some less competitive east coast IM programs with what sounds like some strong letters from my former PD and residency faculty. A lot has transpired in the past year. I met with my program director and she was convinced I was experiencing severe burnout during residency. What she said not only made a lot of sense, but it resonated in a way I never expected. Additionally, I underwent a workup for my extreme fatigue and other issues that have been ongoing for 5 years which revealed an endocrine disorder that has been addressed and I feel like a completely new person these days. I don't have a lot of expectations about what happens next, but if I don't try I'll always wish I did. Thanks again to everyone who offered solid and realistic advice.

 

[ThoracicGuy]

Just an update from me, the OP. I obtained my medical license from a neighboring east coast state and am working at concierge clinic. While the job itself is pretty cush and I make good money for non-BC doc, the clinic does have its problems that make me question its longevity. I'm hoping to transition into a job that involves more primary care (community health clinic or something similar) and plan to apply to some less competitive east coast IM programs with what sounds like some strong letters from my former PD and residency faculty. A lot has transpired in the past year. I met with my program director and she was convinced I was experiencing severe burnout during residency. What she said not only made a lot of sense, but it resonated in a way I never expected. Additionally, I underwent a workup for my extreme fatigue and other issues that have been ongoing for 5 years which revealed an endocrine disorder that has been addressed and I feel like a completely new person these days. I don't have a lot of expectations about what happens next, but if I don't try I'll always wish I did. Thanks again to everyone who offered solid and realistic advice.

Always good to see the OP circle back with an update. Good luck with the future.

 

[GoSpursGo]

Just an update from me, the OP. I obtained my medical license from a neighboring east coast state and am working at concierge clinic. While the job itself is pretty cush and I make good money for non-BC doc, the clinic does have its problems that make me question its longevity. I'm hoping to transition into a job that involves more primary care (community health clinic or something similar) and plan to apply to some less competitive east coast IM programs with what sounds like some strong letters from my former PD and residency faculty. A lot has transpired in the past year. I met with my program director and she was convinced I was experiencing severe burnout during residency. What she said not only made a lot of sense, but it resonated in a way I never expected. Additionally, I underwent a workup for my extreme fatigue and other issues that have been ongoing for 5 years which revealed an endocrine disorder that has been addressed and I feel like a completely new person these days. I don't have a lot of expectations about what happens next, but if I don't try I'll always wish I did. Thanks again to everyone who offered solid and realistic advice.

Agree with above--thank you for taking the time to give an update, and I'm glad to hear things are moving in a positive direction!