Resigned IM residency due to health issues; chances?

Started by LeaveNoTrace
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LeaveNoTrace

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I had to resign from an internal medicine residency due to health issues that have since resolved. Stats:

Medical school class rank: bottom quartile; no failures
Step 1: pass
Step 2: 230
Step 3: not taken yet

Applied psychiatry in 2024; 15 interviews, no match. Applied 2025; 4 interviews, no match. Have worked on interviewing skills and will discuss it with a fourth-year psych resident I am friends with.

How do things look on paper? What are my chances like of returning to psychiatry residency? Any residency at all? What careers might be plausible if I cannot return to residency?
 
I’m going to be blunt. This doesn’t look good for obtaining a psychiatry residency. Could you return to your IM residency program? How far did you get? I would apply broadly across multiple fields. Completing a residency is very important to making this journey worth it. Bare minimum to me would be completing a year to obtain a license in many states. Some states have options for work with a completed year. Some preventative medicine programs accept those with a completed year of IM.
 
TexasPhysician said:
I’m going to be blunt. This doesn’t look good for obtaining a psychiatry residency. Could you return to your IM residency program? How far did you get? I would apply broadly across multiple fields. Completing a residency is very important to making this journey worth it. Bare minimum to me would be completing a year to obtain a license in many states. Some states have options for work with a completed year. Some preventative medicine programs accept those with a completed year of IM.
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Fair. Returning to my IM residency program is not an option; I lasted about six months. How does it look for obtaining any residency at all?
 
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remember, in general, the further out you are from med school the less competitive you become. So your chances of matching into a psych residency having not matched twice before, and having resigned IM residency for barely 6 months, is very grim. If you want to get back into some other residency, at least pass step 3 and you will need a good LoR from your prior residency director.

You could become a psych NP. some people who aren't successful the physician route do that.
 
splik said:
remember, in general, the further out you are from med school the less competitive you become. So your chances of matching into a psych residency having not matched twice before, and having resigned IM residency for barely 6 months, is very grim. If you want to get back into some other residency, at least pass step 3 and you will need a good LoR from your prior residency director.

You could become a psych NP. some people who aren't successful the physician route do that.
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would they be able to take Step 3 if no longer in residency and not having completed the full PGY1 year ?
 
splik said:
remember, in general, the further out you are from med school the less competitive you become. So your chances of matching into a psych residency having not matched twice before, and having resigned IM residency for barely 6 months, is very grim. If you want to get back into some other residency, at least pass step 3 and you will need a good LoR from your prior residency director.

You could become a psych NP. some people who aren't successful the physician route do that.
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Do you think that it is realistic to attempt to get into any residency at all?
 
I think it is potentially realistic, but you need to drop psych and likely IM. Statistically family is the least competitive. You should apply to that and you should apply to a very large number of (relatively) very low competition programs. If you have an extremely clear geographic tie to an area you could apply to slightly more competitive programs there, but beyond that (and it should be way beyond) it should be programs that lean towards rural, new and non-academic. The slight trick is that some of these programs prefer IMGs or other specific applicant types and that may not be you. What have you been doing with all this free time since you haven't been in residency? Hopefully it is at least something you can talk about. At this point, interview style is a little less important. You are mostly playing a numbers game and just trying to get through electronic filtration, although a horrible interview would still tank you. It is going to get exponentially harder each year, but I still think it might be possible. That said, I don't think a "health issue" is really going to cut it to explain things. Have some amazing explanation for what exactly happened and why the heck it for sure will never, ever happen again. Programs bend over backwards to accommodate the medical needs of a resident, often beyond all reason. They are legally required to. In this case, from an outside observer, it looks like maybe they wanted you gone. Will the old program director write a letter of support for you? If not, why not?

You can take Step 3 without residency through some state medical boards. I don't know how much that will help. That isn't why you left the IM residency. NP is silly. That is a totally different training route and philosophy that would add many years, lots of debt and little income. It has no relationship to your MD training. You would literally need to redo some undergrad just to start. It's not a backup to residency. One of those associate physician (words in that order) things might be possible in certain states.
 
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The old program director and my academic advisor will write neutral letters for me.
I had been receiving treatment for my health issues; they have resolved themselves. PM me for more details.
Thanks for everything.
 
LeaveNoTrace said:
Do you think that it is realistic to attempt to get into any residency at all?
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This is a psychiatry forum so we are not best placed to comment on your ability to match into non-psych residencies. However you're not being honest with us (and perhaps yourself) if you say that you resigned simply due to health reasons. No one is going to believe that, especially with the bad references (a neutral LoR is basically a negative LoR). Very few people are going to be willing to take a chance on someone who flunked out of residency so early on and who cannot provide a single supportive LoR from that time unfortunately.

If residency is an option I'd be thinking about non-competitive FM or preventive medicine spots, or else doing a medical or surgical prelim year so you can at least get a license. If you're not able to get further training, some people set up psych PP (I don't recommend it but people do it) or functional medicine practices.

very occasionally, some unfilled CAP fellows will accept people without any postgraduate medical training, and then you'd have to do psychiatry residency afterwards. But these are few and far between.
 
splik said:
very occasionally, some unfilled CAP fellows will accept people without any postgraduate medical training, and then you'd have to do psychiatry residency afterwards. But these are few and far between.
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I have heard of both CAP and addictions fellowships that have done this, but mainly for foreign grads trying to come to the US who weren’t able to get into residency through the match originally. These were solid candidates otherwise and idk any fellowships that have taken individuals who were just poor applicants or who already matched and had to drop out, though I suppose it could be possible.
 
Stagg737 said:
I have heard of both CAP and addictions fellowships that have done this, but mainly for foreign grads trying to come to the US who weren’t able to get into residency through the match originally. These were solid candidates otherwise and idk any fellowships that have taken individuals who were just poor applicants or who already matched and had to drop out, though I suppose it could be possible.
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Yeah the N=2.5 of people I know who did this - 2 did addiction fellowships first but were IMGs who graduated at the top of their class had 250+ step scores and multiple legit research publications in addiction psychiatry. Their main barrier to getting a residency first was visa issues. The 0.5 doesn’t necessarily count as he went the PPPP pathway so had already completed a peds residency but had been out of practice for 10 years due to substance use issues so managed to overcome tremendous red flags.
 
That seems...very odd that someone would do an end run on lack of residency training by doing a fellowship. Just odd. Not as odd as becoming a NP, but odd.
 
comp1 said:
That seems...very odd that someone would do an end run on lack of residency training by doing a fellowship. Just odd. Not as odd as becoming a NP, but odd.
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I think the weirdest part about it is just that fellowships will accept candidates who have not completed or are actively in residency. Those completing fellowship before residency actually aren’t eligible to sit for their fellowship boards until after they finish residency. So it really is a back door to get into residency.
 
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Stagg737 said:
I think the weirdest part about it is just that fellowships will accept candidates who have not completed or are actively in residency. Those completing fellowship before residency actually aren’t eligible to sit for their fellowship boards until after they finish residency. So it really is a back door to get into residency.
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100%. I had a med school classmate who for some reason couldn’t match cards but got accepted into an advanced HF fellowship that didn’t fill. After that fellowship he somehow managed not to match general cards again, so is working as a hospitalist. So, basically took a year long massive pay cut for nothing.
 
It sounds absurd that I could get into an unfilled child and adolescent fellowship without a residency, do that, then get into a psychiatry residency.
 
Stagg737 said:
I have heard of both CAP and addictions fellowships that have done this, but mainly for foreign grads trying to come to the US who weren’t able to get into residency through the match originally. These were solid candidates otherwise and idk any fellowships that have taken individuals who were just poor applicants or who already matched and had to drop out, though I suppose it could be possible.
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Were these already attending physicians in their own country?
 
The more I think about it, the associate physician thing might be the route to go. I don't know how these work in practice and I see they are mostly for IMGs, but if you could actually hold down a job doing this, it would seem to be helpful for a residency application somewhere and help negate the IM residency experience to some extent. I mean certainly apply to family medicine residencies, still. https://www.fsmb.org/siteassets/adv...cian-legislation-by-state-key-issue-chart.pdf
 
LeaveNoTrace said:
Fair. Returning to my IM residency program is not an option; I lasted about six months. How does it look for obtaining any residency at all?
Click to expand...

Tough, but I would try. I’d apply to every FM, prelim, psych, etc program that isn’t well-regarded. I’d hope to land anywhere, regardless of reputation. Future income ability greatly improves with residency, so I’d try.
 
comp1 said:
NP is silly. That is a totally different training route and philosophy that would add many years, lots of debt and little income. It has no relationship to your MD training. You would literally need to redo some undergrad just to start. It's not a backup to residency.
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It sounds crazy, but I know of someone who did this, although she was an RN before ever going to medical school so presumably she didn't need to redo some undergrad. It was someone who was in my residency program for a time. She had previously started a residency in another field, but quit (allegedly because she didn't like that field, though I'm sure that's not the full story.) She then started our psych residency, but went out on leave supposedly for health reasons (echoes of the OP) and never came back. None of us knew what had happened, but years later, I remembered her, got curious about what happened to her, Googled her name, and... she's now a psych NP.
 
You don't need to redo undergrad to become an NP, even without an RN background. There are combined post-bacc/NP programs that'll get you to a full PMHNP degree in 3 years without any previous nursing background.

I knew a guy who did med school in the Caribbean and didn't match residency. He started a post-bacc/NP program while applying to residency again. He ended up matching residency so dropped out of the program after match day.
 
So the OP wouldn't need to repeat ALL of undergrad to become a PMHNP, but they most likely would need to do some undergrad as they have weird pre-reqs. So I'm looking here at direct entry Master's programs:

Direct-Entry Master’s in Nursing (MSN) Programs

Learn about direct-entry nursing programs for students who want to become an RN or APRN without a nursing degree.
nursinglicensemap.com nursinglicensemap.com

I'm just not seeing 3 years to PMHNP here. It does look like you could maybe get to be a RN in as little as 15 months (with pre-reqs in place), but after that things start getting a lot longer to get to the PMHNP from there. A lot of those programs have clinical work experience requirements before the PMHNP. I'm think it's a bit closer to 5 years to go from non-nursing BS to PMHNP. All of these are highly state dependent too, almost as much as the associate physician stuff.
 
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comp1 said:
So the OP wouldn't need to repeat ALL of undergrad to become a PMHNP, but they most likely would need to do some undergrad as they have weird pre-reqs. So I'm looking here at direct entry Master's programs:

Direct-Entry Master’s in Nursing (MSN) Programs

Learn about direct-entry nursing programs for students who want to become an RN or APRN without a nursing degree.
nursinglicensemap.com nursinglicensemap.com

I'm just not seeing 3 years to PMHNP here. It does look like you could maybe get to be a RN in as little as 15 months (with pre-reqs in place), but after that things start getting a lot longer to get to the PMHNP from there. A lot of those programs have clinical work experience requirements before the PMHNP. I'm think it's a bit closer to 5 years to go from non-nursing BS to PMHNP. All of these are highly state dependent too, almost as much as the associate physician stuff.
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There are numerous 1 year BSN programs for people who already have bachelor’s degrees - here’s one:

Accelerated Bachelor of Science in Nursing.

And all you have to do is Google PMHNP programs that don’t require clinical experience and you’ll find plenty. I personally know 2 people who did this and completed their BSN and “advanced” nursing degree in 3 years.
 
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A friend of mine developed MS while a 1st year IM resident and they allowed him to do a modified program over 4-5 years total. Would this be possible?
 
milesed said:
A friend of mine developed MS while a 1st year IM resident and they allowed him to do a modified program over 4-5 years total. Would this be possible?
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Well, that's the specific issue. Generally programs will move mountains to avoid terminating a resident as it harms everyone. That didn't happen here.
 
Were the two psych applications after you quit the IM residency? Or did you apply two cycles of psych, didn’t match psych, and then soaped/scrambled into IM?
 
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You’re right, 15 interviews after quitting a residency wouldn’t make sense.

I’m just a lowly nontrad med student but have many friends who are PDs who give me the tea. My honest guess (based on previous conversations with these folks) is that at first glance many will see you applied psych twice, soaped into IM, and then assume you quit IM as a temper tantrum because you didn’t get the specialty you wanted. Most people just usually take a medical LOA instead of dropping out entirely.
 
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LeaveNoTrace said:
It sounds absurd that I could get into an unfilled child and adolescent fellowship without a residency, do that, then get into a psychiatry residency.
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Wait what...how? I thought you need to do a residency before getting any fellowship spot, filled or not
 
LeaveNoTrace said:
I had to resign from an internal medicine residency due to health issues that have since resolved. Stats:

Medical school class rank: bottom quartile; no failures
Step 1: pass
Step 2: 230
Step 3: not taken yet

Applied psychiatry in 2024; 15 interviews, no match. Applied 2025; 4 interviews, no match. Have worked on interviewing skills and will discuss it with a fourth-year psych resident I am friends with.

How do things look on paper? What are my chances like of returning to psychiatry residency? Any residency at all? What careers might be plausible if I cannot return to residency?
Click to expand...
Why not try for FM? FM has a lot of psych in it and you could probably even specialize.
 
Taddy Mason said:
You have to be enrolled in a residency program or have completed one year of residency to take step 3.
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I just looked it up and that's not true. Lots of IMGs take STEP3 after graduating to show programs that they can handle the curriculum/residency. It is just recommended that you take it during residency b/c most programs will pay for you to take it, so you can save money.

If you want me to post sources, I can.
 
Starr_key said:
I just looked it up and that's not true. Lots of IMGs take STEP3 after graduating to show programs that they can handle the curriculum/residency. It is just recommended that you take it during residency b/c most programs will pay for you to take it, so you can save money.

If you want me to post sources, I can.
Click to expand...

Yeah step 3 can be taken any time after you graduate medical school.
 
Starr_key said:
I just looked it up and that's not true. Lots of IMGs take STEP3 after graduating to show programs that they can handle the curriculum/residency. It is just recommended that you take it during residency b/c most programs will pay for you to take it, so you can save money.

If you want me to post sources, I can.
Click to expand...
I mean that's neat that they can do that. Are you sure about Americans who didn't complete PGY-1 and don't have a program's backing, which the OP seems to be?

I specifically recall needing my residency to sign off on a form before I could schedule Step 3. I'm glad that IMGs can get around it, I just recall needing it to get step 3 scheduled. They wouldn't fill the form out until July 1, which meant I had to hustle in order to get it in and schedule Step 3 for October of PGY-1 (got a week of light schedule for exam prep at the end of IM, took the test the first day and relaxed the rest of the week).

This was important because I started residency in 2019, so several of my peers who didn't get the ball rolling after starting residency ended up not being able to take Step 3 before the end of first year due to covid shutting down the testing locations and they continued to avoid scheduling Step 3 in PGY-2 on time either. The program gave them all extensions (6 months!) but ultimately four of eight of us took it too late (the one FMG had passed Step 3 before applying, the other three of us followed instructions). They got letters saying their contract wouldn't be renewed unless they passed by the fourth final extension date.
One passed and decided she was offended too much to continue to PGY-3 if a program was going to enforce its own policies and dropped out to go ruin some other program.
One failed and dropped out and has done nothing related to medicine or obtaining a license to this day.
One passed but then dropped out mid-way through PGY-3.
The fourth one passed and continued through the program.

This meant there was a gap in our year. A resident who had previously left the program after multiple step 3 failures was allowed to take her PGY-3 year with us. She had gone to a child fellowship for two years after having only done PGY-1 and 2 of psychiatry, then came back and graduated after PGY-3 with us, making hers a 2+2+1 = 5 instead of 3+2 = 5-year training for C&A.
 
ObsequiousAplomb said:
I mean that's neat that they can do that. Are you sure about Americans who didn't complete PGY-1 and don't have a program's backing, which the OP seems to be?

I specifically recall needing my residency to sign off on a form before I could schedule Step 3. I'm glad that IMGs can get around it, I just recall needing it to get step 3 scheduled. They wouldn't fill the form out until July 1.
Click to expand...
This was my experience as well and my understanding regarding American med school grads, hence my previous posts.
 
ObsequiousAplomb said:
I mean that's neat that they can do that. Are you sure about Americans who didn't complete PGY-1 and don't have a program's backing, which the OP seems to be?

I specifically recall needing my residency to sign off on a form before I could schedule Step 3. I'm glad that IMGs can get around it, I just recall needing it to get step 3 scheduled. They wouldn't fill the form out until July 1, which meant I had to hustle in order to get it in and schedule Step 3 for October of PGY-1 (got a week of light schedule for exam prep at the end of IM, took the test the first day and relaxed the rest of the week).

This was important because I started residency in 2019, so several of my peers who didn't get the ball rolling after starting residency ended up not being able to take Step 3 before the end of first year due to covid shutting down the testing locations and they continued to avoid scheduling Step 3 in PGY-2 on time either. The program gave them all extensions (6 months!) but ultimately four of eight of us took it too late (the one FMG had passed Step 3 before applying, the other three of us followed instructions). They got letters saying their contract wouldn't be renewed unless they passed by the fourth final extension date.
One passed and decided she was offended too much to continue to PGY-3 if a program was going to enforce its own policies and dropped out to go ruin some other program.
One failed and dropped out and has done nothing related to medicine or obtaining a license to this day.
One passed but then dropped out mid-way through PGY-3.
The fourth one passed and continued through the program.

This meant there was a gap in our year. A resident who had previously left the program after multiple step 3 failures was allowed to take her PGY-3 year with us. She had gone to a child fellowship for two years after having only done PGY-1 and 2 of psychiatry, then came back and graduated after PGY-3 with us, making hers a 2+2+1 = 5 instead of 3+2 = 5-year training for C&A.
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Interesting! Yea it makes sense since for STEP1 schools have to verify you, but I know one US grad who somehow took it before starting residency. I have no idea how he did it tbh with you but my *guess* is that your school just has to verify that you do have your degree. I think they did that for him.
 
Starr_key said:
Interesting! Yea it makes sense since for STEP1 schools have to verify you, but I know one US grad who somehow took it before starting residency. I have no idea how he did it tbh with you but my *guess* is that your school just has to verify that you do have your degree. I think they did that for him.
Click to expand...
His/her residency likely verified her/him. I’m aware of programs doing that for PGY-1s before they start.
 
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