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Rma294

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Hello all,

I am an IM resident and I was informed by my PD that I have to restart residency as an intern and complete 3 years because of a gap in training. I had 2 medical leaves one at the end of my intern year from mid June to beginning of August. I returned in August. The I had my second leave at the end of my second year for 4 months and returned. I am at a loss at how this is legal/fair. Of note this is a new PD, the previous one left in April and I believe if he were still here that I would not be in this situation. I've contacted ACGME and awaiting a reply. I really don't know what to do. Any advice/help is strongly needed/appreciated.

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Your PD decides whether you get credit for your incompletely completed intern year. They feel you didn't do enough to get credit for it. No one can realistically over-rule them (the GME administration at your institution might theoretically be able to do so - but they almost certainly won't).
 
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Are your scores great and evals flawless? Any personality conflicts with staff?

My guess is there is slightly more to it than just some LOAs
 
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I would say the program has been *extremely* accommodating so far. There are programs that would have looked to figure out a way to force a resignation or terminate (yes, before anyone says what a hassle it is to do so).

I can't recall exactly but in some scenarios where you don't defer starting at the start, having a resident come back as PGY1 isn't straightforward either.

You missed what, 4 months out of 11????? And 1.5 mos intern year?

As far as not having to make up the months you did complete, you do realize that even if you passed them, there are 2 issues: one is that you have to be competent in those "competencies" by end of year, and it's hard to say so when you've only got 7/11 rotations under your belt. No, you probably haven't done enough of the year to say you've grown enough to be PGY3.

As far as why you can't just shoe in as PGY2 all over again, that may not be possible with the schedule. It may not be considered reasonable accomodation to do so, in which case you definitely are not entitled to do so under ADA, even assuming that applies to you.

As far as getting credit for those months, it might not be feasible with the overall schedule to waive you doing them over.

Not to mention, if you only have 7/11 months with a 4 month gap, the argument can easily be that you need to have a more consistent run of practice to have developed the skills to go on to PGY3.

This is not illegal. If anything, they have made exceptions for you and gone to a lot of trouble.

If I were you, I would take a fruit basket for the GME office and get down on my knees to kiss my PD's feet.

You should be unbelievably grateful your career is not ENDED over this, let alone thinking you've been wronged in any way.

Actually, starting with a bit of a clean slate (in that you get to start from the beginning) with a few months under your belt, you should be grateful because you are poised for success as you go forward.
 
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It's unlikely this represents discrimination. It's unlikely that this doesn't count as reasonable accommodation (I think it's above and beyond, personally). It's unlikely this punitive because of your medical situation. Not to mention you would have to prove one of the above, and unlikely to have anything good whatsoever come out of trying.

Be grateful you get to continue at this program.

Lastly, I may be wrong, but I think the ABIM likely has rules about how much time off you can have in a year and still have it count towards requirements for certification.

I don't know, but I wouldn't be surprised if ACGME had similar rules.

Sorry, I'm just seeing red that you think the program is boning you when likely they have done all they can to salvage your completion of your residency.

Not to mention, while you seem upset at making up some months, how do you think your fellow residents felt picking up the slack for you? This is a team sport. Be glad you have the chance to learn more and carry your load the next PGY1. Not to mention paying your dues again is likely the only way to ease any resentment I'm sure is there.

Start your intern year again with a smile. Work extra hard for having the chance. Do all you can to be a leader and example for the poor clueless bastards starting with you. Do more to make the seniors' lives easier. Don't cop any attitude whatsoever if you happen to have a bit more experience than some of the others.

I'm trying to help you get your head on straight so you can make the most of a fresh start and not look a gift horse in the mouth.
 
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Unless there are positions funded outside what the program is allotted by the system, then likely the program is losing money and basically paying out of their pocket to keep you for extra time to see you trained up.
 
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Ok, I misread. I see that you are PGY2 and this is happening. Most of what I said still applies.

Training is cumulative and you only get to miss so much/make up so many months before it's an issue that the residency can't control for.
 
Hello all,

I am an IM resident and I was informed by my PD that I have to restart residency as an intern and complete 3 years because of a gap in training. I had 2 medical leaves one at the end of my intern year from mid June to beginning of August. I returned in August. The I had my second leave at the end of my second year for 4 months and returned. I am at a loss at how this is legal/fair. Of note this is a new PD, the previous one left in April and I believe if he were still here that I would not be in this situation. I've contacted ACGME and awaiting a reply. I really don't know what to do. Any advice/help is strongly needed/appreciated.
It's certainly legal, and unfortunately it doesn't really matter if it's "fair" or not.

I'm sorry you're going through this, but I don't really think you have a case here. You need to learn a lot in residency, and there's just no way to learn it all while having a cumulative 6 month gap in your training. If the current PD thinks that your abilities are more on par with an intern due to your gaps, then I don't see how you're going to be able to fight this.

Frankly, it sounds like you're on thin ice. I would probably roll with it, keep your head down and finish residency as soon as you can. If you really try to fight this, they may decide you shouldn't get a second chance at all and just not renew your next contract. It's certainly "unfair," but the reality is the program holds all the cards in these kinds of scenarios.
 
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I understand in terms of finances, being geographically restrained, having more years of your life spent in the life suck of residency, this sucks super bad for you.

Put it in the perspective of what not completing a residency would be like. At this point with the fact you had leave during your PGY1, I don't even know if your program would certify its completion making you licensable. If you are IMG I think you might need more time than that for a license.

I highly suspect this has nothing to do with the PD having other options to help you. Maybe realizing that will help you accept the trap you're in is not something they can avoid, and make the best of it.
 
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It's certainly legal, and unfortunately it doesn't really matter if it's "fair" or not.

I'm sorry you're going through this, but I don't really think you have a case here. You need to learn a lot in residency, and there's just no way to learn it all while having a cumulative 6 month gap in your training. If the current PD thinks that your abilities are more on par with an intern due to your gaps, then I don't see how you're going to be able to fight this.

Frankly, it sounds like you're on thin ice. I would probably roll with it, keep your head down and finish residency as soon as you can. If you really try to fight this, they may decide you shouldn't get a second chance at all and just not renew your next contract. It's certainly "unfair," but the reality is the program holds all the cards in these kinds of scenarios.
I'm wondering if this is really unfair at all. Do you really think so? Just honestly wondering. I respect your opinion.
 
I'm wondering if this is really unfair at all. Do you really think so? Just honestly wondering. I respect your opinion.
Hard to know if it's unfair from the program perspective without more information, which I would not expect the OP to divulge. I don't think it would be fair to expect to come back as a PGY-3, but it seems a bit harsh to not let them come back as a PGY-2--this means they're essentially only getting 2 months of credit for 18 months of training. Of course, if there are performance issues on top then that's a separate issue.

What is certainly unfair is getting sick enough (for any reason) to need to take 6 months leave in the middle of training. One of our co-fellows was diagnosed with cancer, needed to take medical leave, and didn't graduate on time through no fault of their own. So I can empathize, at a minimum, from that perspective.
 
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Don’t get me wrong. I am very grateful and appreciative to the program and I made that clear to them. Also I am a very humble person. I never throw an attitude at work and always work professionally. I don’t have any personality conflicts with anyone. I’m well liked. I have completed all my step exams and I have never had any issues. No conflicts with anyone. I am a very humble person.

I am in no way saying I should return as a PGY3 but I do not think it’s fair to repeat intern year when I did my time.






QUOTE="Crayola227, post: 20316556, member: 576613"]I would say the program has been *extremely* accommodating so far. There are programs that would have looked to figure out a way to force a resignation or terminate (yes, before anyone says what a hassle it is to do so).

I can't recall exactly but in some scenarios where you don't defer starting at the start, having a resident come back from PGY1 and as PGY1 isn't straightforward either.

You missed what, 5 months out of 11?????

Do you really think you're ready to supervise interns and run a service now? Honestly?

As far as not having to make up the months you did complete, you do realize that even if you passed them, there are 2 issues: one is that you have to be competent in those "competencies" by end of year, and it's hard to say so when you've only got 7/11 rotations under your belt. No, you probably haven't done enough of the year to say you've grown enough.

As far as getting credit for those months, it might not be feasible with the overall schedule to waive you doing them over. Also, doing a month of wards as an intern should not be considered equivalent to doing it as a PGY2 or 3. Where you see credit given it's usually going a transfer going PGY of the same level to somewhere else, should that program see them as equivalent (and they don't have to and don't always see it that way).

Not to mention, if you only have 7/11 months all broken up, the argument can easily be that you need to have a more consistent run of practice to have developed the skills to go on to PGY2.

This is not illegal. If anything, they have made exceptions for you and gone to a lot of trouble.

If I were you, I would take a fruit basket for the GME office and get down on my knees to kiss my PD's feet.

You should be unbelievably grateful your career is not ENDED over this, let alone thinking you've been wronged in any way.

Actually, starting with a bit of a clean slate (in that you get to start from the beginning) with a few months under your belt, you should be grateful because you are poised for success in completing your intern year and residency, strong.[/QUOTE]
Hard to know if it's unfair from the program perspective without more information, which I would not expect the OP to divulge. I don't think it would be fair to expect to come back as a PGY-3, but it seems a bit harsh to not let them come back as a PGY-2--this means they're essentially only getting 2 months of credit for 18 months of training. Of course, if there are performance issues on top then that's a separate issue.

What is certainly unfair is getting sick enough (for any reason) to need to take 6 months leave in the middle of training. One of our co-fellows was diagnosed with cancer, needed to take medical leave, and didn't graduate on time through no fault of their own. So I can empathize, at a minimum, from that perspective.
 
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Don’t get me wrong. I am very grateful and appreciative to the program and I made that clear to them. Also I am a very humble person. I never throw an attitude at work and always work professionally. I don’t have any personality conflicts with anyone. I’m well liked. I have completed all my step exams and I have never had any issues. No conflicts with anyone. I am a very humble person.

I am in no way saying I should return as a PGY3 but I do not think it’s fair to repeat intern year when I did my time.






QUOTE="Crayola227, post: 20316556, member: 576613"]I would say the program has been *extremely* accommodating so far. There are programs that would have looked to figure out a way to force a resignation or terminate (yes, before anyone says what a hassle it is to do so).

I can't recall exactly but in some scenarios where you don't defer starting at the start, having a resident come back from PGY1 and as PGY1 isn't straightforward either.

You missed what, 5 months out of 11?????

Do you really think you're ready to supervise interns and run a service now? Honestly?

As far as not having to make up the months you did complete, you do realize that even if you passed them, there are 2 issues: one is that you have to be competent in those "competencies" by end of year, and it's hard to say so when you've only got 7/11 rotations under your belt. No, you probably haven't done enough of the year to say you've grown enough.

As far as getting credit for those months, it might not be feasible with the overall schedule to waive you doing them over. Also, doing a month of wards as an intern should not be considered equivalent to doing it as a PGY2 or 3. Where you see credit given it's usually going a transfer going PGY of the same level to somewhere else, should that program see them as equivalent (and they don't have to and don't always see it that way).

Not to mention, if you only have 7/11 months all broken up, the argument can easily be that you need to have a more consistent run of practice to have developed the skills to go on to PGY2.

This is not illegal. If anything, they have made exceptions for you and gone to a lot of trouble.

If I were you, I would take a fruit basket for the GME office and get down on my knees to kiss my PD's feet.

You should be unbelievably grateful your career is not ENDED over this, let alone thinking you've been wronged in any way.

Actually, starting with a bit of a clean slate (in that you get to start from the beginning) with a few months under your belt, you should be grateful because you are poised for success in completing your intern year and residency, strong.
[/QUOTE]

Glad to hear it. Sorry to come off harsh. Just wanted to help you see that there is a glass half full view despite the hardship, getting a second chance doesn't happen every day. I expect they are doing their best, as I'm sure you are. It isn't easy for anyone. I hope you have a better time the 2nd time around and complete your program without too much more trouble.

I know it's really hard.


I'm glad you came to SDN and hope we can be a help for you in the future. Good luck.
 
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I would say the program has been *extremely* accommodating so far. There are programs that would have looked to figure out a way to force a resignation or terminate (yes, before anyone says what a hassle it is to do so).

I can't recall exactly but in some scenarios where you don't defer starting at the start, having a resident come back as PGY1 isn't straightforward either.

You missed what, 4 months out of 11????? And 1.5 mos intern year?

As far as not having to make up the months you did complete, you do realize that even if you passed them, there are 2 issues: one is that you have to be competent in those "competencies" by end of year, and it's hard to say so when you've only got 7/11 rotations under your belt. No, you probably haven't done enough of the year to say you've grown enough to be PGY3.

As far as why you can't just shoe in as PGY2 all over again, that may not be possible with the schedule. It may not be considered reasonable accomodation to do so, in which case you definitely are not entitled to do so under ADA, even assuming that applies to you.

As far as getting credit for those months, it might not be feasible with the overall schedule to waive you doing them over.

Not to mention, if you only have 7/11 months with a 4 month gap, the argument can easily be that you need to have a more consistent run of practice to have developed the skills to go on to PGY3.

This is not illegal. If anything, they have made exceptions for you and gone to a lot of trouble.

If I were you, I would take a fruit basket for the GME office and get down on my knees to kiss my PD's feet.

You should be unbelievably grateful your career is not ENDED over this, let alone thinking you've been wronged in any way.

Actually, starting with a bit of a clean slate (in that you get to start from the beginning) with a few months under your belt, you should be grateful because you are poised for success as you go forward.
Welcome back, Cray!!! :hello::hello::hello:
 
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I agree with the OP that this solution seems unfair, based upon what we've been told.

If I'm reading the story correctly, the OP completed PGY-1 and was promoted to PGY-2. They had 2 LOA's -- 1 in the PGY-1 year, and 1 in the PGY-2 year. One was 2 months long, the other 4.

If the OP successfully completed PGY-1, then there's no reason to have them repeat PGY-1 again. The only way this makes sense is if the OP's skills at the PGY-2 level were poor, or if the leaves somehow caused their skill set to regress back to the PGY-1 level. But in those cases, repeating the entire PGY-1 year still seems excessive.

The other possibility as raised by others is funding. The OP is now at least 6 months off cycle because of the leaves. If the program keeps them at their current training level, during that last 6 months of training they will be "over cap" by 1 resident. This means they will have to pay the OP without getting reimbursement from Medicare. This usually is only a problem at smaller programs with lower caps. Restarting the OP at a PGY-1 fits them back into a funding slot (although their payments will decrease after 36 months, so this still causes a financial problem, just not as extreme). I think this is a terrible way to solve the problem, but I have an understanding GME office who sorts these things out for me without complaint.

EDIT: This assumes the program has an empty PGY-1 now, or is planning on starting the OP as a PGY-1 next July. Else, this makes no sense either.

Contacting the ACGME isn't going to help, and neither is contacting the ABIM. You need to work this out with your program, and your GME office. Much depends upon your performance. Also, much depends upon whether leaves like this are likely to continue.
 
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What in the world? OP has completed PGY-2 (granted with a medical LOA or whatever). There is no rationale to having to go backwards and repeat all of intern year.

aPD, if the OP repeats PGY-2, they will not be graduating 6 months late, right? That would be only if they moved on to PGY-3. Unless OP somehow did not receive credit for any of the 8 months of rotations that were completed around the LOA.

I don't know what the recourse is for this situation, but OP needs to figure out what rotations they have received credit for if you didn't receive credit for any of your PGY-2 year. Why was the program letting you work at the level of a PGY-2 if you can't even do intern duties properly? The reasonable option is that OP, with 18 months of training under their belt thus far, repeats PGY-2 (18 + 12 = 30) and then does PGY-3
 
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Another variable is the PD change. It's possible the new PD is more of a "hawk" (compared with a "Dove"), and feels the old PD promoted the OP incorrectly. Even if that's the case, I agree it seems crazy to demote them, and repeating the whole year seems ridic.

No matter what the OP does now, they are off cycle. This potentially creates a funding problem for the program, even if the OP's training isn't extended beyond 36 months. If they were to continue at the PGY-2 level right on schedule, they will end up being a PGY-3 during 6 months after they would have initially planned to graduate. During those months, the program should have it's full complement of PGY-1,2, and 3's, and the OP would be an extra PGY-3 (since all of their classmates would have graduated). Programs are capped at total funding, so if this was a program with 6 per year / 18 total, their funding might be capped at 18. If they have 19, they only get funding for 18. Any repeated / remediated time only compounds the problem.
 
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Hello all,

I am an IM resident and I was informed by my PD that I have to restart residency as an intern and complete 3 years because of a gap in training. I had 2 medical leaves one at the end of my intern year from mid June to beginning of August. I returned in August. The I had my second leave at the end of my second year for 4 months and returned. I am at a loss at how this is legal/fair. Of note this is a new PD, the previous one left in April and I believe if he were still here that I would not be in this situation. I've contacted ACGME and awaiting a reply. I really don't know what to do. Any advice/help is strongly needed/appreciated.

You have a spot and a chance to become board certified. Retake the intern year and be the best intern in your program.
 
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My opinion doesn't matter so much to your situation, but based on what you've told us I think it would be fair to have you repeat second year, but not start from day one.

If the faculty agree that you fulfill the ACGME milestones for being done with intern year, I think it is fair to have you restart at the level of 2nd year.

Basically this decision is taking about $300 (or whatever you may get paid yearly) off of your lifelong cumulative earning. This may not mean much to you, but it is what it is. Also, it's another 12 months of whatever interest may be adding to your student loans (if you have them).

*shrug* good luck, I think it's unfair, but again, I'm not the PD.
 
Damn, your PD is screwing you over big time. Sounds like a good program turned super malignant smh.
 
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Pretty shocked to read this thread and hear people thinking this is fair or even not unreasonable. Unless the op is functioning below beginning intern level there is no reason he needs to repeat the entire year. Missing that much training I agree should be handled with just tacking 6 months onto the end of training and graduating off cycle.
Worst case restarting at the pgy-2 level. But if there are no clinical deficiencies or professionalism issues then this person should be grandfathered in and continue with the old PD’s plan even if the new PD wouldn’t have done it.

My guess is the new PD sucks personally and disagrees with granting the medical leaves and now is trying to wash this person out.
 
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Pretty shocked to read this thread and hear people thinking this is fair or even not unreasonable. Unless the op is functioning below beginning intern level there is no reason he needs to repeat the entire year. Missing that much training I agree should be handled with just tacking 6 months onto the end of training and graduating off cycle.
Worst case restarting at the pgy-2 level. But if there are no clinical deficiencies or professionalism issues then this person should be grandfathered in and continue with the old PD’s plan even if the new PD wouldn’t have done it.

My guess is the new PD sucks personally and disagrees with granting the medical leaves and now is trying to wash this person out.

I think restarting intern year is ridiculous. Presumably, they were functioning well enough to not hold them back or consider a non-renewal during second year. I think restarting second year is still a bit harsh, but more reasonable, especially if the program doesn't think OP is ready to be a senior year (may function fine at an intern level, but not so fine at a second year level). But, as with many things, one side of the story often paints a different picture than the whole story, so there might be something else going on as well.
 
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@Crayola227 , I am glad you came back and apologized after multiple replies filled with harshness. You do not know the details of the situation and neither do we, but You are already siding with the PD. Believe it or not, there are some very malignant PDs out there. Based on what the OP had told us, at face value, it would make much more sense for he or she to have to repeat PGY 2 year If he or she indeed got promoted to PGY2 after the first leave of absence. He or she shouldn’t be kissing anybody’s feet and being forever grateful because it sounds like to some of us here that he or she’s potentially getting screwed.
 
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Lol, I think I'm one of the first people on here to believe in malignant PDs, and usually the first on the side of the resident. I'm usually the last one to suggest that this isn't quite adding up as far as what the resident describes as the problem, but I don't think it is.

Without knowing more it's hard for me to see if this is really a step towards washing out or a sincere if crappy attempt by the program to reach the ultimate goal of graduation.

I could see it being a way to squeeze them for more labor depending what sort of place this is.

I'm heavily biased because I think we have a lot more posts on SDN regarding changes in grad date that seem to be about never getting one at all (termination/resignation/not matching) or places so malignant one must transfer with little support. And then of course the people for whom it seems clear they can't be rehabilitated and also see their career end.

I spoke a bit soon earlier thinking the OP was at start of PGY2.

In any case, I am sorry for any harshness. I do stand by the opinion that any resident who gets to finish a residency and be board certified, should be glad of that. They can always hurt you worse.

If the program is dicking this resident and malignant, it's all the more reason to just roll over and bust ass to be the biggest asset they possibly can be. So I still stand by the opinion that they need to appear grateful even if they aren't. If this is an attempt, however misguided, by the program to do their best by the resident, being upset at this "help" could leave the program with a sour taste (despite ultimately being unfair to the resident). If this is the move of a malignant program, then ass kissing might also be the only chance of an OK outcome.

TLDR:
Sorry to be harsh. Something about this isn't adding up for me. If this program is screwing over the resident on purpose, it's all the more important that they "act" grateful for a "second chance" because that's probably what such a program would expect and may make things worse. If the program has the resident's best interests at heart, but has a funny way of showing it, then I also don't really trust this program to process any reaction from the resident correctly, so a smile is also probably safest.

We all agree there is no real recourse. There is risk of serious harm. Beyond validating that this sucks, I hesitate to encourage an attitude that this is unfair without knowing more. It could be unfair but I doubt thinking so or acting on it will make anything better and has a higher chance of harm. Why cultivate a chip on your shoulder?
 
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Any updates on this, OP? It is wild to me that someone who completed 18 of the first 24 months of residency is being asked to start over as an intern.
 
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