Returning to medicine---after 4 years!

[bythesea]

Hi everyone! I'm new to the forum---I actually just found out about it. Looks great!

So, I graduated med school 4 years ago (US grad). After graduation, however, I took off. And I mean I took off----I pretty much hit the road. I can't say I've done anything even remotely clinically relevant. I traveled extensively, worked abroad in various jobs, got hitched, and basically became a vagabond.

I don't regret for one moment what I did. I took Step 3 of the boards 2 years ago and passed it on the first try. I'm happy with the path I took.

But, it's time to get back to reality! I want to go into internal medicine---location isn't really important, as my wife is willing to relocate wherever I get a spot.

Does anyone have any advice for me? Do programs lock out applications from people who've been out of medicine for x number of years?

Also, do I go through the match, or do I just scramble for unfilled spots? Do I do interviews?

Thanks!

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[fang]

If I were you I'd probably get back in touch with your medical school first and see what advice they have. It might be worthwhile to do a few rotations or at least shadowing in the upcoming year; in the meantime you could submit an eras application in september and see if you get some interviews.

 

[raptor5]

How do you "do a few rotations"? That would require you to be either a student or resident with malpractice ins. and a temp license if a resident. Just curious. I guess maybe that is why should contact your school.

 

[NinerNiner999]

And how do you take step 3 without being enrolled in or finishing an internship?

 

[2007er]

And how do you take step 3 without being enrolled in or finishing an internship?

some states like california don't require u to be intern to take step 3. i know of an intern who registered for texas and took step 3 as a 4th year med student.

 

[bythesea]

It was easy to take step 3 without being in residency. it involved routing my paperwork through California, then taking the test right down the street in my home state. not sure if they still allow it, but it was A-OK with the NBME. In fact, they were the ones who told me how to do it!



But yes, I don't think I can take rotations anymore, seeing as how malpractice won't cover me. I'll call my school and ask them.

 

[Apollyon]

How do you "do a few rotations"? That would require you to be either a student or resident with malpractice ins. and a temp license if a resident. Just curious. I guess maybe that is why should contact your school.

There are FMGs doing "externships" all over. If they can do it, they're doing something. The OP can do the same.

 

[mig26x]

some states like california don't require u to be intern to take step 3. i know of an intern who registered for texas and took step 3 as a 4th year med student.

I know Connecticut also doesnt requiere a one year intership to take the step 3.

 

[raptor5]

Do you still need a Dean's Letter if you take time off after graduation.

 

[bythesea]

well I talked to my med school, and the dean is on vacation, but the tentative answer is that they can't write me a dean's letter, nor can I get letters of rec from med school faculty (which makes sense. I'm not complaining).

it appears I may have to go outside the match or scramble.

 

[Nico47]

I knew some students who took time off, came back, and went to hospitals as 'observers' while the reapplied. They technically weren't allowed to touch patients, but I've seen them help out the residents in whatever ways they were asked.
You could also do clinical research in the meantime.

Hope this helps.

 

[Chianti]

I know a guy who graduated from a US med school then spent 2 years traveling around the world, teaching English and partying. Then he came back and bar-tended for a year. Then he matched into psychiatry the next year at a great program without any trouble.

 

[bythesea]

yeah I'm actually not anticipating any major problems. Sure, I can't go to Yale or get into rads or ortho, but having worked as a barback on a floating resort on the Great Barrier reef makes it all OK.

 

[mlw03]

to the OP: do you feel you can step right back into things and practice good internal medicine? i have 2 weeks off for winter break and i have to dust off cobwebs. seriously, isn't a 4 year hiatus going to be a problem? a lot changes in that amount of time, to say nothing of the fact that it's natural to forget things with time or the rustiness you'll have when it comes to procedural skills like intubating or placing central lines. i'm not trying to sound like a jerk, but these are legit issues relating to patient care and i'm sure someone's going to ask you these things at some point. you'll also probably get asked, "what have you been doing with your life since medical school?"

to answer another of your original questions: you're not a graduating US senior, therefore you're free to sign outside the match.

 

[TheMightyAngus]

yeah I'm actually not anticipating any major problems. Sure, I can't go to Yale or get into rads or ortho, but having worked as a barback on a floating resort on the Great Barrier reef makes it all OK.

Wow, you're my hero. I take it you didn't have massive loans to pay back.

 

[CHMer]

Seriously,

How were you able to swing your time off financially? I thought about taking some time off during school, but it was financially difficult unless I was working hard at a decent paying job (which kind of defeated the purpose).
You only get 6 months of a grace period, right?

 

[bythesea]

No. 3 years of deferral, followed by forebearance. State school tuition. Government has been paying my interest for the past few years. I'm in roughly the same debt position I was in right after I graduated.

But why am I having to defend myself here? I just wanted to know if anyone had any specific advice about returning to medicine----it seems like some people are attacking me.

 

[CHMer]

Definitely not attacking you. If anything, I am jealous. Good for you for taking the path you wanted to take.

I wish I could help you out with some good advice, but I am not aware of anyone personally that has gone through anything similar. However, I am sure that if you are doing IM and you are not picky about where to go, you should have few problems landing a spot somewhere. It might be a rough internship, playing catch up and shaking off the cobwebs. However, assuming you work hard and are capable, you should be good to go after the first year or so.

good luck to you...

 

[gutonc]

This statement (at the beginning of the thread)...

Hi everyone! I'm new to the forum

explains this question at the end...

But why am I having to defend myself here? I just wanted to know if anyone had any specific advice about returning to medicine----it seems like some people are attacking me.

Welcome to SDN. Basically, after about the 3rd post in any given thread people are responding to each other, not to the OP (they've likely not even read the OP) and are busy w/ their own agenda.

As to your initial question, observerships, clinical research and seeing if you can't work some personal angles if you have contacts in programs are you best options.

What I don't understand is why your Dean's office says you can't even ask your former faculty to write letters. Sure, they may not be able to write letters that would be as good as if they were fresh but I don't see what the Dean's office has to lose by you getting letters from folks. Just out of curiousity, did you get letters before you went on your walkabout? If so, just go back to those people and ask them to update (or just re-date) them. If not...I got nothing.

Good luck.

 

[Doc Oc]

I took two years off to be with my new baby. I matched to my 1st choice FP and will be starting this June.

Yes, June, not July. My program is letting me start a month early (with pay and benefits) to work out the kinks from being off for so long. I am more nervous about the time off than they seem to be.

Another program that I interviewed at (one that regularly doesn't fill) gave me a hard time about the time off, but was going to start me two months early, without pay, to work out the kinks. They said that they routinely do this with people who've been off. They also told me that they won't even look at apps after people have been off five years or more. They were more worried than I am about the time off, and seemed to carefully evaluate how I felt about the struggles that I will have at the beginning.

At every program that I interviewed at (6 FP programs), I discussed my time off, and without exception, every program stated that although they are not worried about the two years, they are encouraged that I took USMLE Step 2 a month before interviews and rocked it as sort of "proof" that I have been giving my best efforts at keeping up. This seemed to be huge (the whole effort at keeping up thing).

Also at every program, when they stated that they weren't too worried about two years, they all also said a variation of two things:
1) They expect me to take 1-2 MONTHS to catch up to my classmates
and
2) If I had been out for more than two years, they may not have considered me (4 programs out of 6 said 3 years worries them greatly, one said 5 years, another didn't mention a time frame)

When discussing my reasons for taking time off, I didn't seem to be grilled too much on it. Time off for a baby (although one year is more common) isn't too off-the-wall. Two programs said that they were glad that my time off wasn't something vague like "to find myself".



I don't know what you will make of these anecdotes, but I thought that it might get the gears going on how you will answer questions like these and how you will explain it.


ONE POSSIBLE BIG PROBLEM THOUGH -

When I applied for my Illinois temporary license, it asks me to explain what I have been doing if I will be starting residency MORE THAN TWO YEARS after I graduated. It has a form to list medically relevant activities. Fortunately, I do not have to fill this out. Having to do so might not be the kis of death, but just know that some states may require something like this when you go to apply for your license to start residency.

Good luck to you!

 

[sequela]

i think this last post is dead-on...not to be a buzzkill but 4 years without medical activity of any sort...not even public health or international stuff? forget the fact that you might be rusty on your practical knowledge or skills, you are going to have to defend four years of having fun. it could very well be perceived as immaturity (a second adolescence) or poor work ethic or lack of true interest in medicine as a career...your interesting stories may fall on very deaf ears.

i am not trying to put you on the defense but i imagine that there will most certainly be issue with your hiatus and you'll need to be prepared for it. you'll have to explain it on eras in 500 characters or less, your personal statement in one page or less and again in your interviews. i mean you literally will have to defend yourself from the moment you start this process. in fact, you might nearly have to apologize for it...i mean come on, these are physicians we're talking about here-a pretty conservative, stuck in the mud/we don't like change, that's the way it's always been done-kinda crowd. especially in internal medicine. second to surgeons, those people practically boast about how much they work/suffer.

so, besides getting a really strong story together, i would suggest finding any way to demonstrate your interest in medicine...volunteer at free clinics (even if it's only taking in-take histories or something a premed would do), observerships (maybe you could shadow some of your old classmates who are now jr attendings somewhere)...basically, you need to show that your applying to residency because you want to practice medicine...not because the party is over and now it's time to get a job.

finally, i would check each program to see what their time limit is for leave of absence.

again, not to be harsh but you're in a bit of a situation and it will only help you to better grasp the professional consequences of your personal choice.

good luck.

 

[ramonaquimby]

i took time off before residency as well - so far so good!! good luck, and yes, it's possible

 

[E Z Daring]

First of all, I wanted to say congrats! You took the road less traveled, did what you enjoyed and lived life on your terms. For that I just want to say that you rock, and you are not alone in doing this!

Yes you can go through the match, and do interviews. If you don't care where you go and like to "roll the dice" you could do the so-called suicide match. You took step3 within the specified time frame so you'll be fine. (7 year span allowed for step1-3 in many states, 10 years in some others) I'm not sure how things work without a Dean's letter, I've never heard of that before. Didn't they have one setup for you as a MSIV?

We work in a profession that attracts people who think like the poster above "it could very well be perceived as immaturity (a second adolescence) or poor work ethic or lack of true interest in medicine as a career" LOL there's no real way to communicate to those mindsets, so I don't bother. There is NOTHING outside of the standard program and NOTHING outside of medicine that is worthy of experience.

You'll be fine having already passed step3, and I seriously doubt you need an externship if you are a U.S. grad. Oh I'm totally sure there are programs that might suggest it - of course, why would a hospital possibly want free labor? (as if they don't get enough of it already!) Just review a bit every day and you'll be set for when things start. We all got into this field to help people, and I am grateful you are going forward with your training. Wish ya the best!

 

[sequela]

We work in a profession that attracts people who think like the poster above "it could very well be perceived as immaturity (a second adolescence) or poor work ethic or lack of true interest in medicine as a career" LOL there's no real way to communicate to those mindsets, so I don't bother. There is NOTHING outside of the standard program and NOTHING outside of medicine that is worthy of experience.

i regret that you can not read a thread without infering incorrectly. i did not say that this is the way i think...did you miss this part????:

"i mean come on, these are physicians we're talking about here-a pretty conservative, stuck in the mud/we don't like change, that's the way it's always been done-kinda crowd. especially in internal medicine. second to surgeons, those people practically boast about how much they work/suffer."


that my dear, was suppose to reflect the toxic culture of this profession...essentially how backwards it is!!!! does it sound like i am in support of it? that i believe and hold true this philosophy?

weather you like it or not, this is the culture you have to deal with. i was merely pointing it out to the op that this will be ONE of the obstacles he will face (in addition to externships, dean's letter etc which seems to be the topic of the rest of the posts). i never once stated my own value judgement about his time off...i simply stated how it "could very well be percevied" by those who are in the position to grant him a residendcy (and you're a complete fool if you don't think this is and will be the case to a large extent). no where in my post is MY actual opinion/belief system stated....oh except for the part where i bag on the institution of medicne!!!!

i'm sorry i couldn't dumb-it down for you any further.

to the op: i can only hope that you did not mis-read this post as it was only intended to give you a heads up on some of the other bs you might have to deal with.

 

[LADoc00]

Hi everyone! I'm new to the forum---I actually just found out about it. Looks great!

So, I graduated med school 4 years ago (US grad). After graduation, however, I took off. And I mean I took off----I pretty much hit the road. I can't say I've done anything even remotely clinically relevant. I traveled extensively, worked abroad in various jobs, got hitched, and basically became a vagabond.

I don't regret for one moment what I did. I took Step 3 of the boards 2 years ago and passed it on the first try. I'm happy with the path I took.

But, it's time to get back to reality! I want to go into internal medicine---location isn't really important, as my wife is willing to relocate wherever I get a spot.

Does anyone have any advice for me? Do programs lock out applications from people who've been out of medicine for x number of years?

Also, do I go through the match, or do I just scramble for unfilled spots? Do I do interviews?

Thanks!

Im very jealous...in the 4 years since you left the healthcare system is even more BUSTED than it was before..might want to consider staying a vagabond.

 

[bythesea]

Thanks for all the advice! You all have given me some great input. I'm starting to see why so many of my former classmates recommended this site to me!

So I found out I can, in fact, get a dean's letter, but they destroyed my letters of rec from med school. (I had gone through the early motions of the app process but never went into the match). They say they hold onto the letters for one year and then shred 'em.

My plan is to start calling programs now and finding out their specifics. I'll also consider broadening my apps to family medicine---in practice, I'd never want to do OB, but I wouldn't mind seeing kids AND adults in my practice.

Yes, I'm sure I'll be grilled on what I've done the past 4 years, and I genuinely don't care. When I'm on my deathbed, I won't look back and say, "Oh man, I could've had so much more respect in the medical community had I not gone off like that. I could've gone to a prestigious program, blah blah." I choose to live my life in a way that gives me purpose. I'm not going to lie or be ashamed of the past 4 years.

Had I not done this, I'd never have met my wife. That alone is worth more than anything that anyone in the medical community can ever offer me. Period.

 

[sequela]

Had I not done this, I'd never have met my wife. That alone is worth more than anything that anyone in the medical community can ever offer me. Period.

see, that's a strong story to me. good, now you're set. good luck.

 

[njbmd]

Thanks for all the advice! You all have given me some great input. I'm starting to see why so many of my former classmates recommended this site to me!

So I found out I can, in fact, get a dean's letter, but they destroyed my letters of rec from med school. (I had gone through the early motions of the app process but never went into the match). They say they hold onto the letters for one year and then shred 'em.

My plan is to start calling programs now and finding out their specifics. I'll also consider broadening my apps to family medicine---in practice, I'd never want to do OB, but I wouldn't mind seeing kids AND adults in my practice.

Yes, I'm sure I'll be grilled on what I've done the past 4 years, and I genuinely don't care. When I'm on my deathbed, I won't look back and say, "Oh man, I could've had so much more respect in the medical community had I not gone off like that. I could've gone to a prestigious program, blah blah." I choose to live my life in a way that gives me purpose. I'm not going to lie or be ashamed of the past 4 years.

Had I not done this, I'd never have met my wife. That alone is worth more than anything that anyone in the medical community can ever offer me. Period.

Just to help you out a bit here, I ran a bit of your story by my program director. Essentially my PD said that you definitely want to do something like an observership or two just to get some recent letters/experience that is clinically related. (If you did something clinical while you were away from medicine like worked in a free clinic etc, then be sure to get a letter from one of our superiors there too).

Yes, you can get a Deans letter even though you have graduated from medical school. They keep your records and can generate a MSPE for you when the time comes but be sure that you have your LORs submitted by your LOR writers in a timely manner.

You may also want to speak with a few programs that interest you as some programs will not consider an applicant who graduated from medical school more than four years prior to application. (I am not sure why that should make a difference if you do an observership but PD mentioned it???)

I am not sure that you will be "grilled" but questioned about your hiatus from medicine. It's unusual but other than being away because you spent four years in prison, I think you can "spin" your experience into something positive and life-enriching that will enhance your application.

Good luck and congrats on finding the love of your life.

 

[ronin8]

Thanks for all the advice! You all have given me some great input. I'm starting to see why so many of my former classmates recommended this site to me!

So I found out I can, in fact, get a dean's letter, but they destroyed my letters of rec from med school. (I had gone through the early motions of the app process but never went into the match). They say they hold onto the letters for one year and then shred 'em.

My plan is to start calling programs now and finding out their specifics. I'll also consider broadening my apps to family medicine---in practice, I'd never want to do OB, but I wouldn't mind seeing kids AND adults in my practice.

Yes, I'm sure I'll be grilled on what I've done the past 4 years, and I genuinely don't care. When I'm on my deathbed, I won't look back and say, "Oh man, I could've had so much more respect in the medical community had I not gone off like that. I could've gone to a prestigious program, blah blah." I choose to live my life in a way that gives me purpose. I'm not going to lie or be ashamed of the past 4 years.

Had I not done this, I'd never have met my wife. That alone is worth more than anything that anyone in the medical community can ever offer me. Period.

you're my hero. wanna do a split residency with me? pm me

 

[E Z Daring]

i regret that you can not read a thread without infering incorrectly. i did not say that this is the way i think...did you miss this part????

Ha ha, woah there! I wasn't talking about you personally - I was talking about the personality you were quoting. Peace! (waves the white flag on a stick!)

that my dear, was suppose...

LOL anytime a women starts an argument with those first 3 condescending words, I put up my fists for battle. LOL

weather you like it or not, this is the culture you have to deal with.

Don't we all know it. And I happen to like my weather here in sunny California.

i'm sorry i couldn't dumb-it down for you any further.

Please dumb it down more next time, geez, what am I a rocket scientist or something.

 

[sequela]

Ha ha, woah there! I wasn't talking about you personally - I was talking about the personality you were quoting. Peace! (waves the white flag on a stick!)


LOL anytime a women starts an argument with those first 3 condescending words, I put up my fists for battle. LOL



Don't we all know it. And I happen to like my weather here in sunny California.



Please dumb it down more next time, geez, what am I a rocket scientist or something.

alright smarty pants. next time i'll be sure to spell it all out (correctly) for you.

-peace, olive branch and white flag on a stick to you too.

 

[bythesea]

Just to help you out a bit here, I ran a bit of your story by my program director. Essentially my PD said that you definitely want to do something like an observership or two just to get some recent letters/experience that is clinically related. (If you did something clinical while you were away from medicine like worked in a free clinic etc, then be sure to get a letter from one of our superiors there too).

Yes, you can get a Deans letter even though you have graduated from medical school. They keep your records and can generate a MSPE for you when the time comes but be sure that you have your LORs submitted by your LOR writers in a timely manner.

You may also want to speak with a few programs that interest you as some programs will not consider an applicant who graduated from medical school more than four years prior to application. (I am not sure why that should make a difference if you do an observership but PD mentioned it???)

I am not sure that you will be "grilled" but questioned about your hiatus from medicine. It's unusual but other than being away because you spent four years in prison, I think you can "spin" your experience into something positive and life-enriching that will enhance your application.

Good luck and congrats on finding the love of your life.

Wow! You're awesome! Thank you so much for your help!!!

 

[Annoyances]

Way cool I think this is sooo cool hahaha wish I had thought of doing this myself twoyears ago. Would ahve made quite the difference in my life. I often ffeel like i need a brake.

 

[pillion]

So for those of you who have taken time off (1yr, 4 yrs, whatever), what would say the options are for returning to medicine: Family medicine? Psych? Internal medicine? Peds? anything else? What about ER or anesthesia?

 

[Doc Oc]

I planned to take two years off, and at the time was thinking IM. My advisor said that it might limit the more competitive programs, who don't really have to deal with someone with forgotten knowledge if they don't want to. He was confident that I should be able to get something though, and the places that I was going for weren't the most competitive.

I was told that if I wanted ENT, rads, derm, or another more competitive specialty, that I could have a problem.

I ended up changing my mind after having a baby, and wanted to do peds and OB also, so I decided to apply to FM instead. I got interviews everywhere I applied and matched #1. But that's probably not a surprise, I think most people would assume that after a year or two off, FM is still an option.