- Joined
- Sep 20, 2004
- Messages
- 6,009
- Reaction score
- 6,721
this. this is your problem.
Terminated from IM residency (PGY-2)
- Thread starter nirvana88
- Start date
this. this is your problem.
- Joined
- Sep 20, 2004
- Messages
- 6,009
- Reaction score
- 6,721
really? you SAY that ALL these people are supporting you...but you still were dismissed...these people are being empathic, polite or whatever but don't feel strongly enough to actually stand up for you...
I don’t feel comfortable sharing all the details but since everybody thinks I’m that bad, I’ll just say this much that 2 attendings with whom I was on personal terms offered me loans and tried to convince me to get a lawyer. That’s how unfair they thought this was. But I declined because I know there is no way a court of law can help me.
There are more details I could share to show the extent of injustice but I know it will be of no avail so I prefer not to make this any more messier than this already is. Plus I’m pretty sure my PD is following this thread by now as well (Hello!). Like I said so many times before, I was at fault many a times which I never denied. I just had trouble contemplating how I was worthy of dismissal.
I’m a healer, I don’t believe in causing destruction. I have just two purposes here: to raise awareness about mistreatment of residents and to evaluate the chances of rebooting my career.
I think this is the problem right here. You may be working from a mindset that you are the equal if not better compared to your attendings. Whether or not you are indeed better than them or not is irrelevant, you were PGY-1/2 and it seems you have had a hard time adjusting to life as a trainee all over again, after being a 'highly respected physician in [your] home country'. This is not exclusive to IMGs, as I have also seen this apply to those who have worked as a hospitalist / primary care IM for a few years before fellowship, and have had a hard time swallowing being a trainee again and accepting lessons from physicians they feel are their equal (or worse inferior to them clinically).
- Joined
- Oct 22, 2013
- Messages
- 25,548
- Reaction score
- 40,740
Goes with my saying for trainees, "Get used to the flavor of your own tongue, because you'll need to bite it at every opportunity."
"When you go to open your mouth, ask yourself: will this make me look smarter or make me seem more likeable?" Go with likeable every time.
Someone else said there's a nuance to how you "challenge" an attending, that won't make you seem like a dick, for those times when you absolutely must because it makes a big difference to patient care.
No offense, I wonder if that is more difficult if one is ESL. I say that because I am SSL (Spanish as a second language) and it's all to easy to say things more bluntly than you mean to.
"When you go to open your mouth, ask yourself: will this make me look smarter or make me seem more likeable?" Go with likeable every time.
Someone else said there's a nuance to how you "challenge" an attending, that won't make you seem like a dick, for those times when you absolutely must because it makes a big difference to patient care.
No offense, I wonder if that is more difficult if one is ESL. I say that because I am SSL (Spanish as a second language) and it's all to easy to say things more bluntly than you mean to.
- Joined
- Jul 11, 2017
- Messages
- 244
- Reaction score
- 141
Jeez, think of everyone who will die without you being there. You being a “highly respected” physician in your home country is the detrimental mentality that lead to your demise. You won’t change, your ego won’t let you.
denial, anger, bargaining, depression and acceptance - you’re just mulling around the first two as your “highly respected” ego won’t let you move on.
Also, your PD isn’t reading this forum, they’ve moved on and have the chiefs working to plug the holes in the schedule for adequate coverage, which I’m sure your co-residents enjoy. Probably will match an extra resident/prelim to help out as well.
Let me just establish a few facts here:
1. I never went out of my way to impress others and I never tried to look smart or anything. I used to discuss ideas because I would either improve patient care or learn something new. That is why I chose medicine and why I love it so much.
2. Talking back to attendings was NEVER mentioned in any of the letters and I was never asked to tone it down.
3. I know that at times I’m difficult to work with because my inquisitiveness tends to get the better of me. But does that make me worthy of dismissal during residency? I don’t think so. Dismissal during residency is not a small deal. It has everlasting consequences for my career. For the rest of my life I will have to explain why I was fired and no matter how logical my arguments would be, my PD’s view will always overshadow everything else; including strong LORs from the attendings I worked with.
4. The primary reason for my dismissal was quoted as “non-seriousness”. I think the least one could say about me after reading all my rants is that I’m anything but non-serious.
- Joined
- Nov 20, 2009
- Messages
- 15,492
- Reaction score
- 10,128
It does if it interferes with work. Look, I've worked with residents in the past. I used to love teaching. However, in medicine we need to take care of patients first. That means that I won't waste 45 minutes of the team's time just because you want to debate if the patient should be on amlodipine or lisinopril. A timely decision must be made and any teaching/discussion has to respect our time constraints.
I didn't enjoy when residents questioned me endlessly about things that were clear to me.
I particularly remember a case where I even showed an intern the IDSA guidelines for management of soft tissue infections and she was still questioning my decision.
At that point I simply said, you know what? I've known the right answer to this question for years. This discussion does not benefit me in the slightest and I asked her to let it go because we needed to move on. At least she was smart enough to recognize her mistake and she apologized and made a short presentation on the topic the next day.
I also had a resident make endless questions and I just said "well, as long as I am the attending this is what we are doing. You can do what you want when you actually have patients of your own."
In summary, we cannot entertain your intellectual curiosity forever. We have to take care of patients in a timely fashion. That's why your attitude was annoying to some.
- Joined
- Jul 11, 2017
- Messages
- 244
- Reaction score
- 141
You keep saying how “logical” you are. What “logical argument “ will you provide IF you get an interview and they ask you what happened and why YOU think you were fired from your previous residency? You’re going to need to work REALLY hard on correcting that gut response your personality disorder will give because the rebuttals from your interviewers will rattle that “logical” ego. Will you talk about how you “corrected” your attending, ED attending and radiology attending and “saved” another pt from dying at the hands of you incompetent institution?
Or the time you “gracefully allowed” your program to put another pt on your already “full” schedule during clinic, but how it was all a “misunderstanding” regarding your response/complaint and actually the pt “misunderstood “ you about what you said to them.
Everybody seems to be illogical and lack the pragmatic approach and logical stepwise thinking of such a highly respected clinician, such as yourself, has - why should you even have to complete a residency? Doesn’t seem logical?
- Joined
- Oct 22, 2013
- Messages
- 25,548
- Reaction score
- 40,740
I remember one time I was treating this complicated UTI in a patient with an indwelling cath.
I looked up in the most recent Sanford guide to abx and the hospital biogram the best recs for my plan.
When I talked about it with the attending, they were like "And give them blank number of days of this antibiotic."
"Actually, sir, I was going to write them blank, based on what I looked up from the Sanford guide and biogram."
They asked me how I looked it up, and I explained, and they didn't point out that I had used the wrong parameters or anything. In fact, they complimented me on the fact that I did this and was using a good resource. However, they still said "OK, well, go ahead and write my plan." I think they just were used to doing things a certain way, because they couldn't tell me why they were doing it their way and not mine (not that I asked!!!!)
That was it. I tried, but for whatever reason we had different ideas. It wasn't wrong of me to try to come up with my own plan and justify it. It would have been wrong if I did any more than that when the attending said what they wanted.
The patient wasn't going to die. Probably their UTI was going to be fine. Was it ideal? I don't think so. Was it worth pissing anyone off? No.
I looked up in the most recent Sanford guide to abx and the hospital biogram the best recs for my plan.
When I talked about it with the attending, they were like "And give them blank number of days of this antibiotic."
"Actually, sir, I was going to write them blank, based on what I looked up from the Sanford guide and biogram."
They asked me how I looked it up, and I explained, and they didn't point out that I had used the wrong parameters or anything. In fact, they complimented me on the fact that I did this and was using a good resource. However, they still said "OK, well, go ahead and write my plan." I think they just were used to doing things a certain way, because they couldn't tell me why they were doing it their way and not mine (not that I asked!!!!)
That was it. I tried, but for whatever reason we had different ideas. It wasn't wrong of me to try to come up with my own plan and justify it. It would have been wrong if I did any more than that when the attending said what they wanted.
The patient wasn't going to die. Probably their UTI was going to be fine. Was it ideal? I don't think so. Was it worth pissing anyone off? No.
I understand but I doubt you recommended their dismissal? And anyway, I wasn't that argumentative that any attending needed to give me a shut up call or even say "because I said so". And as I've mentioned, my program never criticised this habit. This "toning down" suggestion was given by some residents and attendings off the record as a strategy to escape the spotlight.
You made a number of assumptions in your post. The biggest one is that I was asked repeatedly to be more passive and I ignored that feedback. There'not true, I was accused of being "non-serious". That's as subjective as it gets and I had no way of disproving that. Whatever I was, I wasn't non-serious. That's why I don't know what to say to future interviewers.
P.S. I don't have a big ego but if your purpose of replying is just to be condescending, please feel free not to. Thank you.
- Joined
- Nov 20, 2009
- Messages
- 15,492
- Reaction score
- 10,128
I would advise you to listen to the advice you were given by your coresidents and attendings. There's nothing more to say about this, I don't think.
I wish you the best. Good luck!
I’ve already realized that and will be more mindful about it in the future. I would be betraying myself by doing that but I know you can’t always learn and thrive, sometime you’ve got to shut up and survive.
- Joined
- Jul 20, 2017
- Messages
- 443
- Reaction score
- 443
I honestly suggest you seek professional help. I'm not trying to be mean or funny when I say that. Either that or run for president.
I did get help from a therapist recommended by my hospital. I was told to request a transfer because they thought I was being misunderstood. But I didn’t out of fear of retaliation.
But thank you.
I was also dismissed from residency a few years ago. I know what it feels like after such a lengthy investment has been made into this career. My PD was neutral towards me, but one attending did not like me for whatever reason, and wrote all kinds of dubious statements about me. On my evaluation, there was a statement like "performs at the level of a MS-3" and yet I had completed 9 months of training with excellent evaluations prior to that rotation. I was put on probation. The outcome was the same and I was dismissed towards the end of my PGY-1 year. All the other posters have no clue what you had to deal with. Most of these posts are condescending without any mercy. It is neither of any help to you or to the other readers on this site. Staying positive is the best thing both for yourself, your wife and your family. The best advice I can give you is try your luck applying to open PGY-2 spots if you can manage to get some letters or recommendation or seek another career. Your chances for another spot are going to be low, no matter what you say or don't say. You will need to have the guts and glory to start anew in a different profession, and I think from your standpoint, you will do quite well. God bless.
- Joined
- Sep 16, 2008
- Messages
- 3,368
- Reaction score
- 3,025
That is kinda funny.....
Well......feel free to interject.
I'm sorry, but this isn't exactly great advice. Obviously, he's going to either try again or move on to something else. What did you do?
I think God is occupied with more important things...but in case he is reading this thread, my Lakers could really use some divine intervention.
Last edited:
- Joined
- Jun 11, 2013
- Messages
- 11,783
- Reaction score
- 27,962
Nobody is fired or nonrenewed because of one person (unless that one person is the PD or Chair, I suppose)...
One person is enough to bring you under the microscope; which is hell and is followed by a vicious cycle.
- Joined
- May 15, 2008
- Messages
- 1,401
- Reaction score
- 749
Agree about this.
Update:
I finally matched into a PGY-1 position this year. It did take making a lot of contacts and continued support from attendings who believed in me.
I have received many messages from residents who were fired or were threatened to be fired over the past three years. I tried my best to guide each and every one of them. I hope all of you having similar troubles end up matching somewhere. Here are a few pieces of advice I would give to future readers of this thread:
1. Don't listen to naysayers. Seek help but make your own decisions. I posted this thread to ask for guidance, and as you can see, most people kept acting "holier-than-thou" with condescending remarks. It's funny that people who wanted to encourage me were sending me DMs and not posting replies to this thread. Some people kept asking me to stop replying to this thread as I was only going to get toxic replies. I was actively suicidal at one point, and people here kept saying "you just don't get it." A lot of people I knew in real life recommended things like becoming a PA or getting an MBA/PhD, as they said I had zero chances of getting a residency position. But I kept trying.
2. Keep in touch with your PD and supportive attendings. My PD was nice enough that even though they refused to talk to me about the dismissal, they still provided help in me getting a residency position. When asked by my new program about me directly, they said that they would enroll me again if they had the chance. That was incredibly nice of them. I was also lucky that the attendings who believed in me from my former program were extremely supportive and kept sending letters of recommendation within 24 hours of whenever I asked them for both programs within and outside of ERAS all these years.
3. If you feel like things aren't going in your favor, try transferring to another program. I know that is hard, but if it happens, it's much better than having to deal with a dismissal.
4. Try to negotiate a resignation instead of a dismissal. The appeal process is never going to be in your favor. If you have been told about being dismissed or are sure you will be dismissed soon, try to resign instead. At least then you won't have to explain yourself (from a disadvantage) for the rest of your life wherever you go.
5. Try to identify if your program is malignant. My previous program had an average of firing one resident every year. When I joined the program, I was told about it jokingly as a "lotto." As in there's a small chance it's gonna be you, but someone will win the lotto every year. If your program is like that, try to transfer.
6. Don't suppress your anxiety or depression. Don't try to "push through." If you are overwhelmed, seek help. If you are struggling with mental health, acknowledge and share it early.
The one thing that made me feel so much better was that during the interview with my new PD, they said that if I had been promoted to PGY-2 while being on probation, there was definitely injustice in the process. The acknowledgment of this injustice made me feel so much better.
I would be happy to continue responding to DMs as well.
I finally matched into a PGY-1 position this year. It did take making a lot of contacts and continued support from attendings who believed in me.
I have received many messages from residents who were fired or were threatened to be fired over the past three years. I tried my best to guide each and every one of them. I hope all of you having similar troubles end up matching somewhere. Here are a few pieces of advice I would give to future readers of this thread:
1. Don't listen to naysayers. Seek help but make your own decisions. I posted this thread to ask for guidance, and as you can see, most people kept acting "holier-than-thou" with condescending remarks. It's funny that people who wanted to encourage me were sending me DMs and not posting replies to this thread. Some people kept asking me to stop replying to this thread as I was only going to get toxic replies. I was actively suicidal at one point, and people here kept saying "you just don't get it." A lot of people I knew in real life recommended things like becoming a PA or getting an MBA/PhD, as they said I had zero chances of getting a residency position. But I kept trying.
2. Keep in touch with your PD and supportive attendings. My PD was nice enough that even though they refused to talk to me about the dismissal, they still provided help in me getting a residency position. When asked by my new program about me directly, they said that they would enroll me again if they had the chance. That was incredibly nice of them. I was also lucky that the attendings who believed in me from my former program were extremely supportive and kept sending letters of recommendation within 24 hours of whenever I asked them for both programs within and outside of ERAS all these years.
3. If you feel like things aren't going in your favor, try transferring to another program. I know that is hard, but if it happens, it's much better than having to deal with a dismissal.
4. Try to negotiate a resignation instead of a dismissal. The appeal process is never going to be in your favor. If you have been told about being dismissed or are sure you will be dismissed soon, try to resign instead. At least then you won't have to explain yourself (from a disadvantage) for the rest of your life wherever you go.
5. Try to identify if your program is malignant. My previous program had an average of firing one resident every year. When I joined the program, I was told about it jokingly as a "lotto." As in there's a small chance it's gonna be you, but someone will win the lotto every year. If your program is like that, try to transfer.
6. Don't suppress your anxiety or depression. Don't try to "push through." If you are overwhelmed, seek help. If you are struggling with mental health, acknowledge and share it early.
The one thing that made me feel so much better was that during the interview with my new PD, they said that if I had been promoted to PGY-2 while being on probation, there was definitely injustice in the process. The acknowledgment of this injustice made me feel so much better.
I would be happy to continue responding to DMs as well.
Last edited:
- Joined
- Oct 22, 2013
- Messages
- 25,548
- Reaction score
- 40,740
I have to answer this to say that terminating a resident is not difficult in the slightest, as far as actually carrying it out. Sure it requires a great deal of paperwork and talking to various people to dig up dirt and filling out forms as negatively as possible, and consulting with HR and possibly hospital legal risk management, but otherwise, not at all hard to make a case to fire a resident, because no one is perfect under the microscope, and the microscope not only finds problems it generates them.
The only difficulty it truly creates is what it does to scheduling and the work load and trying to finish out the year, find someone off cycle, and the class size moving forward.
Residents have little to no recourse when a program takes the administrative steps to fire them, and it's just paperwork and looking for problems. Granted, the resident under the gun is going to have fodder for this process or they wouldn't be under the gun.
The most innocent of struggling residents is often getting orders in late, notes in late, order errors, being late to conference, missing conference, work hour violations, annoyed nurses. Every single resident I've ever known has at least a few of these black marks. Usually this isn't enough to get anybody fired.
But when the program makes it their mission to get you gone, best believe they can write these up and get you gone.
I'm not saying this is what happens all the time or accounts for a lot of firings. I'm just countering the notion that firing a resident is hard. It really isn't. Replacing a resident is hard.
- Joined
- Oct 22, 2013
- Messages
- 25,548
- Reaction score
- 40,740
Exactly this, been trying to tell students and trainees this for years. My favorite saying is learn to like the taste of your own tongue - you need to be biting it at every opportunity.
- Joined
- Oct 22, 2013
- Messages
- 25,548
- Reaction score
- 40,740
- Joined
- Oct 22, 2013
- Messages
- 25,548
- Reaction score
- 40,740
What's blowing my mind is why they moved to terminate you, yet were so willing to help you get a new position!
The only time I know of this happening, the resident was struggling with their health, and the program went the forced resignation route so they could just hire someone else off cycle. It was unjust, but not due to maliciousness on the part of the program, so the PD was very supportive to the resident after.
Did you gain any further insight into why the PD let you go? You said they wouldn't discuss it. Did you or any of the attendings figure this out?
- Joined
- Mar 31, 2008
- Messages
- 1,902
- Reaction score
- 2,762
@Crayola227 @nirvana88
Good posts. I can't stress how much this (quoted below) not only applies to residency but also attending jobs out in the real world. Always try to resign if dismissal seems imminent.
"Try to negotiate a resignation instead of a dismissal. The appeal process is never going to be in your favor. If you have been told about being dismissed or are sure you will be dismissed soon, try to resign instead. At least then you won't have to explain yourself (from a disadvantage) for the rest of your life wherever you go.
I have to answer this to say that terminating a resident is not difficult in the slightest, as far as actually carrying it out. Sure it requires a great deal of paperwork and talking to various people to dig up dirt and filling out forms as negatively as possible, and consulting with HR and possibly hospital legal risk management, but otherwise, not at all hard to make a case to fire a resident, because no one is perfect under the microscope, and the microscope not only finds problems it generates them.
The only difficulty it truly creates is what it does to scheduling and the work load and trying to finish out the year, find someone off cycle, and the class size moving forward.
Residents have little to no recourse when a program takes the administrative steps to fire them, and it's just paperwork and looking for problems. Granted, the resident under the gun is going to have fodder for this process or they wouldn't be under the gun.
The most innocent of struggling residents is often getting orders in late, notes in late, order errors, being late to conference, missing conference, work hour violations, annoyed nurses. Every single resident I've ever known has at least a few of these black marks. Usually this isn't enough to get anybody fired.
But when the program makes it their mission to get you gone, best believe they can write these up and get you gone.
My biggest disappointment was the fact that I was mistaken to believe that critical thinking and a logical approach were welcome here. They just need mindless drones who don’t ask questions, just do what they’re told and keep their mouths shut while nodding their heads."
Good posts. I can't stress how much this (quoted below) not only applies to residency but also attending jobs out in the real world. Always try to resign if dismissal seems imminent.
"Try to negotiate a resignation instead of a dismissal. The appeal process is never going to be in your favor. If you have been told about being dismissed or are sure you will be dismissed soon, try to resign instead. At least then you won't have to explain yourself (from a disadvantage) for the rest of your life wherever you go.
I have to answer this to say that terminating a resident is not difficult in the slightest, as far as actually carrying it out. Sure it requires a great deal of paperwork and talking to various people to dig up dirt and filling out forms as negatively as possible, and consulting with HR and possibly hospital legal risk management, but otherwise, not at all hard to make a case to fire a resident, because no one is perfect under the microscope, and the microscope not only finds problems it generates them.
The only difficulty it truly creates is what it does to scheduling and the work load and trying to finish out the year, find someone off cycle, and the class size moving forward.
Residents have little to no recourse when a program takes the administrative steps to fire them, and it's just paperwork and looking for problems. Granted, the resident under the gun is going to have fodder for this process or they wouldn't be under the gun.
The most innocent of struggling residents is often getting orders in late, notes in late, order errors, being late to conference, missing conference, work hour violations, annoyed nurses. Every single resident I've ever known has at least a few of these black marks. Usually this isn't enough to get anybody fired.
But when the program makes it their mission to get you gone, best believe they can write these up and get you gone.
My biggest disappointment was the fact that I was mistaken to believe that critical thinking and a logical approach were welcome here. They just need mindless drones who don’t ask questions, just do what they’re told and keep their mouths shut while nodding their heads."
- Joined
- Apr 4, 2012
- Messages
- 2,120
- Reaction score
- 551
I’m just seeing this for the first time. Your program must have been malignant because honestly the two episodes you provided sound stupid. Didn’t auscultate someone’s chest? Who cares. That doesn’t sound like it should be even near the list of reasons for dismissal. That’s just something you do next time if you forgot.
I believe I have provided enough information on this subject in this thread. The program was very political, and I felt the PD was just under a lot of pressure from some attendings and residents who just didn't like me. Every time I met my PD, they understood my side of the story but always replied with something like, "I just keep hearing these things about you." I believe they eventually just caved in to the pressure from some of those people.
- Joined
- Oct 10, 2007
- Messages
- 4,602
- Reaction score
- 8,246
@nirvana88
First of all congrats on finding another spot especially under current match conditions--truly a remarkable feat and a testament to your perseverance (although I am assuming no massive loan debt probably helps a small bit). I do hope you have learned that no matter what the culture of the program is you best be humble, quiet, and obedient to get through this because there are no third chances.
And it is absolutely true that sometimes someone malicious with political sway will do a take down for no clear reason. I have seen it happen to other residents and it is horrible and unjust. Whenever I was a senior and had one of the 'struggling' residents (I always was given a warning phone call/email from admin prior to rotation start to identify these people) I could tell they were spiraling and freaking out whenever I gave them any kind of feedback or did something to try to help them--it really does destroy your self confidence. I know I basically never reported anything negative in writing about people under me during training unless it was profoundly egregious to try to limit any small contribution I would have to the process.
First of all congrats on finding another spot especially under current match conditions--truly a remarkable feat and a testament to your perseverance (although I am assuming no massive loan debt probably helps a small bit). I do hope you have learned that no matter what the culture of the program is you best be humble, quiet, and obedient to get through this because there are no third chances.
And it is absolutely true that sometimes someone malicious with political sway will do a take down for no clear reason. I have seen it happen to other residents and it is horrible and unjust. Whenever I was a senior and had one of the 'struggling' residents (I always was given a warning phone call/email from admin prior to rotation start to identify these people) I could tell they were spiraling and freaking out whenever I gave them any kind of feedback or did something to try to help them--it really does destroy your self confidence. I know I basically never reported anything negative in writing about people under me during training unless it was profoundly egregious to try to limit any small contribution I would have to the process.
- Joined
- Apr 22, 2006
- Messages
- 2,866
- Reaction score
- 2,828
Congrats man. I would echo others' advice that it would be most prudent to just put your head down and don't ruffle any attendings' feathers at your new shop. Medicine has egos like no other, and it's just not worth it to risk your livelihood against dumb/stubborn attendings.
Best of luck.
Lol... Many of us don't do that regularly if we have been taking take of a patient for many days. Someone was out to get OP imo.
Last edited:
Did you work as a physician? because you were eligible to get a medical license in many states after completing PGY2.
That doesn't apply to IMGs. I was eligible for a license in only one state, and that state's board denied my application.
Did not know you were an IMG... If you got credit for your PGY2 year as an IMG/FMG, you were probably eligible for licensure in ~20 states. Now, it's all mute since you are about to restart residency. Keep your head down. Good luck!
Last edited:
- Joined
- Dec 28, 2010
- Messages
- 5,052
- Reaction score
- 6,084
It could be that there was a one attending/aPD on the Clinical Competency Committee who wrote an overwhelming majority of the information (who most other attendings think is a bit extreme at times). That probably lead to the microscope (cue the PIP, followed by Probation). Once you're under the microscope, you are getting evaluated a helluva lot more than other residents (chief residents attending rounds, being required to submit more evals, your notes get scrutinized, upper PGYs in your program know from rumors that you're in a bad spot, as well as pretty much every attending you work with from thereon out). Add that to meaningless administrative meetings and caregiver support meetings to try to address issues, but really just end up forcing you to take more time off rotations because you can't skip them because that reflects poorly on your willingness to improve. It's enough to mess with anyone. Most attendings and PDs can see what's going on too. It's not that the comments made against the resident in question are inaccurate, but put a sizable amount of residents in that spot and they'll get exposed too and the PD knows it. Sometimes all it takes is really one person with a strong viewpoint to put you on the radar and afterwards any further comments are analyzed meticulously, the CCC spends way more time with residents with microscopes than discussing residents without it...and it's also messed up as all those people evaluating when you are under the microscope do it from a perspective assuming you aren't on your game and many feel obligated to give constructive feedback.
OP, you've been given a second chance. I commented on this thread 3 years ago and it's probably one of my most ironic posts on SDN (sorry if I was a jerk, it's been a hell of a time for me too and I basically had to take my own advice I posted earlier and am in your exact spot). You (we) need to be absolutely spotless this time around and exceed expectations for good measure. Do not rest on your laurels even if you've already done PGY-1 and part of PGY-2. Your mentality towards almost everything needs to be completely altered from this. Truly, this is not even a fresh start because your PD knows the circumstances. You have a clean slate now, but if issues arise the PD has some baggage they can dig up on you to splatter your slate with moreso than someone elses if the same thing comes up with them. If I were you, I'd do the following:
1.) Tell absolutely no one (even friends you make) at your new program about what happened. Lie through your teeth if you have to about your timeline before residency. There is so much anchoring bias and judgement amongst evaluators in medicine and everyone in residency is evaluating each other. This is supposed to be a fresh start so try to keep it that way as much as possible. Attendings right now DONT KNOW you've done part of residency. Let them assume any strengths you have are just you coming in with good med school training or natural ability. This will allow them to have a higher tolerance for any weaknesses you still have. There will be times where you'll know answers to things especially at the beginning. I would even go as far to say don't be the one blurting out answers to impress everyone even if you're 100% right and know exactly what the attending wants to hear. It may feel good, but others will wonder how you know so much and may google you or whatever and word may spread. Bite your tongue until it's sore if you have to. If you can, just channel any extra knowledge you have into empathy to help others struggling as you once were to gain good karma.
2.) Being modest is going to be more difficult than you think. You have completed intern year in the past and now you will have someone at the level you were at instructing you. Even good interns have to suppress their resentment for seniors as the system's inherently competitive in nature. Imagine what it's going to be like for you having completed intern year and having issues in the past arguing about medical technicalities. This is something you're really going to have to think about deeply. I'm not saying you aren't able to fix it, but be very wary of it because this is the last chance.
Last edited:
- Joined
- Oct 11, 2006
- Messages
- 10,796
- Reaction score
- 15,742
I am glad that you are getting another chance. Restarting as a PGY-1, while I'm sure is frustrating, is honestly the best way to get through the training process. It will allow you to build on your knowledge, learn a new system, and start with a clean slate.
I went back through this thread and had planned to insert a bunch of your quotes here to help you focus on how to not end up in the same situation again - but then I thought that might just derail this positive outcome. Hopefully this new program will have a different culture and be more supportive. Reviewing your posts, it's clear that you feel strongly about patient advocacy -- and that's a good thing. My advice to you is that if your opinion doesn't match that of the faculty supervising you, that's OK but tread lightly. Advocate for your thoughts in a positive and professional manner. As you have learned, upsetting just a few people in key positions can be catastrophic.
I am interested in hearing how you have managed your visa status in the meanwhile if you're comfortable doing so. Here on SDN we unfortunately have residents on J visas discussing termination. J visas create two problems -- first, the need to leave the US immediately or get another visa (which may be impossible), and second the inability to repeat a PGY year on a J visa in the same specialty. If you're more comfortable answering in PM, that's fine with me.
I went back through this thread and had planned to insert a bunch of your quotes here to help you focus on how to not end up in the same situation again - but then I thought that might just derail this positive outcome. Hopefully this new program will have a different culture and be more supportive. Reviewing your posts, it's clear that you feel strongly about patient advocacy -- and that's a good thing. My advice to you is that if your opinion doesn't match that of the faculty supervising you, that's OK but tread lightly. Advocate for your thoughts in a positive and professional manner. As you have learned, upsetting just a few people in key positions can be catastrophic.
I am interested in hearing how you have managed your visa status in the meanwhile if you're comfortable doing so. Here on SDN we unfortunately have residents on J visas discussing termination. J visas create two problems -- first, the need to leave the US immediately or get another visa (which may be impossible), and second the inability to repeat a PGY year on a J visa in the same specialty. If you're more comfortable answering in PM, that's fine with me.
- Joined
- Mar 6, 2005
- Messages
- 22,281
- Reaction score
- 19,591
+1 on wanting to hear about how you managed the visa issue. This comes up quite frequently and many/most of us who have a lot of knowledge about how the med ed/residency/real worlds work and can answer the most questions, know f*** all about dealing with the visa system. An insider's view would be super helpful.
Thank you for your kind words.
As for the visa, I didn't even know that the 202-E applied to me after termination. I kept applying for residency for the first two years without knowing that there was no legal way for me to get into residency. ECFMG does not offer J-1 visas to dismissed residents, and I was not eligible for an H-1 without completing my two-year home requirement. I completed that requirement, moved to the US on my spouse's visa, and got an EAD.
- Joined
- Oct 11, 2006
- Messages
- 10,796
- Reaction score
- 15,742
Sounds like a tough road, but I'm glad it worked out.
I'm not certain that a dismissed resident cannot get a J visa at all. The EVSP Guide EVSP Reference Guide (ecfmg.org) states that the ECFMG has the right to decline to offer you a J, but it doesn't expressly forbid it. But the problem is the prohibition on redoing the same PGY year - if you're term'ed as a PGY-2 but completed a PGY-1 successfully, you can get stuck -- can't start in a program as a PGY-1 because can't get a J visa for a successfully completed year, and can't start as a PGY-2 as programs may be unwilling to do so given your history. Theoretically can be worked around by applying to a different field, which then does allow you to back up in PGY years (I believe).
Anyway, best of luck.
Similar threads
