Terminated from residency, Applying again, Need advice

[deleted839398]

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Hi everyone,


I am a visa requiring IMG terminated from internal medicine residency in my intern year. Reasons being unable to meet one of the 6 ACGME core competencies; not improving after repeated remediation attempts; unable to perform at the level of an intern. This happened earlier this year. Due to visa regulations, I had to exit the country after termination. I am aware of the mistakes pointed out and since been working very hard to improve my shortcomings. Internal Medicine is always the only field I am interested in and I can't see myself doing anything else. I have applied for the match again this year. I was being truthful in my application. I've explained about my termination in my personal statement, my previous PD is kind enough to write me a decent LOR and also in the ERAS application I have mentioned about my termination. I applied to a total of 103 programs and received 1 interview. My plan is to perform best in this interview and get back again into residency. I have read in several posts here that it is impossible to match into the terminated specialty again and seniors suggesting to go for non-clinical branches like pathology. But my heart goes only for internal medicine and I cannot imagine myself in any other fields. Considering how this year's match went for me, ending up with only 1 interview, although it might seem unethical to withheld information, would it be reasonable to think about considering not to mention the termination in my application next year. I feel like if I get more interviews, I could explain myself to the PDs in person and might succeed in convincing them. Please suggest me the best way to approach this situation in my application. I feel like if I've known a proper way to portray this red flag in my ERAS application, I would have gotten more interviews this year. Please help!

 

[geripalgal]

The liklihood of you getting a spot at this point is very low, PDs would rather have a candidate with zero Redflags. Not disclosing this information would be considered unethical and would be viewed unfavorably (ie if i were a PD and you lied or withheld this information , I would not rank you at all)- your personal statement would be the only place i can see where you try to convince a PD to offer a second chance. Maybe consider a writing service/consultant to make sure your personal statement is as amazing as possible..?

You need to reconsider if you would rather work in any field of medicine that is willing to give you a second shot vs continue trying and likely being unsuccessful with IM alone. If you have the option of continuing to work in your home country while applying, i guess it would be ok to keep trying...

Good luck.

 

[deleted480308]

Would you rather be in fm/path or literally never be a doctor in the US?

That’s the question

 

[GoSpursGo]

If you conceal your termination, even if you somehow score an interview you would immediately go on the "do not rank list" for having such poor judgement. It seems unethical because it IS unethical, and that is a blatant professionalism red flag which you would be unable to recover from.

I get that you really want to do internal medicine, but if you fail to match this year it seems like the resounding message that you need to receive is that you are no longer competitive for that specialty. This isn't a matter of you didn't write a nice enough personal statement or where you could get a little more USCE and be OK. The termination is what it is, and there's probably no coming back from that in the same specialty.

 

[deleted839398]

Being an IMG, FM is more competitive than internal medicine. I am in desperate need of a job. I have expectations and responsibilities to be fulfilled for family. My plan is to pass Step 3 with the highest score possible and apply with a good application to even more programs like 200. I am considering to apply for other specialties as well. But at this point, I can't convince myself and even write a personal statement, why I wanted to be in those specialties. That is not being truthful to myself and the programs, which is again unfair to them.

Please suggest, how to improve my chance of successfully getting into any residency next year. How to best approach my situation. Thanks!

 

[GoSpursGo]

Being an IMG, FM is more competitive than internal medicine. I desperately need a job. I have expectations and responsibilities to be fulfilled for family. My plan is to pass Step 3 with the highest score possible and try again with a good application to even more programs like 200. I am considering to apply for other specialties as well. But at this point, I can't convince myself and even write a personal statement why I wanted to be in those specialties. That is lying as well both to myself and the programs, which is again unfair to them. Why does it have to be so bad for physicians? In other professions, people get fired all the time and acquire new positions within a span of days to months. After going through a hell lot of work and investing lot of resources, why does it have to be so tough for doctors? The sole reason for my termination is, being a foreigner, it took me more time than the fellow AMGs to get acclimatized and become comfortable with the system. Although I realize and acknowledge my weaknesses, I still strongly believe that if I would have been in a program with more IMGs who understands IMG mindset I would be doing fine.

Please suggest whatever you can guys, for me to improve my chance of successfully getting into any residency next year. How to best approach my situation. Thanks!

Believe me, I'm very sympathetic to your plight. It's a brutal situation that you are in. However, the mindset that your program is the SOLE reason you didn't succeed is at best not helpful, and at worst will come off that you lack insight into your weaknesses. If asked in an interview about what you will do differently from your first program to succeed, I definitely would come up with a better answer than "my old program didn't understand the IMG mindset"--YOU are responsible for adapting to how medicine is practiced here, not the other way around.

I don't believe you are correct about FM being "more competitive," I think there are just more applicants. Regardless, I suspect that IM will be "more competitive" for you specifically because, again, you already have been terminated from one IM program. At least an FM program might think that the problem had to do with the faster pace and higher acuity of the specialty rather than a fundamental problem with your medical reasoning.

Hopefully you will shine in your interview and match IM this year. If not, swallow your pride, "lie" about how much you want to be a family medicine physician, and cast a broad net in FM and, if you have the funds for it, IM programs where you didn't apply this year. Right now, I would start looking into ways that you can get letters of recommendation in family medicine in case you do wind up in that situation so that you are not scrambling in the spring.

That's about it--if there was a surefire way to ensure that you'll match I'd tell you, but there's only so much you can do. Apply to a different specialty if it comes to that, and work on that potential application now. Cast a wide net. Step 3 is a good idea.

 

[candbgirl]

What exactly happened at your old program? How far into Intern year were you fired? Was there any improvement during your probation? What are you doing to keep your clinical skills up to date? How are you fixing what are your performance issues? Have you actually seen your old PD’s letter?

 

[atomi]

I am frankly shocked you even got one interview. Getting terminated as an intern takes some serious screwing up. They’ve deemed you untrainable almost immediately. That’s very bad. You need to realize that you were dangerous. Your lack of insight about faults on your end leading to your termination seems to add credence to this fact.

I don’t know how you can properly portray this.

Is there any option for you to train and practice in your home country?

 

[deleted839398]

Thank you for understanding and trying to help out. I really appreciate it. I am sorry if I come off as blaming my program. My program I think did try to help me in their best possible way. But with committees and evaluation systems in place and everything is documented, they have their limitations. I am just trying to take this in a positive note and move on. I completely understand why they had to take that decision putting myself in their shoes. But, I really want programs out there to understand that it is not difficult to fire a resident and be open to listening to his or her story rather than just bluntly rejecting them. Different programs approach struggling residents differently. Some programs try maximum to try to work with the residents to keep them while some try to get rid of them than wasting their time and resources on struggling ones. I just wish some PD out there could relate to my story and give me a chance.

 

[deleted839398]

What exactly happened at your old program? Was there any improvement during your probation? What are you doing to keep your clinical skills up to date? How are you fixing what are your performance issues? Have you actually seen your old PD’s letter?

What exactly happened at your old program? How far into Intern year were you fired?
I was terminated 8 months into my training for the reasons explained above. I don't want to go into detail as I am not intending to dig deep into my past. I got enough suggestions from other posts in the forum regarding why people get terminated and the legal advice etc etc. I am past that. What I am looking for now are my further options and how do I approach this whole situation while applying again.

What are you doing to keep your clinical skills up to date? How are you fixing what are your performance issues?
I am currently working in my home country in a supervised setting.

Have you actually seen your old PD’s letter?
My PD is a nice person and is trying to help. I saw his letter. He mentioned my termination and the reasons leading to it in a subtle way and focused on my strengths. I think, I even have the freedom to discuss with him suggesting him what to mention in the letter. But as a PD he knows better than me, what to mention and what not to mention to help me better in future.

 

[deleted839398]

I am frankly shocked you even got one interview. Getting terminated as an intern takes some serious screwing up. They’ve deemed you untrainable almost immediately. That’s very bad. You need to realize that you were dangerous. Your lack of insight about faults on your end leading to your termination seems to add credence to this fact.

I don’t know how you can properly portray this.

Is there any option for you to train and practice in your home country?

People come and post in this forum for hope and for help. If possible please give them the necessary tools and courage to be able to succeed in life. I am not looking for impressions, I am looking for my options now. You seem like an experienced member in the forum. If you happen to know anyone who was terminated and get back into residency again. Please share their story. I know that it is difficult and not looking for reiterations.

 

[atomi]

People come and post in this forum for hope and for help.

Giving false hope doesn’t help. It hurts. The best help in dealing with reality is unfortunately sometimes a brutal cold reality check. I’m sorry. I know nobody terminated from residency and readmitted.

 

[Shinken]

Considering how this year's match went for me, ending up with only 1 interview, although it might seem unethical to hide information, I am considering not to mention about my termination in the application when applying next year. I feel like if I get more interviews, I could explain myself to the PDs in person and might succeed in convincing them.

I cannot speak for other PDs out there, but for me and the PDs that I know, this would be the kiss of death.

First, it's not hard for us to know there's something going on. The fact that you graduated at a certain year and are applying for residency 2-3 years later tells us there's something going on.

Second, there's a spot in the ERAS application where you have to declare where you've trained before, if you have. Most applicants will leave that empty since most are applying before finishing med school. If you don't declare you were in an IM program, that would be lying in your application.

Third, if you get an interview with me and then I discover that you withheld information on being terminated in the past, you wouldn't be ranked at all. Remember, "the cover-up is worse than the crime."

I desperately need a job. I have expectations and responsibilities to be fulfilled for family. My plan is to pass Step 3 with the highest score possible...

You need to be realistic at this point. Planning to pass Step 3 "with the highest score possible" is not very realistic. And, as a PD, I couldn't care less what your USMLE Step 3 score is, if you were terminated 8 months into your first program. You're not providing much info (which is fine), but my guess is that you weren't terminated because of knowledge deficiency issues, so your board scores are irrelevant.

I echo what other people have already said: Apply broadly, and don't limit yourself to IM only. If you have responsibilities to be fulfilled for your family, then your family should come first, your preference for IM training second. Carefully plan for getting a residency spot to fulfill your responsibility, and if it's not in IM, so be it.

You didn't like Atomi's comments, but he's actually spot on.

Good luck. I hope the single interview you got results in a match.

 

[deleted839398]

I cannot speak for other PDs out there, but for me and the PDs that I know, this would be the kiss of death.

First, it's not hard for us to know there's something going on. The fact that you graduated at a certain year and are applying for residency 2-3 years later tells us there's something going on.

Second, there's a spot in the ERAS application where you have to declare where you've trained before, if you have. Most applicants will leave that empty since most are applying before finishing med school. If you don't declare you were in an IM program, that would be lying in your application.

Third, if you get an interview with me and then I discover that you withheld information on being terminated in the past, you wouldn't be ranked at all. Remember, "the cover-up is worse than the crime."



You need to be realistic at this point. Planning to pass Step 3 "with the highest score possible" is not very realistic. And, as a PD, I couldn't care less what your USMLE Step 3 score is, if you were terminated 8 months into your first program. You're not providing much info (which is fine), but my guess is that you weren't terminated because of knowledge deficiency issues, so your board scores are irrelevant.

I echo what other people have already said: Apply broadly, and don't limit yourself to IM only. If you have responsibilities to be fulfilled for your family, then your family should come first, your preference for IM training second. Carefully plan for getting a residency spot to fulfill your responsibility, and if it's not in IM, so be it.

You didn't like Atomi's comments, but he's actually spot on.

Good luck. I hope the single interview you got results in a match.

Thank you for the valuable input. I really appreciate you taking time and helping out. My plan is to clear step 3 and apply broadly to FM, Pediatrics, Pathology and Internal Medicine. But, after seeing a lot of negativity in the forum, I could not progress myself to the next level. There is no point in keep on reminding myself of the past experiences and incidents that lead to my termination? I made a note of my shortcomings and I am constantly working on them. At this point, I am really past that traumatic experience. I still have post-traumatic blues from my experience.

I did not like Atomi's comment because the way he put it sound rude. Just because I am terminated does not make me any less of a person and judging just by my 1 or 2 comments is not the way I approach a situation.

 

[deleted480308]

FM is not more competitive than IM for you. You are wrong.

You should also get very used to writing about how excited you are about other specialties because you need to in order to have any chance at matching. Don't pretend you are hurting a program by not being in your first choice...

 

[Burnted_out]

People come and post in this forum for hope and for help. If possible please give them the necessary tools and courage to be able to succeed in life. I am not looking for your impressions, I am only looking for my options now. You seem like an experienced member in the forum. If you happen to know anyone who was terminated and get back into residency again. Please share their story. I know that it is difficult and I did not ask for your reiteration.

My opinion - move on from IM. I would be highly highly doubtful that you will get a position. You are entirely in your right to try to apply as many times as you'd like and to as many programs as you'd like but in the end it's unlikely that you'll have a good outcome in IM. First, realize that there are more and more spots in Allo and Osteopathic schools, so IMG/FMGs will be more and more squeezed going forward. That's an objective statement. You already were given a spot and you were terminated. We can't comment on whether it was handled well or not. However it is needless to say that it happened, and while we can't say whether you tried your best or not, the goal is always to try to put your best effort forward once you have a position. Obviously trying to get another position in the same specialty after you were terminated, and apparently put on probabation and remediation prior to that, bodes poorly for you and for anyone really. If I were a PD, I don't think I would hire a resident that was previously terminated from the same specialty. Sometimes some specialties are simply not a good fit. Doesn't make them a bad person, necessarily bad doctors, etc. Sometimes again not a good fit. If I were you I would try a different specialty.

I think it will be practically impossible for you to get another IM spot. IM while not the most competitive field out there is certainly mid range competitive and has more than enough well qualified applicants, many/most with no red flags. You are an IMG, needing a visa, have not only been put on probation, but outright terminated. Many red flags.

Also as someone else pointed out and a massive pet peeve of mine, whatever YOUR mind set is is irrelevant - YOU need to acclimate to how medicine is done HERE in the US. How Medicine is practiced in your country is completely irrelevant and no one cares. And that is probably a contributing factor to what led to your issues likely.

Do yourself a favor and try for something else.

 

[deleted839398]

Thank you, everyone, such valuable suggestions. Could not appreciate everyone for the kind of support you shower. Means a lot. so I already chalked out a plan to do observerships and research in pathology and complete step 3. Next year I wanted to focus more on pathology although I will apply for other branches too. Does it sound a reasonable plan? or Am I still far from reality?

 

[rokshana]

I am sorry, I don't want to be rude or disrespectful or set your perspective straight and please apologize if I am being direct. If you don't have experience or not seen residents who struggled or successful in the past to get into residency again you don't have the right to spread either hope nor despair. What reality you are talking about here? On what basis? Do you have statistical data to prove that a resident who was fired was dangerous and not able to get into another residency program? If you have facts to back yourself then only write such harsh posts. Otherwise please stay silent.

You post here you are going to get what you get...you don’t like it, well you can ignore it...but let’s face it, common sense say you have little to no chance of getting a new spot, especially if the attitude you put out is that you are not responsible but your program didn’t handle it right or give you enough chances...which given that your former PD actually wrote you a not negative letter sounds like BS...

AND you have had an ACTUAL PD come here and tell you that atomi is spot on??!!! You just want someone to tell you that there is hope...your best hope of being able to practice as an IM doc is to stay in your home country...otherwise you need to be more realistic and if your goal is to practice in the US then you need to decide to apply to other specialties that you may get someone to give you a chance...but you have already proven that you can’t do IM in the US.

 

[Burnted_out]

Thank you, everyone, such valuable suggestions. Could not appreciate everyone for the kind of support you shower. Means a lot. so I already chalked out a plan to do observerships and research in pathology and complete step 3. Next year I wanted to focus more on pathology although I will apply for other branches too. Does it sound a reasonable plan? or Am I still far from reality?

I think honestly that you should work in your native country. It seems you have a reasonable situation there, why is there such a desperate need to come to the US? I find it frustrating that people make this appeal as if the US and having a residency position in the US is such a do or die type of thing. I'm sure your nation also needs physicians. I think again that you can apply to as many programs as you'd like as many times as you'd like however, it is unlikely to have a positive result.

A PD will likely be wary of a resident who has been terminated from the same specialty. A new specialty MIGHT give you a chance however put yourself in a PD's shoes - why would they pick someone who will be years out from training, is a foreign grad who has been terminated, needs a visa, etc when they can just pick a new US grad with no red flags? Not trying to be harsh but trying to help you see reality.

Why is it so bad for you to stay in your own country where you are familiar with the language, culture, way of doing things, etc. I don't think anyone here is trying to be negative, just realistic. By your own admission you have gotten only 1 interview. Sure it is possible that you could match there but most likely statistically it's unlikely.

I wish you the best, but hope that you can see that you have a longggg and challenging road ahead. Also I don't know what your step scores have been, but step 3 is certainly a more clinical type of test so if you had difficulty in terms of practice, it is likely that you might have trouble with step 3. Again not trying to dissuade you just being honest. I am a very good clinical physician and have trained here and had challenges with step 3. Good luck.

 

[deleted839398]

Thank you for your advice. But I am here to just see the positive comments and ignore the negative ones. I am sure I will not have trouble passing step 3 with flying colors. My scores in both steps were in 250s. And we all know that Step 3 is not much different from CK. Please read my question clearly, I have not asked any advice regarding my chances of passing Step 3. I know what I am good at and what I am not good at. Why so much pessimism. I was let down several times in my life and I always made sure I proved everybody wrong. I already acknowledged several times that I know it is going to be difficult. But I am ready to face it. All I need is a wee bit of hope. I am ready to invest more years of time and effort if it ends up with a positive result. There is a reason for us IMGs to come to the States, which you never understand unless you come and work in our respective 3rd world countries as a doctor.

 

[Ironheme]

I have been on recruitment committees. It's very rare that we give an interview to someone that has failed out of a program, especially with a lukewarm at best PD letter. We have literally thousands of other people without that red flag. Things that would help would be a PD to PD phone call. Candidates that don't work out in one field or program may work out in another and it says a lot when that resident's PD is willing to advocate for them. Your case does not sound like that. Step 3 score doesn't really change my mind about an applicant. Do NOT lie even by omission on your application - you will have to explain what you've been doing and one of your letters is about your residency program. We will put two and two together, and I would reject your application on the spot without an interview.

Also, you can be a hospitalist as FM. I would not make your personal statement all about IM though. Good luck. Plan for the worst, hope for the best. I would rock that one interview you have and try not to seem desperate. If you don't match, apply broadly next year. The choice you're looking at is not working as a doctor vs working as a doctor in a field that isn't your first choice. Also, I would have a backup plan to medicine at this point. I half suspect you're trolling, or in denial about your chances.

 

[Burnted_out]

Thank you for your advice. But I am here to just see the positive comments and ignore the negative ones. I am sure I will not have any trouble passing step 3 with flying colors. My scores in both steps were in 250s. And we all know that Step 3 is not much different from CK. Please read my question clearly, I have not asked any advice regarding my chances of passing Step 3. I know what I am good at and what I am not good at. Why so much pessimism. I was let down several times in my life and I always made sure I proved everybody wrong. I already acknowledged several times that I know it is going to be difficult. But I am ready to face it. All I need is a wee bit of hope. I am ready to invest 2 more of years of time and effort if it ends up with a positive result. There is a reason for us IMGs to come to the States, which you never understand unless you come and work in our respective 3rd world countries as a doctor.

Ignoring the "negative ones" is not an adult attitude. It's as if I say hey the Oncologist told me I have metastatic cancer, so I'm going to ignore that and just assume all will be well. Even if you get a 280 on Step 3, and even if you invest 2 more years it is unlikely that it will help. That's the point we are all trying to make. It's your choice to have a "positive" attitude, but having an adult, realistic attitude is important too.
I think you are ignoring the most important point - you had a chance at being a doctor in the US, you were given a spot in an IM program and somehow you did not manage to be able to make it far. You were unfortunately terminated at 8months. Something really wrong must have happened. 8months is not a long time, and many interns screw up - that's the nature of internship. You dont' have to tell us what happened, but something clearly of significance happened. It seems that you did not even make it to a second committee meeting since they typically meet twice a year. So again don't have to tell us, but you are ignoring the fact that you had a spot and either you did something rather wrong or were perceived as lazy or with attitude problem, who knows.
Its unlikely that a second change in IM will occur. I've said my peace. Good luck to you.

 

[deleted839398]

Ignoring the "negative ones" is not an adult attitude. It's as if I say hey the Oncologist told me I have metastatic cancer, so I'm going to ignore that and just assume all will be well. Even if you get a 280 on Step 3, and even if you invest 2 more years it is unlikely that it will help. That's the point we are all trying to make. It's your choice to have a "positive" attitude, but having an adult, realistic attitude is important too.
I think you are ignoring the most important point - you had a chance at being a doctor in the US, you were given a spot in an IM program and somehow you did not manage to be able to make it far. You were unfortunately terminated at 8months. Something really wrong must have happened. 8months is not a long time, and many interns screw up - that's the nature of internship. You dont' have to tell us what happened, but something clearly of significance happened. It seems that you did not even make it to a second committee meeting since they typically meet twice a year. So again don't have to tell us, but you are ignoring the fact that you had a spot and either you did something rather wrong or were perceived as lazy or with attitude problem, who knows.
Its unlikely that a second change in IM will occur. I've said my peace. Good luck to you.

Thank you for patiently putting up with me. I hope you understand what I am going through and try to look from my shoes. What has happened has already happened. Even I am not clearly sure why they have to take such a drastic decision. And they never called me into any committee meetings or whatever when they discuss things. There is no good that comes out of it by blaming myself or the program. I part ways on positive terms, being an IMG, I know I can't afford to fight against them. My evaluations in the initial months struggled and I became a soft target for everyone in the program. They wait for every small mistake that I do and mention in my evaluations to build a case against me. Again please don't ask me the reasons for my termination or try to correct my "attitude problem". I am not looking for it. All I need is some hope to continue my journey in the US in any specialty and how to portray myself to future programs.

By reading all the posts, I did see some hope in trying for other specialties and not IM. That is all I wanted. I wanted to know if I am being realistic in trying for other branches at least if not IM. I will build my application in that field. For a non-clinical branch like pathology, how do I address this concern in my application with my PD's support.

 

[deleted480308]

Thank you for patiently putting up with me. I hope you understand what I am going through and try to look from my shoes. What has happened has already happened. Even I am not clearly sure why they have to take such a drastic decision. And they never called me into any committee meetings or whatever when they discuss things. There is no good that comes out of it by blaming myself or the program. I part ways on positive terms, being an IMG, I know I can't afford to fight against them. My evaluations in the initial months struggled and I became a soft target for everyone in the program. They wait for every small mistake that I do and mention in my evaluations to build a case against me. Again please don't ask me the reasons for my termination or try to correct my "attitude problem". I am not looking for it. All I need is some hope to continue my journey in the US in any specialty and how to portray myself to future programs.

You need a plan for how to describe your termination and what you learned to the places you are applying to.....what you have done here so far would end any interview

 

[deleted839398]

You need a plan for how to describe your termination and what you learned to the places you are applying to.....what you have done here so far would end any interview

I am definitely working on it, doctor. I am planning to join in a reputable university or a place where there are path residency for pathology research and secure good LORs in pathology and also work on my personal statement to explain why I struggled in IM and how pathology would be a good fit. My PD also agrees that I am well off in a small community program if I want to try for IM again and he mentioned in my letter as well. He thinks that my previous program was too hectic for me to handle with high patient load and more critical patients. He always tells me that I will do well in a smaller community program with less patient load and more teaching. I definitely think he will support my application to Pathology.

 

[deleted480308]

I am definitely working on it, doctor. I am planning to join in a reputable university or a place where there are path residency for pathology research and secure good LORs in pathology and also work on my personal statement to explain why I struggled in IM and how pathology would be a good fit. My PD also agrees that I am well off in a small community program if I want to try for IM again and he mentioned in my letter as well. He thinks that my previous program was too hectic for me to handle with high patient load and more critical patients. He always tells me that I will do well in a smaller community program with less patient load and more teaching. I definitely think he will support my application to Pathology.

How many patients was too many?

 

[deleted839398]

I have been on recruitment committees. It's very rare that we give an interview to someone that has failed out of a program, especially with a lukewarm at best PD letter. We have literally thousands of other people without that red flag. Things that would help would be a PD to PD phone call. Candidates that don't work out in one field or program may work out in another and it says a lot when that resident's PD is willing to advocate for them. Your case does not sound like that. Step 3 score doesn't really change my mind about an applicant. Do NOT lie even by omission on your application - you will have to explain what you've been doing and one of your letters is about your residency program. We will put two and two together, and I would reject your application on the spot without an interview.

Also, you can be a hospitalist as FM. I would not make your personal statement all about IM though. Good luck. Plan for the worst, hope for the best. I would rock that one interview you have and try not to seem desperate. If you don't match, apply broadly next year. The choice you're looking at is not working as a doctor vs working as a doctor in a field that isn't your first choice. Also, I would have a backup plan to medicine at this point. I half suspect you're trolling, or in denial about your chances.

My PD is willing to help me in any possible way. In fact, he asked me to provide the email ids of the programs I wanted him to email on my behalf. He did send emails to 5 programs, but I have not heard from those programs yet. Please advise, how do I best work with my PD to help me out. He did say that he can't directly fetch me another residency spot. But, said if I wanted him to contact any programs, he is willing to do so on my behalf which he did already.

 

[deleted839398]

How many patients was too many?

8 patients during weekdays and 10 to 12 patients during weekends as an intern. 5 overnight admissions if on night call.

 

[Burnted_out]

You need a plan for how to describe your termination and what you learned to the places you are applying to.....what you have done here so far would end any interview

8 patients during weekdays and 10 to 12 patients during weekends as an intern. 5 overnight admissions if on night call.

I started with 9 new patients my first day, 10 being the avg, more on weekends given coverage for the other intern. 5 admissions is cap for all interns with 2 transfers also, I typically always capped. What you describe is avg at best not high volume. What are you going to see, 5 patients then? Not realistic for someone wanting to do IM.

Also seems your PD is super supportive, not sure where else you’d find someone so willing to help.

 

[deleted839398]

Ignoring the "negative ones" is not an adult attitude. It's as if I say hey the Oncologist told me I have metastatic cancer, so I'm going to ignore that and just assume all will be well. Even if you get a 280 on Step 3, and even if you invest 2 more years it is unlikely that it will help. That's the point we are all trying to make. It's your choice to have a "positive" attitude, but having an adult, realistic attitude is important too.
I think you are ignoring the most important point - you had a chance at being a doctor in the US, you were given a spot in an IM program and somehow you did not manage to be able to make it far. You were unfortunately terminated at 8months. Something really wrong must have happened. 8months is not a long time, and many interns screw up - that's the nature of internship. You dont' have to tell us what happened, but something clearly of significance happened. It seems that you did not even make it to a second committee meeting since they typically meet twice a year. So again don't have to tell us, but you are ignoring the fact that you had a spot and either you did something rather wrong or were perceived as lazy or with attitude problem, who knows.
Its unlikely that a second change in IM will occur. I've said my peace. Good luck to you.

I am not ignoring. What if I already know I have metastatic cancer and people constantly telling me that no matter what I do, it won't heal. Do you want me to take a pill and die? But I did see the point you are trying to make.

 

[deleted839398]

I started with 9 new patients my first day, 10 being the avg, more on weekends given coverage for the other intern. 5 admissions is cap for all interns with 2 transfers also, I typically always capped. What you describe is avg at best not high volume. What are you going to see, 5 patients then? Not realistic for someone wanting to do IM.

I totally agree with you. That is why program has to take such a decision. I am not denying it. They thought that if I could not properly handle 10 patients at a time, how could I handle 2 floors and take 10 admissions as a 2nd year. I saw that they were scared to progress me to 2nd year.

In our program, 1st year is kind of comfortable without ICUs and patient load is okay compared to most New York programs. The responsibility drastically increases in 2nd year. I think I struggled in convincing them that I can handle 2nd year well.

We have a weekly evaluation system where everyone evaluates everyone. The seniors and attendings are very critical and take the evaluations seriously especially the intern ones because 2nd year is definitely a challenge in our program.

 

[Burnted_out]

I am not ignoring. What if I already know I have metastatic cancer and people constantly telling me that no matter what I do, it won't heal. Do you want me to take a pill and die? But I did see the point you are trying to make.

Maybe think Occupational or Preventive med. it’s not that stressful and essentially no call so more manageable. And no I don’t want you to take a pill and die I think you should be realistic.Medicine in the US is a tough and grueling journey and you are not the first IMG I’ve seen struggle or get put on. Probation or terminated. I think part of that has to do with an entitlement mentality. In my internship there were a number of IMGs some were good but many very entitled, lazy, haughty.
Not saying that’s you but that comment about IMG mentality is crap. You are in the US. We don’t adapt to you, you adapt to the US. Good luck

 

[deleted839398]

Maybe think Occupational or Preventive med. it’s not that stressful and essentially no call so more manageable. And no I don’t want you to take a pill and die I think you should be realistic.Medicine in the US is a tough and grueling journey and you are not the first IMG I’ve seen struggle or get put on. Probation or terminated. I think part of that has to do with an entitlement mentality. In my internship there were a number of IMGs some were good but many very entitled, lazy, haughty.
Not saying that’s you but that comment about IMG mentality is crap. You are in the US. We don’t adapt to you, you adapt to the US. Good luck

Haha, not at all, lol. I am not at all entitled. Sometimes, I feel like I should have acted more entitled. I used to be fun, always smiling and cheering intern. I feel like I should have acted more serious like a 'doctor doctor' kind so that people don't come near me. I feel like I allowed everybody to look through my life and it gave them the freedom to take advantage of me. My personality is always like that. No matter what happens I never lose the smile on my face. My cointerns tell me now, they never expected that I am going to be terminated. Because they didn't realize that a lava is burning inside me throughout. Maybe internal medicine is not a right fit for such a personality. But, I thought once I finish residency, I would go for rheumatology or endocrinology, but things ended up pretty bad. I imagined a comfortable life after residency with a less hectic job and a comfortable life style etc etc. But God has different plans.

 

[GoSpursGo]

But I am here to just see the positive comments and ignore the negative ones.

For someone who ostensibly wants to ignore negative comments, you sure are spending a long time replying to them. Nobody is making you reply to them...

That said, I strongly advise you to listen to some more of these negative comments. It seems like on paper you are a very strong applicant, and if you apply broadly to a different specialty next year I kind of suspect that will be enough to get a spot, but if you are this defensive when it comes to criticism in IRL you may well encounter problems at your next residency program as well.

 

[gutonc]

Thank you for your advice. But I am here to just see the positive fantasy comments and ignore the negative ones reality.

Fixed that for you.

 

[Burnted_out]

Fixed that for you.

Is this the Christmas version of gutonc?

 

[mentirita]

I imagined a comfortable life after residency with a less hectic job and a comfortable life style etc etc. But God has different plans.

I am beginning to see a narrative in your situation. Your PD stated you did not do well with the numbers of patients in your first ten months. You stated you were looking for a comfortable life after residency with a less hectic life....

I cant speak to medicine in your country but medicine in the US is hectic for physicians, and the words comfortable and not hectic dont come to mind post residency.

Perhaps you should assess whether you like the fast paced, high number of needy patients coming at you because frankky that is medicine in America.

As for God having different plans, I cant speak for you, but St Paul of Tarsus, St Peter, missionaries, martyrs, and Pope Francis didnt have a comfortable life. Many gave with their life

Just a thought about sacrifice

 

[Burnted_out]

I am beginning to see a narrative in your situation. Your PD stated you did not do well with the numbers of patients in your first ten months. You stated you were looking for a comfortable life after residency with a less hectic life....

I cant speak to medicine in your country but medicine in the US is hectic for physicians, and the words comfortable and not hectic dont come to mind post residency.

Perhaps you should assess whether you like the fast paced, high number of needy patients coming at you because frankky that is medicine in America.

As for God having different plans, I cant speak for you, but St Paul of Tarsus, St Peter, missionaries, martyrs, and Pope Francis didnt have a comfortable life. Many gave with their life

Just a thought about sacrifice

Agreed. Again Im not trying to come down on IMGs, but I have seen this mentality very frequently in numerous that I have interacted with. Obviously there is nothing wrong with having a less hectic and more relaxed life, but Medicine is a grueling journey as I said in the US - there is no golden bride that leads to this magical life of money and relaxation. I would say many of us can indeed have a good lifestyle and enjoy many aspects of life, but life is definitely busy and a medical career will require sacrifice and work. The impression that some IMGs have that they will come, get a residency, try to get by with little work, and then make a ton of money without working that much is not realistic, and not healthy. It also seems that there are many excuses made when probation, termination are handed.

I will never forget that one girl who was a plastic surgery resident and she sued them and claimed discrimination, hostility, etc. after she got fired after her first year. Sure plenty of evals in residency are BS and people certainly become targets, but it is a problem how many IMGs feel entitled. Not trying to come down on OP or suggesting that he was entitled, but I find this concerning.

 

[geripalgal]

I personally know an IMG resident who did very poorly as an intern and couldnt understand why. He got soo much feedback and support, but still felt that he was being ganged up on (maybe the feedback was a little intense and too frequent.and from too many people... everyone was trying to help him, however he took all the feedback negatively ..). It was clear that he wouldnt be able to catch up by midyear and he was recommended to try a diferent field, thats only when he realized the depth of his issues.

In the end he was very very lucky. with the PDs help he matched (scrambled) to another specialty in a different state as a pGy1 and started without an interruption in training the following july. He is doing better now from what I hear.

So it can be done, just probably not in the same specialty and not without the blessing of your PD. Humility, introspection/reflection, and a willingness to work and improve are stepping stones to success.

 

[mvenus929]

I totally agree with you. That is why program has to take such a decision. I am not denying it. They thought that if I could not properly handle 10 patients at a time, how could I handle 2 floors and take 10 admissions as a 2nd year. I saw that they were scared to progress me to 2nd year.

In our program, 1st year is kind of comfortable without ICUs and patient load is okay compared to most New York programs. The responsibility drastically increases in 2nd year. I think I struggled in convincing them that I can handle 2nd year well.

We have a weekly evaluation system where everyone evaluates everyone. The seniors and attendings are very critical and take the evaluations seriously especially the intern ones because 2nd year is definitely a challenge in our program.

Having been a part of remediation plans--getting terminated 8 months into intern year likely isn't a concern of you being unable to handle second year--it's you being unable to meet the demands of intern year. We had residents who we did not want in 'senior' positions early in 2nd year because they failed intern year rotations or generally struggled. All of them advanced to second year, though a few were on probation during that time. The fact that you were put on probation and terminated with only 8 months of time served is a huge red flag.

I'm not asking you to tell us what happened, but you need to be brutally honest with yourself to determine exactly what it is that went wrong and how you would change that with a second chance.

 

[rokshana]

Thank you for patiently putting up with me. I hope you understand what I am going through and try to look from my shoes. What has happened has already happened. Even I am not clearly sure why they have to take such a drastic decision. And they never called me into any committee meetings or whatever when they discuss things. There is no good that comes out of it by blaming myself or the program. I part ways on positive terms, being an IMG, I know I can't afford to fight against them. My evaluations in the initial months struggled and I became a soft target for everyone in the program. They wait for every small mistake that I do and mention in my evaluations to build a case against me. Again please don't ask me the reasons for my termination or try to correct my "attitude problem". I am not looking for it. All I need is some hope to continue my journey in the US in any specialty and how to portray myself to future programs.

By reading all the posts, I did see some hope in trying for other specialties and not IM. That is all I wanted. I wanted to know if I am being realistic in trying for other branches at least if not IM. I will build my application in that field. For a non-clinical branch like pathology, how do I address this concern in my application with my PD's support.

This is still your problem...that you don’t realize that there WAS problem...you take no ownership that the reason you were terminated was because you had core deficiencies that they program leadership felt there was no coming back or ability to improve... you don’t need to tell us why you were terminated... we have been through residency, many of us on both sides, and know what a pain and how difficult it is to actually fire a resident mid year.

Let me put it this way...recently the powerball and mega millions lotteries were close to a billion dollars and I bought a tix... my chance of winning that lottery is the same chance you have of getting another IM residency.

As it had been pointed out, IF You try for a different specialty then you may be able to explain that IM was not for you and MAYBE, someone will give you a shot and that would be the uphill climb that may have a snowballs chance to succeed.

But apparently finances aren’t an issue and if you want to spend all that money go ahead...

And a great step III score is not going to overcome a termination from residency...great scores just mean you can pass the boards.. . It makes no comment of how good a physician you will be...

 

[rokshana]

In my internship there were a number of IMGs some were good but many very entitled, lazy, haughty.

Eh, the same can be said for many of the US Seniors I’ve seen...

 

[CharlieBillings]

Eh, the same can be said for many of the US Seniors I’ve seen...

Any tips to not be like that?

 

[Burnted_out]

Any tips to not be like that?

I think that's an easy one to answer - don't be lazy, entitled or haughty. Be nice, humble, likeable, hard working. Be nice to your patients, be nice to your colleagues.

 

[deleted839398]

This is still your problem...that you don’t realize that there WAS problem...you take no ownership that the reason you were terminated was because you had core deficiencies that they program leadership felt there was no coming back or ability to improve... you don’t need to tell us why you were terminated... we have been through residency, many of us on both sides, and know what a pain and how difficult it is to actually fire a resident mid year.

Let me put it this way...recently the powerball and mega millions lotteries were close to a billion dollars and I bought a tix... my chance of winning that lottery is the same chance you have of getting another IM residency.

As it had been pointed out, IF You try for a different specialty then you may be able to explain that IM was not for you and MAYBE, someone will give you a shot and that would be the uphill climb that may have a snowballs chance to succeed.

But apparently finances aren’t an issue and if you want to spend all that money go ahead...

And a great step III score is not going to overcome a termination from residency...great scores just mean you can pass the boards.. . It makes no comment of how good a physician you will be...

Again, please don't make me repeat. I think a few people are just here to discourage me. I am not listening to you. Please go away. I don't know what your motivations are. I am not going to try to explain myself to you.

 

[deleted839398]

I

Having been a part of remediation plans--getting terminated 8 months into intern year likely isn't a concern of you being unable to handle second year--it's you being unable to meet the demands of intern year. We had residents who we did not want in 'senior' positions early in 2nd year because they failed intern year rotations or generally struggled. All of them advanced to second year, though a few were on probation during that time. The fact that you were put on probation and terminated with only 8 months of time served is a huge red flag.

I'm not asking you to tell us what happened, but you need to be brutally honest with yourself to determine exactly what it is that went wrong and how you would change that with a second chance.

I have already discussed extensively with my program director and my mentor, both said the program is not a right fit for my goals. They both think I would do well in a smaller program or another specialty like FM or pathology. Why is everybody so excited to know what happened in my previous program after I repeatedly said I am not looking for help in that regard. I knew what went wrong and I will work on it. If you know what I am supposed to do now, please share your thoughts.

 

[deleted839398]

If I know I would get bullied for my past repeatedly that I would have done something majorly wrong, not good enough for the US, better stay back in my country etc, I would not have posted here at all. Look at yourself people - if you behave the same way with patients - they are not gonna like you - if a HIV patient comes to you - do you repeatedly say that he/she did a mistake or try to treat him. I think you get my point. I thought this forum would be a right platform to seek help. Rather all I get is repeated bullying.

 

[Burnted_out]

If I know I would get bullied for my past repeatedly that I would have done something majorly wrong, not good enough for the US, better stay back in my country etc, I would not have posted here at all. Look at yourself people - if you behave the same way with patients - they are not gonna like you - if a HIV patient comes to you - do you repeatedly say that he/she did a mistake or try to treat him. I think you get my point. I thought this forum would be a right platform to seek help. Rather all I get is repeated bullying.

If you think this is bullying then as mentioned the fact that you are from another culture and have difficulty understanding social clues likely also had to do with you being terminated. No one here has bullied you. No one here has any intent to do anything other than provide you with helpful advice. The reason why everyone keeps harping on you thinking about what you did wrong is because if you go to an interview and behave like this, then you would likely have 0 chance at matching. Being cognizant of one's mistakes and ways to fix and prevent them in the future is essential. The random statement you made about "us" is also immature and ridiculous. I don't think you can know how any of us are with our patients. If I have a patient that smokes and they have lung cancer, I will continue to tell them they need to quit. Again no one is bullying.
I'm done with this thread.

 

[deleted839398]

If you think this is bullying then as mentioned the fact that you are from another culture and have difficulty understanding social clues likely also had to do with you being terminated. No one here has bullied you. No one here has any intent to do anything other than provide you with helpful advice. The reason why everyone keeps harping on you thinking about what you did wrong is because if you go to an interview and behave like this, then you would likely have 0 chance at matching. Being cognizant of one's mistakes and ways to fix and prevent them in the future is essential. The random statement you made about "us" is also immature and ridiculous. I don't think you can know how any of us are with our patients. If I have a patient that smokes and they have lung cancer, I will continue to tell them they need to quit. Again no one is bullying.
I'm done with this thread.

I know you are trying to help me. But you did not exactly get which aspects I am seeking help in. My question is clear that I am looking for help in regards to how to prepare my application for my next match to have a shot. I am not here looking for help how to change myself to acclimatize to the US system etc. I am constantly saying I knew what went wrong and I am ready to correct myself. I think I can convince the interviewer about what went wrong in my previous program and I have my PD/friends to discuss what to tell and what not to tell. My question was different, the answers I am getting are different.

 

[DarkHorizon]

I know a couple of people that got terminated from ortho residency. They are now in FM. These people were studs and had to settle for what they could get to salvage their careers. It is very unlikely you will continue your training in the US as a visa needing FMG after being terminated. You can get exceptionally lucky, but it would be highly unlikely in IM. Try FM or path, you might get lucky.

Also, what’s wrong with practicing IM back home? I’m sure they need aspiring IM physicians such as yourself.