Unmatched American MD looking for advice

[MetaWP]

I graduated from medical school in 2015 on an HPSP military scholarship, and then began a military family medicine residency. I was terminated during intern year in due to a long and convoluted story involving recreational substance use (no use at work, 100% clean urine screens over 6 years, no diagnosis of addiction). I got off on the wrong foot with a very heavy-handed program director who viewed me as a liability and forced me out on a technicality at the earliest opportunity.

Anyway, since I was no longer a student, I was ineligible to apply to other residency programs. Additionally, I was ineligible to work as a GMO since I hadn't completed intern year and obtained a full license. Finally, I was ineligible for the NRMP match because I was stuck with the Army for 4 more years. I ended up doing administrative work in the hospital while they worked on involuntarily separating me for failing to maintain branch qualification. The medical board investigated me because I was terminated from a program, but ended up dismissing the case. A NPDB entry was made that noted I was kicked out of residency.

Fast forward to 2019 and I am out of the Army and try for the match. I couldn't score clinical experience as a Soldier since I couldn't get credentialed, but managed to finagle some "shadowing" with local physicians. I took and passed Step 3 (scores were 229/238/227, 1st time passes) and applied broadly, using a letter from my commander/direct supervisor, an old letter from medical school, and 2 new letters from my recent shadowing. Of course I couldn't depend on my old program director for a letter since he hates me.

Unsurprisingly, I got almost no interviews and failed to match/SOAP/scramble. I chalk this up to my 2015 YOG, my lack of recent clinical experience, and the prior residency termination as 3 red flags. I'm still unqualified to gain any real clinical experience, and I have essentially no research experience.

I'm finding myself over-educated and/or under-experienced for positions as a clinical research coordinator/assistant, medical science liaison, and healthcare consultant. I'm looking for PGY-1 vacancies, but I'm not optimistic. I'd consider re-applying for next year's match if I could improve my application, but as far as I can tell that's impossible, and I can't afford to spend a year volunteering or paying for more schooling. I have literally no idea what I'm supposed to do now and would appreciate any and all advice or guidance.

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[LovelyNutella]

I know a US-DO who could not get into a residency. She did MHA, and now work as a residency coordinator for FM.

 

[JustOnePing]

I'm finding myself over-educated and/or under-experienced for positions as a clinical research coordinator/assistant, medical science liaison, and healthcare consultant. I'm looking for PGY-1 vacancies, but I'm not optimistic. I'd consider re-applying for next year's match if I could improve my application, but as far as I can tell that's impossible, and I can't afford to spend a year volunteering or paying for more schooling. I have literally no idea what I'm supposed to do now and would appreciate any and all advice or guidance.

I've heard of unmatched people going to Puerto Rico and completing a 'criollo' internship (basically a non-ACGME internship that is still recognized by the US government for licensing purposes) for several years, usually two, thus allowing them to become licensed as GPs so they could work in federal facilities (prison medicine, etc.) It's not ideal but it's an option. Speaking Spanish is likely necessary.

 

[MetaWP]

I've heard of unmatched people going to Puerto Rico and completing a 'criollo' internship (basically a non-ACGME internship that is still recognized by the US government for licensing purposes) for several years, usually two, thus allowing them to become licensed as GPs so they could work in federal facilities (prison medicine, etc.) It's not ideal but it's an option. Speaking Spanish is likely necessary.

Unfortunately I am a terrible Spanish student. I've taken 7 years of classesand live with a spanish speaker, but cannot hold a conversation to save my life. I'm mono-lingual and the native speakers just go so fast I don't even hear the words. Thanks for the suggestion though!

I know a US-DO who could not get into a residency. She did MHA, and now work as a residency coordinator for FM.

As for the residency coordinator position, it seems to pay less than $50K and I'm not sure if there's career progression there. It certainly wouldn't help in getting back into residency. And if I'm going to invest time and money into getting a masters on top of the education I have already, I'd hope I could earn a bit more than that...

 

[deleted480308]

without a letter from the prior PD, I can't imagine anything happening.

Also, the description of the story would be annoying to me if I was reading it from an applicant. Did you or did you not use banned drugs? own it and don't blame it on a "convoluted story"

 

[MetaWP]

without a letter from the prior PD, I can't imagine anything happening.

Also, the description of the story would be annoying to me if I was reading it from an applicant. Did you or did you not use banned drugs? own it and don't blame it on a "convoluted story"

I did, but I only have 1 page for a personal statement and didn't want to spend much space elaborating on the circumstances. I did use the substance, and I've always been upfront about that, but the circumstances that lead to the firing are in fact quite nuanced. Technically it would be true to say that I was terminated because I had a glass of wine with dinner at a party at the program director's house with the all the other residents. That alone seems hard to believe, which is why the preceding 3 years of story is relevant. Additionally, having met numerous substance abusing/addicted physicians/professionals, I'm loath to simply state something like "I struggle with addiction." The mind goes wild with implications there, especially after having met Doctors who've done surgeries after shooting up heroin, or who've gotten DUIs and reeked of alcohol on the wards. I used mj on my own time in my M1 year and self-disclosed it to a psychiatrist voluntarily, then immediately quit and stayed clean on my first attempt for 7 years and counting, so I feel like some reasoned judgement should apply instead of diving straight into the "addict" bucket. Sometimes I feel like the innocent prisoner being asked to admit my guilt in order to be eligible for parole. Of course I'm not innocent as an angel, but I'm adamant that the punishment has far exceeded the infraction.

 

[deleted480308]

I did, but I only have 1 page for a personal statement and didn't want to spend much space elaborating on the circumstances. I did use the substance, and I've always been upfront about that, but the circumstances that lead to the firing are in fact quite nuanced. Technically it would be true to say that I was terminated because I had a glass of wine with dinner at a party at the program director's house with the all the other residents. That alone seems hard to believe, which is why the preceding 3 years of story is relevant. Additionally, having met numerous substance abusing/addicted physicians/professionals, I'm loath to simply state something like "I struggle with addiction." The mind goes wild with implications there, especially after having met Doctors who've done surgeries after shooting up heroin, or who've gotten DUIs and reeked of alcohol on the wards. I used mj on my own time in my M1 year and self-disclosed it to a psychiatrist voluntarily, then immediately quit and stayed clean on my first attempt for 7 years and counting, so I feel like some reasoned judgement should apply instead of diving straight into the "addict" bucket. Sometimes I feel like the innocent prisoner being asked to admit my guilt in order to be eligible for parole. Of course I'm not innocent as an angel, but I'm adamant that the punishment has far exceeded the infraction.

I’m still lost. You got fired for a beer that the PD served you in their home? Sounds like there are pieces missing

 

[deleted859689]

Was there a behavior issue after you drank that wine? Did you fail a drug test?

 

[MetaWP]

I’m still lost. You got fired for a beer that the PD served you in their home? Sounds like there are pieces missing

That's correct, the PD's wife (also a physician in the residency program) offered me the wine and I accepted. There are many pieces missing, as there were at least 6 distinct events that happened over 3 years, each of which the consequence of the previous one. The wine was simply the straw that broke the camel's back, hence the "convoluted story" I originally referenced. It would take ~300 words to present it all sensibly, but I'm not looking to get into the weeds on this issue here. What's done is done and I'm looking for what to do now.

Was there a behavior issue after you drank that wine? Did you fail a drug test?

I took weekly random drug/alcohol tests for 3 years, followed by 4 years of standard Army random drug tests, 100% of which have always been squeaky clean. I was terminated for integrity violation in that I was on a contract to not consume substances, but was observed to have drank wine. At the time, I knew that one glass of wine on a Friday wouldn't trigger a test on a Monday, and that I don't actually have an alcohol problem, so I was more concerned with "fitting in" with the team. Again though, I'm really here to discuss potential uses of an MD going forward instead of analyzing the details of my termination 4 years ago.

 

[deleted480308]

That's correct, the PD's wife (also a physician in the residency program) offered me the wine and I accepted. There are many pieces missing, as there were at least 6 distinct events that happened over 3 years, each of which the consequence of the previous one. The wine was simply the straw that broke the camel's back, hence the "convoluted story" I originally referenced. It would take ~300 words to present it all sensibly, but I'm not looking to get into the weeds on this issue here. What's done is done and I'm looking for what to do now.



I took weekly random drug/alcohol tests for 3 years, followed by 4 years of standard Army random drug tests, 100% of which have always been squeaky clean. I was terminated for integrity violation in that I was on a contract to not consume substances, but was observed to have drank wine. At the time, I knew that one glass of wine on a Friday wouldn't trigger a test on a Monday, and that I don't actually have an alcohol problem, so I was more concerned with "fitting in" with the team. Again though, I'm really here to discuss potential uses of an MD going forward instead of analyzing the details of my termination 4 years ago.

the details impact the advice.....none of which matters without a PD letter. I'm sorry

 

[NotAProgDirector]

If you're asking about applying for the match again, then we need all the details of your story.

If you're asking what else you can do, unfortunately the answer isn't much. Without one year of GME you can't get a license. There is a thread on here somewhere of a poster who also couldn't get a residency, ended up working in their state insurance office and having a decent career.

Considering leaving medicine, please help?

Hi Everyone, I'm in a bit of a dilemma. I hope you can give me some advice. During my 3rd year of medical school, I realized that clinical medicine/mortality/morbidity caused me to develop incredible anxiety, panic disorder, and an arrhythmia 2/2 to the anxiety. Being on wards makes me...

forums.studentdoctor.net

 

[Gastrapathy]

@MetaWP you’re kinda glossing over the using drugs while in the military thing. You were not off work when you did that, you were on liberty and still AD. You need to just own it.
You aren’t going to get your PD to change his mind but I’m surprised he’s still in the job 5 years later. You havent outlasted him? What you really need is to see your training file from the GME Director’s office and see what that person will write about you. I’m sure they are closed now but I would start there when they reopen.

 

[MetaWP]

@MetaWP you’re kinda glossing over the using drugs while in the military thing. You were not off work when you did that, you were on liberty and still AD. You need to just own it.
You aren’t going to get your PD to change his mind but I’m surprised he’s still in the job 5 years later. You havent outlasted him? What you really need is to see your training file from the GME Director’s office and see what that person will write about you. I’m sure they are closed now but I would start there when they reopen.

I actually wasn't AD when I used, and the use was not the cause of the termination. I'm not "glossing over drug use," I'm just trying to be faithful to the truth without writing an epic story. I've already submitted that story to the medical board and numerous other places, and unless there's a lawyer here looking to represent me, I don't see the value in airing my dirty laundry any more than I already have.

My program director is long gone from the position, but are you suggesting that I'd get a letter from the current PD of the program, who I've never worked with? I could contact the GME director and get some documents, but after only 3 months of training (1 of which was orientation), I can't imagine there's much to work with.

If you're asking about applying for the match again, then we need all the details of your story.

If you're asking what else you can do, unfortunately the answer isn't much. Without one year of GME you can't get a license. There is a thread on here somewhere of a poster who also couldn't get a residency, ended up working in their state insurance office and having a decent career.

Considering leaving medicine, please help?

Hi Everyone, I'm in a bit of a dilemma. I hope you can give me some advice. During my 3rd year of medical school, I realized that clinical medicine/mortality/morbidity caused me to develop incredible anxiety, panic disorder, and an arrhythmia 2/2 to the anxiety. Being on wards makes me...

forums.studentdoctor.net

This is an interesting proposition that I've yet to look into. This is the kind of stuff I've actually been looking for, thank you very much.

 

[Gastrapathy]

The letter from the program would come from the GME office now. So, yes, you need that and it might not be as bad as you think.

 

[deleted480308]

I actually wasn't AD when I used, and the use was not the cause of the termination. I'm not "glossing over drug use," I'm just trying to be faithful to the truth without writing an epic story. I've already submitted that story to the medical board and numerous other places, and unless there's a lawyer here looking to represent me, I don't see the value in airing my dirty laundry any more than I already have.

My program director is long gone from the position, but are you suggesting that I'd get a letter from the current PD of the program, who I've never worked with? I could contact the GME director and get some documents, but after only 3 months of training (1 of which was orientation), I can't imagine there's much to work with.



This is an interesting proposition that I've yet to look into. This is the kind of stuff I've actually been looking for, thank you very much.

You started hpsp in your second year of med school?

This would be so much easier to assess without halfway telling the story

 

[d2305]

You should check into volunteering for NYC. Couldn't hurt your CV.

 

[Mass Effect]

I actually wasn't AD when I used, and the use was not the cause of the termination. I'm not "glossing over drug use," I'm just trying to be faithful to the truth without writing an epic story. I've already submitted that story to the medical board and numerous other places, and unless there's a lawyer here looking to represent me, I don't see the value in airing my dirty laundry any more than I already have

I mean, the value is getting accurate and useful feedback. Not a single person can advise you in any kind of useful way without the details.

 

[LovelyNutella]

@MetaWP you’re kinda glossing over the using drugs while in the military thing. You were not off work when you did that, you were on liberty and still AD. You need to just own it.
You aren’t going to get your PD to change his mind but I’m surprised he’s still in the job 5 years later. You havent outlasted him? What you really need is to see your training file from the GME Director’s office and see what that person will write about you. I’m sure they are closed now but I would start there when they reopen.

You should check into volunteering for NYC. Couldn't hurt your CV.

They already have too many volunteers. People are getting "Thank you for your kind offer. But I regret to inform you" email..
On the tweeter, some new yorkers are complaining about having too many people emailing or calling to volunteer in NYC now

 

[Perrotfish]

So if I am understanding this right:

1) OP had a series of incidents in medical school that caused his superiors to be concerned that he has issues with substance abuse and addiction.

2) Before intern year the OP signed, as a condition of being offered his contract, a clause that he would not use any addictive substance as a condition for continuing residency. Its unclear whether this was a state level impaired physician program, a command level program, or something the PD decided to do on his/her own.

3) In a separate series of incidents, OP really annoyed his PD for reasons not related to drugs.

4) The PD's wife, not knowing about this contract (which she shouldn't) offered him a glass of wine at a party. He drank the glass of wine at the PD's house, thus violating the contract and giving the PD a reason to dismiss him.

5) Being active duty and not having done anything to merit a dishonorable discharge, the Army was obligated to place him in the MSC to serve out his obligation to the military, during which time he has not failed any additional tests and has had no disciplinary issues.

All correct?

 

[Raryn]

So if I am understanding this right:

1) OP had a series of incidents in medical school that caused his superiors to be concerned that he has issues with substance abuse and addiction.

2) Before intern year the OP signed, as a condition of being offered his contract, a clause that he would not use any addictive substance as a condition for continuing residency. Its unclear whether this was a state level impaired physician program, a command level program, or something the PD decided to do on his/her own.

3) In a separate series of incidents, OP really annoyed his PD for reasons not related to drugs.

4) The PD's wife, not knowing about this contract (which she shouldn't) offered him a glass of wine at a party. He drank the glass of wine at the PD's house, thus violating the contract and giving the PD a reason to dismiss him.

5) Being active duty and not having done anything to merit a dishonorable discharge, the Army was obligated to place him in the MSC to serve out his obligation to the military, during which time he has not failed any additional tests and has had no disciplinary issues.

All correct?

That's the impression I got.

Hell, maybe the PD's wife was "testing" him with that wine offer. Who knows?

Regardless, he has a 5 y/o YOG, which even without a prior dismissal is a big problem.

If I were him, I'd reach out to the *current* PD of his former program and see what kind of summative letter they'll be able to put forward. That's the important letter.

 

[MetaWP]

So if I am understanding this right:

1) OP had a series of incidents in medical school that caused his superiors to be concerned that he has issues with substance abuse and addiction.

More or less. I had an incident of concerning professionalism and saw state level impaired physician program, where I self-disclosed use.

2) Before intern year the OP signed, as a condition of being offered his contract, a clause that he would not use any addictive substance as a condition for continuing residency. Its unclear whether this was a state level impaired physician program, a command level program, or something the PD decided to do on his/her own.

Yes, state Physician health contract

3) In a separate series of incidents, OP really annoyed his PD for reasons not related to drugs.

Also true. Mostly by showing up with the contract, which he didn't know about when I got accepted, and which was so burdensome logistically as to threaten my ability to function as an intern.

4) The PD's wife, not knowing about this contract (which she shouldn't) offered him a glass of wine at a party. He drank the glass of wine at the PD's house, thus violating the contract and giving the PD a reason to dismiss him.

Yes

5) Being active duty and not having done anything to merit a dishonorable discharge, the Army was obligated to place him in the MSC to serve out his obligation to the military, during which time he has not failed any additional tests and has had no disciplinary issues.

Almost, except that I couldn't be placed in MSC despite applying for branch transfer. No one knows why, though running assumption is that they were already over-strength. I was separated for failing to maintain branch qualification in MC.

I am going to contact the GME leadership and current PD of the program to see what kind of letter they can generate. I usually waive my right to see letters of recommendation, but I can't imagine waiving my right to see this one. Not sure how big of a deal that is on the application...

 

[MetaWP]

You should check into volunteering for NYC. Couldn't hurt your CV.

Already did. California as well. I am not qualified to do anything

 

[NotAProgDirector]

Mostly by showing up with the contract, which he didn't know about when I got accepted, and which was so burdensome logistically as to threaten my ability to function as an intern.

Wait. So you're telling us that you had some sort of substance abuse contract that limted your ability to function as an intern (probably due to inability to prescribe scheduled meds such as benzos and narcs), didn't tell your program about this, then showed up on day one and told them about these issues, and you were fired? And this is because your PD was "heavy handed"?

 

[Raryn]

Wait. So you're telling us that you had some sort of substance abuse contract that limted your ability to function as an intern (probably due to inability to prescribe scheduled meds such as benzos and narcs), didn't tell your program about this, then showed up on day one and told them about these issues, and you were fired? And this is because your PD was "heavy handed"?

Wow, I didn't even think of that.

Telling them the day the contract was signed, or on match day at the latest would be the more correct thing to do.

 

[Gastrapathy]

He’s Army so it’s a little more complicated even than that.

 

[Mass Effect]

More or less. I had an incident of concerning professionalism and saw state level impaired physician program, where I self-disclosed use.



Yes, state Physician health contract



Also true. Mostly by showing up with the contract, which he didn't know about when I got accepted, and which was so burdensome logistically as to threaten my ability to function as an intern.

Dude...

I know these PHPs often do more harm than good, but once you're under contract, you need to abide by the rules. You PD had every right to be annoyed for not disclosing this contract.

 

[MetaWP]

Wait. So you're telling us that you had some sort of substance abuse contract that limted your ability to function as an intern (probably due to inability to prescribe scheduled meds such as benzos and narcs), didn't tell your program about this, then showed up on day one and told them about these issues, and you were fired? And this is because your PD was "heavy handed"?

No, it limited my ability to function because I had to skip out in the middle of the day every week in order to take a drug test halfway across town, attend 3 AA meetings a week, schedule weekly psychotherapy, weekly meetings with a worksite monitor, monthly meetings with PHP, and have my PD, psychiatrist, and monitor submit monthly and quarterly reports. Otherwise I could prescribe like any other intern. I was told to not inform the residencies during applications by the deans of my medical school. I also had to transfer the contract from one state agency to the other after match but before starting the job, which took time for re-evaluations, contract review, and I was considering a lawyer. The final contract was signed weeks before starting residency, and I then brought it to the PD.

I'm continuing to get replies that ask for further details of this story, and then try and explain to me what I did wrong, as if I'm not fully aware. I acknowledge that I took some missteps, and that there are many things I could have done differently to prevent this outcome. I've agonized over the details for years. I came here asking for advice about what to do now, because I don't have a time machine to fix the past.

 

[deleted480308]

No, it limited my ability to function because I had to skip out in the middle of the day every week in order to take a drug test halfway across town, attend 3 AA meetings a week, schedule weekly psychotherapy, weekly meetings with a worksite monitor, monthly meetings with PHP, and have my PD, psychiatrist, and monitor submit monthly and quarterly reports. Otherwise I could prescribe like any other intern. I was told to not inform the residencies during applications by the deans of my medical school. I also had to transfer the contract from one state agency to the other after match but before starting the job, which took time for re-evaluations, contract review, and I was considering a lawyer. The final contract was signed weeks before starting residency, and I then brought it to the PD.

I'm continuing to get replies that ask for further details of this story, and then try and explain to me what I did wrong, as if I'm not fully aware. I acknowledge that I took some missteps, and that there are many things I could have done differently to prevent this outcome. I've agonized over the details for years. I came here asking for advice about what to do now, because I don't have a time machine to fix the past.

I wouldn’t describe your pd as heavy handed to anyone.they weren’t

 

[46Long]

I know a US-DO who could not get into a residency. She did MHA, and now work as a residency coordinator for FM.

How does one graduate and not land even family practice residencies. Tons of these go unfilled

 

[deleted480308]

How does one graduate and not land even family practice residencies. Tons of these go unfilled

Some missing info there

 

[deleted859689]

How does one graduate and not land even family practice residencies. Tons of these go unfilled

Someone didn’t read the thread.

 

[Mass Effect]

No, it limited my ability to function because I had to skip out in the middle of the day every week in order to take a drug test halfway across town, attend 3 AA meetings a week, schedule weekly psychotherapy, weekly meetings with a worksite monitor, monthly meetings with PHP, and have my PD, psychiatrist, and monitor submit monthly and quarterly reports. Otherwise I could prescribe like any other intern

This is a huge burden to the program you matched at.

I was told to not inform the residencies during applications by the deans of my medical school. I also had to transfer the contract from one state agency to the other after match but before starting the job, which took time for re-evaluations, contract review, and I was considering a lawyer. The final contract was signed weeks before starting residency, and I then brought it to the PD

But the point is that you knew you were under contract, knew you'd be under contract in your new state. You should have said something on Match Day.

I'm continuing to get replies that ask for further details of this story, and then try and explain to me what I did wrong, as if I'm not fully aware. I acknowledge that I took some missteps, and that there are many things I could have done differently to prevent this outcome. I've agonized over the details for years. I came here asking for advice about what to do now, because I don't have a time machine to fix the past.

We wouldn't be pointing these things out if you didn't display a shocking lack of insight. You came into the thread telling us that your PD got you on a technicality because he didn't like you. Had you just come in, said you did some dumb stuff, made lots of mistakes, and got tossed out of residency, we wouldn't be pointing these things out to you. I think the first step to you moving on, either in or out of medicine, is coming to terms with what you did rather than a "heavy-handed" PD and a dismissive attitude about the seriousness of it all.

 

[MetaWP]

This is a huge burden to the program you matched at.

Yes I'm aware. Is your argument that any resident under a PHP contract, which is purportedly signed for the "best interest if the impaired physician," should ideally be terminated from residency instead in order to avoid burdening their program? I didn't want the contract anymore than the PD did, but my hand was forced by a mistake 3 years prior.

But the point is that you knew you were under contract, knew you'd be under contract in your new state. You should have said something on Match Day.

No, I was under a much less burdensome contract in the old state. In hindsight, I should have paid the lawyer and taken it to the board to get it dismissed, but I was too cheap to risk $5000 on the lawyer knowing that there was still a chance that it might end up in the NPDB and permanently affect my career. I was back and forth on this until weeks prior to starting the residency.
[/QUOTE]

We wouldn't be pointing these things out if you didn't display a shocking lack of insight. You came into the thread telling us that your PD got you on a technicality because he didn't like you. Had you just come in, said you did some dumb stuff, made lots of mistakes, and got tossed out of residency, we wouldn't be pointing these things out to you. I think the first step to you moving on, either in or out of medicine, is coming to terms with what you did rather than a "heavy-handed" PD and a dismissive attitude about the seriousness of it all.

I'm not sure how you can have so much more insight than me into my own case when, despite everything I've said here, you are still missing 75% of the story. For example, I was first assured that while accepting the wine was stupid, I would not be punished or reported for the infraction. Later, a separate conversation was overheard from through the wall , erroneously interpreted, and the PD re-thought his decision and decided to use the drink as a tool to terminate me instead. I was never given a chance to explain the misinterpreted conversation. Now, unless you have suggestions for future careers that utilize an MD without residency, I ask kindly that you refrain from continuing to try and pointlessly dig up more details to prove whatever point you think you're making.

 

[deleted480308]

Yes I'm aware. Is your argument that any resident under a PHP contract, which is purportedly signed for the "best interest if the impaired physician," should ideally be terminated from residency instead in order to avoid burdening their program? I didn't want the contract anymore than the PD did, but my hand was forced by a mistake 3 years prior.



No, I was under a much less burdensome contract in the old state. In hindsight, I should have paid the lawyer and taken it to the board to get it dismissed, but I was too cheap to risk $5000 on the lawyer knowing that there was still a chance that it might end up in the NPDB and permanently affect my career. I was back and forth on this until weeks prior to starting the residency.


I'm not sure how you can have so much more insight than me into my own case when, despite everything I've said here, you are still missing 75% of the story. For example, I was first assured that while accepting the wine was stupid, I would not be punished or reported for the infraction. Later, a separate conversation was overheard from through the wall , erroneously interpreted, and the PD re-thought his decision and decided to use the drink as a tool to terminate me instead. I was never given a chance to explain the misinterpreted conversation. Now, unless you have suggestions for future careers that utilize an MD without residency, I ask kindly that you refrain from continuing to try and pointlessly dig up more details to prove whatever point you think you're making.

@Mass Effect gave you good advice. You do seem to display a pretty significant lack of insight and self-responsibility in the way you describe this. It’s possible you have both of things in spades but it sure isn’t coming across and you have to start thinking about that. If you spoke like this about your situation to any PD (and again, without that letter you almost definitely won’t get thst far) I cannot imagine you getting in

i would suggest considering the way you are coming across

 

[deleted859689]

I think OP understands the situation he is in and that he has little chance of finding another residency position. He’s just looking for job suggestions for his MD.

My thoughts were looking for a pharmaceutical company that hires MDs. I searched for a little but most of them require few years clinical experience. Jobs were high $100s, low $200s. I feel for you OP.

 

[MetaWP]

I think OP understands the situation he is in and that he has little chance of finding another residency position. He’s just looking for job suggestions for his MD.

My thoughts were looking for a pharmaceutical company that hires MDs. I searched for a little but most of them require few years clinical experience. Jobs were high $100s, low $200s. I feel for you OP.

This catch-22 of lack of clinical experience has been obstructing both my job search and Match attempts, which is what brought me to this forum seeking guidance. To others, it may seem I'm hiding things or dismissing my past, but I'm really just looking to redirect them to the actual question lol. I'm still hopeful that someone who has been in my shoes sees this and has a success story instead of a career with uber...

 

[Ironheme]

I'm looking for PGY-1 vacancies, but I'm not optimistic.

This is why we're asking for details. Re-entering the match means we need to understand why you lost your residency position in the first place. My advice would be if you manage to end up in another residency (I agree with you that it's a small chance), I would be SQUEAKY CLEAN. No wine, no unrelated workplace conversations. Nothing to even give people a reason to question you.

Jobs for ex-residents is a different question. You might be able to finagle a research position if you have any research experience, and could start with temp agencies to build up the CV if you don't. Pharma pays almost double of academics, so that would be what I'd suggest. You may be able to sell your previous limited clinical experience to working in a clinical research environment.

 

[MetaWP]

This is why we're asking for details. Re-entering the match means we need to understand why you lost your residency position in the first place. My advice would be if you manage to end up in another residency (I agree with you that it's a small chance), I would be SQUEAKY CLEAN. No wine, no unrelated workplace conversations. Nothing to even give people a reason to question you.

Jobs for ex-residents is a different question. You might be able to finagle a research position if you have any research experience, and could start with temp agencies to build up the CV if you don't. Pharma pays almost double of academics, so that would be what I'd suggest. You may be able to sell your previous limited clinical experience to working in a clinical research environment.

I've essentially given up on another residency, and most likely won't even bother applying for the match. Unfortunately, I have literally no research experience because all my spare time in med school (as if there was much to begin with lol) was spent complying with the terms of the PHP contract lol. I've looked at Clinical research coordinator, assistant, and associate roles, but they are always looking for someone with experience, so I've gotten 0 interviews/callbacks. Maybe I'm not looking for the right job titles? Also, are there particular temp agencies that get people into a research environment? I always thought of those as essentially unskilled labor/ filing clerk types of positions...

 

[NotAProgDirector]

Actually, now I feel like I have a much better sense of what happened to the OP and how they ended up in this hole. They ended up getting caught using illegal substances of some sort in medical school. The OP hasn't been totally clear with the details, but it appears it wasn't anything related to being a student. Per the OP, used MJ outside of school, disclosed to psych. The details here matter somewhat -- caught with a small amount of MJ in a strict state is very different from found dealing MJ with bags and scales. Regardless, it happened and escalated to a PHP assessment and plan.

The OP applied for residency, and per advice from his school didn't disclose this. They matched at a program in a different state, with a different PHP. This new PHP was much stricter than the old, and insisted on a much more aggressive contract plan. The OP then showed this plan to their PD, who became very upset. Ultimately they were fired from the program because the PD was upset, the trigger appears to be a glass of wine at a party which probably violated their PHP contract.

OP then appears to be stuck in the military system for several years -- I don't know enough about that to comment. Was unable to get any sort of clinical posting, so worked doing non-clinical jobs. Now is done with military and is looking to restart their career. The OP has reasonable insight into the situation -- getting a residency seems very difficult / impossible, and they are looking for advice about "what else" they can do with their degree.

So:

1. Not to beat a dead horse, but the advice to not disclose your PHP contract was horrible. It's probably true that you don't need to legally disclose it -- it's almost certainly covered by the ADA, and being involved with the PHP gives you some cover. But disclosing it was absolutely the right thing to do. It would have absolutely affected your invites, you would have gotten less. But PD's might know that their state's PHP is much more aggressive. And you probably would have found some programs willing to work with you -- and knowing what the issues were starting, they would have given you much more support. All water under the bridge, but the advice you got was criminal.

2. As far as applying to residency again, I agree it's not looking good. You'd need to network -- get someone to know you and be willing to take a chance. If you're still involved with a recovery network, you could try to network there. I'm sure there are other physicians there. Some meetings are specifically designed for physicians. You could try to sell your story as getting back into clinical work to end up with a career in addiction medicine. You could also try to target programs that are based at a VA -- sometimes they will be very flexible for a fellow soldier / vet. You didn't mention what field you applied to -- your chances are best in the least competitive fields (FM, Neuro, Path).

3. Other career options aren't easy. There's no company out there hiring MD's with no residency. You are going to need to be creative, find your own way. As mentioned already, working for a state insurance commission might be an option. If you have tech skills, you might be able to get some sort of position with one of the EMR companies. People often talk about "research" or "consulting" but neither of those is really an option unless you have some skills to sell. Unfortunately, none of these options has the earning potential of being a clinician.

 

[CalmAndCollected]

I've essentially given up on another residency, and most likely won't even bother applying for the match. Unfortunately, I have literally no research experience because all my spare time in med school (as if there was much to begin with lol) was spent complying with the terms of the PHP contract lol. I've looked at Clinical research coordinator, assistant, and associate roles, but they are always looking for someone with experience, so I've gotten 0 interviews/callbacks. Maybe I'm not looking for the right job titles? Also, are there particular temp agencies that get people into a research environment? I always thought of those as essentially unskilled labor/ filing clerk types of positions...

Hi OP, I feel you, I really do. I don't think you should give up on residency after not matching for a single cycle. I am an IMG who didn't match last cycle and felt my world falling before me, but I learned from my missteps and applied again and got into my first choice in a wonderful program.

With that said, you make a true point of people having done worse things relating to substances who have gotten second chances, and I am sure you deserve as much as a second chance as any of those people do. I don't think lingering on the specifics on what happened five years ago has any value in going forward, so I encourage the discussing to move from morbid curiosity of someone's past to constructive advice.

The biggest issues you are facing here.

1. Lack of guidance. You need to take into account that you are no longer a medical student or in the military, and there is no longer an institution who is looking out for your best interest and make efforts to correct your missteps. You need to find a mentor or group of people who are knowledgeable of how to get into residency into the current day (not just well-meaning but oblivious mentors) and get as much help as you can. I would recommend you look for groups or mentors through resources available for IMGs, as many are in similar boats (past year of graduation, questionable US clinical experiences, lack of knowledge of the system) and find advice and help with them. Many resources for IMGs can help you land better clinical experiences and recommendation letters.

2. Lack of clarity of your situation. You seem to have not gone into detail of the situation yourself, nor offered a letter from your program offering that explanation for you. From a PDs perspective, they are likely to suspect the lack of transparency is because you are trying to minimize the issue, rather than trying to get past it. The most important step here, and probably the most important thing you can do, is reach out to the program you trained and ask for a letter of rec. It might be difficult, but I am sure whoever is PD currently would at least do you the favor of writing a neutral letter that explains the situation of your termination and subsequent and describes your capacity as an intern at the time. If you do one thing to help you next year it is GET A LETTER FROM YOUR OLD PROGRAM.

3. Lack of appropriate letters of recommendation. Your letters of recommendation need to be recent, from physicians who directly supervised your activity and worked closely with you. Have and old letter, one from a mentor who likely hasn't worked with you for years, and two from physicians you merely shadowed are not enough. I cannot stress that you must make an effort to find meaningful clinical rotations like IMGs to get these letters. And remember, one of these letters MUST come from your old program.

4. Lack of meaningful clinical experience. Like above, make sure to obtain this before applying for the next cycle.

5. Apply broadly to an noncompetitive specialty. Many places will reject you, and you need to cast a wide net. Like IMGs, you will likely need to apply into the triple digits, primarily to less competitive specialties, likely IM or FM (although there are plenty of great options like PM&R or Neurology that are less competitive but allow you to be a specialist). I also recommend you use guidance to help you apply appropriately. Your scores are good enough that you shouldn't get filtered out for that reason, so your job is to now convince these programs that you are just as capable as any other applicant.

I hope this is helpful for you. There are many groups and organizations out there that claim to aid disadvantaged applicants like yourself, I would start there, and use them to get connections. Here is a place to start, with organizations vouched for by the AMA:

Observership Program listings for international medical graduates

Find the AMA's Observership Programs to help international medical graduates adapt to the practice of medicine in the United States.

www.ama-assn.org

Establish an observership for international medical graduates

Explore observerships for international medical graduates and the guidelines to apply for an observership program.

www.ama-assn.org

I'm sure reaching out to any of these places would be fruitful in your search.

Don't give up.

 

[Roce33]

If PD is unhelpful, can you ask your former APD for a letter and use it as a substitute? Since you had been in a program you would alway be asked for an LoR from that program leadership on your application.

 

[MetaWP]

Wow, I really appreciate these last few very thoughtful and immensely helpful responses! This last year I applied to 72 programs in FM and got 2 interviews without the letter from my previous PD. I think if I arranged for some observership/externships, I could get some strong letters and maybe match next cycle. My issue is that I'm pretty risk averse, and having spent most of my money on last year's match and step 3, as well as living expenses for 10 months of unemployment, I'm not in a position to afford another 14 months and the cost of these programs at ~$1000/week. If it would surely translate to a residency, I'd take out a personal loan from the bank, but there's still a high risk of not matching. I might have to bite the bullet and roll the dice if I'm still hopelessly floundering over the next couple months...

Given that my current earning potential is minimal/nil, and my path forward is likely spending money on further training, I've also been considering getting a masters. I'm seriously considering an MHA, or maybe even an MBA or MPH. The future earning potential is less, but with my NPDB note, I imagine malpractice insurance would eat a huge chunk of my earnings for the rest of my career as a clinician anyway. It's also a lot less risky in terms of finding steady employment.

Anyone switch fro medicine to healthcare administration, or know someone who has? Please feel free to DM me

 

[Emmet2301]

Could you find a job in the military?

An acquaintance of mine dropped out of medicine and got an MHA so it can be done. (And of course lots of pre-med kids do an MHA instead.)

 

[CluvK]

On the day 1 of orientation starting off my residency, my PD told me two things to avoid: do not do drugs, do not take off your pants.

 

[Franzd'Epinay]

Wow, I really appreciate these last few very thoughtful and immensely helpful responses! This last year I applied to 72 programs in FM and got 2 interviews without the letter from my previous PD. I think if I arranged for some observership/externships, I could get some strong letters and maybe match next cycle. My issue is that I'm pretty risk averse, and having spent most of my money on last year's match and step 3, as well as living expenses for 10 months of unemployment, I'm not in a position to afford another 14 months and the cost of these programs at ~$1000/week. If it would surely translate to a residency, I'd take out a personal loan from the bank, but there's still a high risk of not matching. I might have to bite the bullet and roll the dice if I'm still hopelessly floundering over the next couple months...

Given that my current earning potential is minimal/nil, and my path forward is likely spending money on further training, I've also been considering getting a masters. I'm seriously considering an MHA, or maybe even an MBA or MPH. The future earning potential is less, but with my NPDB note, I imagine malpractice insurance would eat a huge chunk of my earnings for the rest of my career as a clinician anyway. It's also a lot less risky in terms of finding steady employment.

Anyone switch fro medicine to healthcare administration, or know someone who has? Please feel free to DM me

What's your financial situation like? You mentioned serving out your military commitment, so is it safe to assume you don't have huge loan obligations?

If this is the case, I would "roll the dice" as you say and go all out to try to match one more time.

If that doesn't work out (or if you financially cannot wait around to try to match), then it's time to start over, possibly even outside of healthcare entirely. If you're not able to find a job you like with your current resume, then going back to school for a masters is not the worst idea.

 

[Mass Effect]

On the day 1 of orientation starting off my residency, my PD told me two things to avoid: do not do drugs, do not take off your pants.

Wish my Grey's Anatomy wannabee hospital had followed that advice when I was in residency.

 

[throckmortonDO]

If likelihood of residency matching impossible, suggest the following as possible options:

MBA/MHA likely not helpful as you aren't a licensed physician. It may help slightly to become a hospital administrator with MD but likely not have the career outcome you had envisioned.

I would seriously think about some equivalent level of training that also would help with dual degree scenario.

Consider enrolling in a PHD program such as biomedical science, or health physics etc. MD will be an adjunct to that career.

Consider going to law school. MD/JD will help in terms of a career in policy, risk management, med mal defense etc.

 

[Goro]

If likelihood of residency matching impossible, suggest the following as possible options:

MBA/MHA likely not helpful as you aren't a licensed physician. It may help slightly to become a hospital administrator with MD but likely not have the career outcome you had envisioned.

I would seriously think about some equivalent level of training that also would help with dual degree scenario.

Consider enrolling in a PHD program such as biomedical science, or health physics etc. MD will be an adjunct to that career.

Consider going to law school. MD/JD will help in terms of a career in policy, risk management, med mal defense etc.

There's also teaching

 

[b52bomber]

...NP or PA?

Do a bridge program or something and then an online NP.

 

[samac]

...NP or PA?

Do a bridge program or something and then an online NP.

...Are there bridge programs from MD to nursing?