Back to residency after recommending cannabis

[rainbowdoctor88]

Greeting SDN! Its been a while and I appreciate any input!

I left a residency after intern year on great terms in 2012 (6 months notice, they found a replacement from same institution, No bad blood whatsoever), moved to California, got licensed and started recommending cannabis to pay the bills. Since then I have also worked urgent care at festivals and concerts and done some volunteering, but nothing in the hospital. It has been an interesting experience and I know the healing power of plants is real, especially cannabis.

Nothing bad happened during intern year, I got along great with everyone and did fine in rotations, I just took a chance. I told my PD way early about my intentions.


4 questions????
1- is it possible to enter as a PGY-2?
2- is being a "cannabis doc" a huge red flag (i know it will depend on the program)
3- what should i be doing to match in 2017?
4- what are my chances?

much love and respect

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[IMPD]

Just when you think you've heard every story, SDN comes through with a doozy. Thank you, internet.

Ok. Now, back to your questions.

#1. Almost certainly no. Not sure if there are any FM PDs on any threads, but any credit you get would probably max out at 6 months. That is IM. FM might not even be able to give that much.
#2. For many PDs, yes. But not as much as your initial dropping out was by itself. It shows uncertainty in your mind and makes me worry that when things gets difficult, you will drop out again.
#3. Save cash for applying to literally *every* FM program in the country, cultivate and use whatever connections you have at your home medical school and prior residency to see if you can get a face-to-face with an actual FM PD.
#4. Unknowable. You are not just a below average student anymore. You are a prior grad with a sketchy career decision. Small pro-tip: If completing a residency is your priority, be ready to totally jettison the bontanicals until you are done and gone from training. If you limit your applications to Cannabis-friendly states (which may not have cannabis friendly PDs), you are screwing yourself. If you talk about how great cannabis is to the wrong person, you will literally have your application flushed down the toilet no matter what else happens.

 

[rainbowdoctor88]

IMPD, Thank you for the valuable input and the pro-tip.

How is my story such a "doozy"? The idea of cannabis as a medicine? Or of an MD having the balls to step up and say so? You sound like a nice person, smell the herb, it helps.

What is your preferred remedy for Migraine? Insomnia? Nausea? Epilepsy? Pain?

If I limit my applications to cannabis friendly states how am I screwing myself? By being true to my beliefs? By being able to recommend a safe herb with unlimited uses?

 

[septoplasty]

As a recruitment resident chair, PGY-3 in a great Midwest program.

Honestly, I can't understand why you'd be applying to my program. I think most of the programs will have the following questions (they're rhetorical fyi)..

1. Backup?
2. You can't get anything else?
3. You made a life changing decision, which didn't turn out well, now you think FM will make the best of your situation and "take you"?
4. Why would I chose this person when I have a more "talented" carrib. graduate (not knocking, I myself am one), who doesn't have red flags?

Bottom line is what happens if you make another questionable decision *if* you're accepted into the program? Simple. Fired. But.. the repercussions are felt not only by your fellow residents, but fall the way to the top in terms of increased work.

BTW, I don't have anything personal. My opinions are formulated based on what my committee would *think* about, based on some liberal thought process. I myself don't judge patients who chose marijuana and admit it.

 

[LucidSplash]

IMPD, Thank you for the valuable input and the pro-tip. Your positive outlook on life oozes from your well crafted prose.

How is my story such a "doozy"? The idea of cannabis as a medicine? Or of an MD having the balls to step up and say so? You sound like a dinosaur, come down from your ivory tower and smell the herb, it even helps with anal-retentiveness.

Before you became an administrator, what was your preferred remedy for Migraine? Insomnia? Nausea? Epilepsy? Pain? Informed patients are "literally" "jettisoning" all your crap "down the toilet".

If I limit my applications to cannabis friendly states how am I screwing myself? By being true to my beliefs? By being able to recommend a safe herb with unlimited uses? By partnering with others who practice medicine in the 21st century?

I might be a prior grad who made a sketchy career move, but you sir (or ma'am) are a pompous ass in "*every*" way.

You asked for answers to your questions and he gave you honest ones. You may not like the answers, but they reflect a viewpoint you are likely to experience in many/most places during your quest to enter a FM residency. He suggested you apply widely to improve your chances - most places are going to be wary of someone who quit residency once already (regardless of your particular reason). Limiting yourself to cannabis-friendly states means not applying as widely as you should. You are likely to have a difficult time landing interviews with your track record, that is all.

I will never understand people who ask open-ended questions like "what are my chances" and then get upset when people provide honest responses.

 

[gutonc]

Should also point out that, if you, the OP are a cannabis user yourself, even if you Match successfully, you are likely to lose that spot when you piss positive during the pre-employment physical.

 

[Doctor4Life1769]

If you want to gain brownie points about your love for the Mary Jane, hit up a Naturopathic School.

 

[jonb12997]

 

[RadOncDoc21]

Heh. Autocorrect and/or Freud said "bake" instead of back but I'm gonna just leave it that way...

I think "bake" is more appropriate in this particular setting...

 

[Doctor4Life1769]

Ricky Williams baby

 

[dpmd]

IMPD, Thank you for the valuable input and the pro-tip. Your positive outlook on life oozes from your well crafted prose.

How is my story such a "doozy"? The idea of cannabis as a medicine? Or of an MD having the balls to step up and say so? You sound like a dinosaur, come down from your ivory tower and smell the herb, it even helps with anal-retentiveness.

Before you became an administrator, what was your preferred remedy for Migraine? Insomnia? Nausea? Epilepsy? Pain? Informed patients are "literally" "jettisoning" all your crap "down the toilet".

If I limit my applications to cannabis friendly states how am I screwing myself? By being true to my beliefs? By being able to recommend a safe herb with unlimited uses? By partnering with others who practice medicine in the 21st century?

I might be a prior grad who made a sketchy career move, but you sir (or ma'am) are a pompous ass in "*every*" way.

What an incredibly rude response to an honest helpful answer. Nowhere in his post did he denigrate medical marijuana or even let you know his viewpoint on it (for all you know he is in favor of it). He simply pointed out that not everyone agrees with it and even those that do are still going to have an issue with the fact that you abandoned training to be an herb mill provider and now appear have a very narrowly focused agenda aside from wanting to finish your training. Ignore that if you want and be rude to more people if you wish but that isn't going to help you get in anywhere.

 

[PMR_doc]

Well I'll chime in with my opinion here. I know you didn't ask this but just in case (I like to be efficient), there's really very little chance that you'd get back into PMR even if you want to. If you don't, that's even better. As far as FM, I think it's likely that you would get a spot as long as you apply broadly and don't have many restrictions as far as location and/or where you end up. I think of all specialties, FM is probably by far the most forgiving given the immense need for residents and the work load. Not knocking FM, I just think that's the reality. As a below average grad as you've said you are, I think given your history and the decisions made FM might be a possibility for you.

As far as the cannabis goes, I personally think that while you should disclose it, but not make a big deal out of it. I think not infrequently med grads/residents feel they need to disclose and expound upon everything they have done. I feel that's not the case. Obviously you cannot hide it, but when it comes to residency applications, it's all bout how you frame things and how you package yourself. I say this as someone who has been able to change from one specialty into another without even telling my initial specialty's PD given how difficult they were and had no trouble matching. So I think it would make sense for you to think about how you can package your decisions, which I don't feel were the appropriate ones, but nevertheless the decisions made.

Out of curiosity, did you quick your rehab residency just to go into the MJ business or did you quit for something else and then decide to do the MJ thing? I guess I am not entirely sure why you would quit residency to prescribe MJ.

I wish you luck.

Greeting SDN! Its been a while and I appreciate any input!

I left a PM&R residency after intern year on great terms in 2012 (6 months notice, they found a replacement from same institution, No bad blood whatsoever), moved to California, got licensed and started recommending cannabis to pay the bills. Since then I have also worked urgent care at festivals and concerts and done some volunteering, but nothing in the hospital. It has been an interesting experience and I know the healing power of plants is real, especially cannabis. However, I am too one dimensional and I want to go into Family Medicine. I need the diverse skill set to fullfil my life goals.

IN 2011 I ranked FM, PM&R and EM and obviously ended up in PM&R. Nothing bad happened during intern year, I got along great with everyone and did fine in rotations, I just took a chance. I told my PD way early that I was thinking of dropping out, and the reason I gave was that I was thinking of going into Occ/Env. This was true, but I also wanted to explore California and recommend cannabis. Wow was I naive.

My step one is 192 and step 2 is 212, step 3 i failed once and passed the second time. I was a below average student in a very competitive US allopathic medical school. I also have a masters degree. I am likable and get along great with FM people.

4 questions????
1- is it possible to enter FM as a PGY-2?
2- is being a "cannabis doc" a huge red flag (i know it will depend on the program and I hope to keep recommending it to patients)
3- what should i be doing to match in 2017?
4- what are my chances?

much love and respect

 

[calvnandhobbs68]

IMPD, Thank you for the valuable input and the pro-tip. Your positive outlook on life oozes from your well crafted prose.

How is my story such a "doozy"? The idea of cannabis as a medicine? Or of an MD having the balls to step up and say so? You sound like a dinosaur, come down from your ivory tower and smell the herb, it even helps with anal-retentiveness.

Before you became an administrator, what was your preferred remedy for Migraine? Insomnia? Nausea? Epilepsy? Pain? Informed patients are "literally" "jettisoning" all your crap "down the toilet".

If I limit my applications to cannabis friendly states how am I screwing myself? By being true to my beliefs? By being able to recommend a safe herb with unlimited uses? By partnering with others who practice medicine in the 21st century?

I might be a prior grad who made a sketchy career move, but you sir (or ma'am) are a pompous ass in "*every*" way.

Go smoke some of your herb bro you sound stressed.

 

[rokshana]

IMPD, Thank you for the valuable input and the pro-tip. Your positive outlook on life oozes from your well crafted prose.

How is my story such a "doozy"? The idea of cannabis as a medicine? Or of an MD having the balls to step up and say so? You sound like a dinosaur, come down from your ivory tower and smell the herb, it even helps with anal-retentiveness.

Before you became an administrator, what was your preferred remedy for Migraine? Insomnia? Nausea? Epilepsy? Pain? Informed patients are "literally" "jettisoning" all your crap "down the toilet".

If I limit my applications to cannabis friendly states how am I screwing myself? By being true to my beliefs? By being able to recommend a safe herb with unlimited uses? By partnering with others who practice medicine in the 21st century?

I might be a prior grad who made a sketchy career move, but you sir (or ma'am) are a pompous ass in "*every*" way.

wow...just wow...
IMPD was honest and helpful and you frankly are the ass...

your scores are crap, you abandoned your previous residency to pretty much sell dope...you may want to consider staying in the job you have now...can't imagine any FM residency being that desperate to fill a spot to take you.

 

[NotAProgDirector]

Although you might not want to hear it, IMPD's advice was spot on.

You will need to start an FM residency at the PGY-1 level. You can think about it this way: if you were to start as a PGY-2, you would need to be ready to, on day #1, supervise 1-2 new interns admitting multiple patients to the hospital. If you're not ready for that, which you probably aren't, then you need to start at the PGY-1 level. In addition, starting as a PGY-2 at a new program is always a big challenge, even with adequate clinical skills -- you don't know the EMR, the system, or how to get things done. People will expect a PGY-2 to be moderately independent.

As mentioned, you probably need to tone down the MJ rhetoric as a resident. You can only do what whomever your supervisor will approve you to do. Just because you might be in an MJ lenient state, that doesn't mean that your supervising physicians will OK its use. And, despite what's happening on the state levels, it remains a federally illegal drug and recommending its use might put your DEA license in some jeopardy. Most states that allow medical MJ get around this by having physicians just write a letter of some sort stating the reason for MJ use, not an actual prescription.

From an evidence based standpoint, the evidence for medical MJ is horrible. There was a recent issue of JAMA that had multiple articles and an editorial about it: http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=934167. Even the indications with some supporting evidence have very small sample sizes, and results have been mixed. That doesn't mean that it doesn't work, but I have trouble recommending MJ use to patients based upon current science. And, when the drug you're recommending supposedly works for a zillion completely unrelated problems, one has to wonder how much is hype.

You are welcome to limit yourself to MJ liberal states, but you may find your options / interview offers are limited. As mentioned, you were not a stellar candidate to start, now you're several years out from your graduation, have a failed Step 3 (which you didn't have when you applied the first time). You may not have the luxury of limiting your applications.

As to your "administator" label to @IMPD, most (if not all) PD's remain clinically active. I am a hospitalist, busy as all heck. I'm sure @IMPD is doing lots of clinical work also. Suggesting that you know more about clinical medicine than him/her or me is naive at best, and insulting at worst.

My personal feeling is that we should consider legalizing MJ use completely. It seems no worse than alcohol, and used in moderation is probably fine. It clearly has side effects and abuse potential, but again no different from EtOH. Physicians should get out of the business of recommending it for treatment for anything, unless there is clear evidence of benefit. Some people will see your work as an MJ Doc as simply being a facilitator of unproven therapy -- no different from Dr. Oz and his crap on TV. It is unlikely to be seen as a positive experience -- one where you are doing good for your community or patients. You may not like that assessment, and you have every right to disagree. But you need to convince a program that you are serious about returning to training, that you're ready for the serious commitment it entails, and that you're not going to simply recommend MJ for every patient that you see.

And, as mentioned, you can't be using yourself. At all. Even in states where it is legal, if your program/hospital labels it as an unacceptable substance and it shows up in any drug screen, ever, you will be fired immediately and that will be the end of that.

If your plan was to complete a residency and practice medicine, you made a very poor choice several years ago when you abandoned your training. You are not just going to get a "do-over". You need to earn yourself a new training spot.

 

[Winged Scapula]

Users are reminded to refrain from calling each other names.

One of the double-edged swords of SDN is that users are typically honest with each other, especially in the specialty forums. That means users may hear things they don't want to hear.

 

[Perrotfish]

So the OP asked for his odds and a strategy.

Odds: I think I am with the consensus here is stating that the odds are bad. However I feel like the conversation has focused a bit too much on the cannabis, and has underemphasized the OP's main problem, which is that he is applying to restart training after a 5 year gap. Based on the (limited) history provided by other posters on SDN, a training gap of more than three years, for any reason, seems to be very difficult to overcome even with just 0-1 red flags and full time experience in a primary care/urgent care setting since leaving training. A training gap of 5 years coupled with an equally long gap in true primary care practice is going to be hard to overlook for even the lowest tier programs. Even leaving aside the other red flags of leaving a residency without a terribly compelling reason, a step 3 failure, and the OPs choice of employment, I feel like the OP has a really low chance (like vanishingly low) if his strategy is to just apply. Obviously there aren't a lot of data points for this kind of thing, so I could be wrong, but I don't think that spending a fortune pan-applying to every FM program would be the best short term strategy.

Strategy: Its a long shot, but if it were me I would look in to physician reentry programs. I'm not sure exactly how much they would help the OP, or if they would take him, but if they took the OP I think his bet shot would be to have some recent academic medical experience (and hopefully LORs) behind him. Link: http://www.ama-assn.org/ama/pub/education-careers/finding-position/physician-reentry.page? A structured preceptorship with Drexel in particular seems to be the OP would be looking for: http://www.drexel.edu/medicine/Academics/Continuing-Education/Physician-Refresher-Re-entry-Program/ . Trying to publish some research would, of course, also help

 

[rainbowdoctor88]

Okay this is interesting, Thank you all for the input. I apologize for the name calling. IMPD I am sorry, and I edited my post. I understand you are trying to help, but the way it comes across to me....well I guess thats my problem. Seriously, thank all of you for your thoughts.

I made a decision and am living with the consequences. I left a lot of great people, but I did not abandon anyone. As I said, more than 6 month notice was given, and an inhouse replacement slid right into my spot. No harm, no foul, no increased workload. It all worked out for the program. I have a passion for physiatry, and cannabis has so much utility in MS, migraine, brain injury, GBM, neurodegenerative disease, pain, spasticity, seizure disorders and many more PM&R type complaints, that it was frustrating to me, not being able to use a safe herb to treat these conditions. Patient outcomes could be greatly improved and one day they will. To say that evidence is lacking is rediculous. Life is full of problems, inequalities, and non-sense. My solution was to face this injustice head on. Mistake. Pissing in the wind.

Most people in the program where quite supportive, they did not try to stop me or change my mind. I was rather upfront about my intentions.
I decided to explore the merits of cannabis. I was just naive and foolish to think that I knew everything. It has been an education, one patient at a time. Have I helped people and the community? Do I have thousands of happy patients? Have you heard of the endocannabinoid system? CBD? terpinoids? Have I found a niche that will be of value and provide me an enduring livelyhood? So many questions.

When it comes to cannabis, everyone has a unique viewpoint. Basically I have the opportunity to recommend an effective, safe herb with countless uses. Unless you have worked in this field, you really dont understand what it is like to be able to utilize this treatment modality. I may be one-dimensional, but wow, this herb helps with so many conditions. Most of my days are happy and it is a fullfulling job. I treat sick people and healthy people, men and women, old and young, diabetic and brain damaged, lost and forgotten, poor and rich, famous and infamous, and most of them are appreciative. I have recommended cannabis to thousands of patients, and they have taught me that this herb does have tremendous power in treating a vast range of conditions. Believe it or not, cannabis is an extremely versatile, safe herb, that can be grown virtually anywhere for very little cost. I will never back down from that. It's just the truth. I have heard over and over in life that once you find your truth, you do your best to share it, regardless of who is ready to accept it. Most of the world uses plant based medicine.

So most people are saying that I if I want to get back into residency, I have a hole to dig myself out of, a mountain to climb and brownies to bake for many program directors. I have a huge gap after graduation, I was a below average student, my scores are crap, I made a sketchy choice, and I might have to pee in a cup. Life could be worse.

Honestly some people throw their stones and disrespect me, but being a cannabis doctor has been a dream come true.

 

[rainbowdoctor88]

So the OP asked for his odds and a strategy.

Odds: I think I am with the consensus here is stating that the odds are bad. However I feel like the conversation has focused a bit too much on the cannabis, and has underemphasized the OP's main problem, which is that he is applying to restart training after a 5 gap. Based on the (limited) history provided by other posters on SDN, a training gap of more than three years, for any reason, seems to be very difficult to overcome even with just 0-1 red flags and full time experience in a primary care/urgent care setting since leaving training. A training gap of 5 years coupled with an equally long gap in true primary care practice is going to be hard to overlook for even the lowest tier programs. Even leaving aside the other red flags of leaving a residency without a terribly compelling reason, a step 3 failure, and the OPs choice of employment, I feel like the OP has a really low chance (like vanishingly low) if his strategy is to just apply. Obviously there aren't a lot of data points for this kind of thing, so I could be wrong, but I don't think that spending a fortune pan-applying to every FM program would be the best short term strategy.

Strategy: Its a long shot, but if it were me I would look in to physician reentry programs. I'm not sure exactly how much they would help the OP, or if they would take him, but if they took the OP I think his bet shot would be to have some recent academic medical experience (and hopefully LORs) behind him. Link: http://www.ama-assn.org/ama/pub/education-careers/finding-position/physician-reentry.page? A structured preceptorship with Drexel in particular seems to be the OP would be looking for: http://www.drexel.edu/medicine/Academics/Continuing-Education/Physician-Refresher-Re-entry-Program/ . Trying to publish some research would, of course, also help

Thank you for the guidance. This is very helpful.

 

[calvnandhobbs68]

Just stay where you are and keep prescribing cannabis, it's fairly obvious right now that the only reason you want to complete any type of residency is so you can advance your cannabis prescribing agenda. You haaven't talked about anything else. We haven't heard about any kind of passion for anything else medical that a family doctor would do, so it seems obvious to me that this is just a route for you to legitimize your beliefs about cannabis and maybe help you get your "book deal" and movie with Will Smith. It won't hurt you to apply but if the reason you dropped out of residency was because you couldn't prescribe weed and you don't have any other compelling reason for leaving and your plan is to go prescribe weed again....you can see why program directors would just say to themselves"whats going to stop this guy from doing the same thing again".

 

[j4pac]

This has to be a troll post. Right?

OP...if you aren't a troll...Quite frankly...I'm shocked that you gave up PM&R. The exposure that you have with pain management would have legitimized your weed business. FP is a huge step back in that regard.

Now you recommend marijuana as a treatment option for...well everything...because marijuana is a cure-all. And let's face it...you know nothing about medicine anyway because you are only residency dropout. Migraine vs seizure disorder...doesn't matter...because you may not know the difference, and weed is the treatment to both anyway.

 

[Law2Doc]

... Trying to publish some research would, of course, also help

If the OP took a 180 degree approach, and did some anti-MJ research, maybe demonstrating detrimental brain changes in users, or perhaps debunking the medicinal value for anything other than glaucoma patients or as an anti-emetic for chemo patients, that would make him a much more intriguing applicant, actually.

Truth of the matter is, it doesn't really matter what one's personal views on pot or legalization are. It doesn't even matter if you live in a state where it's legal. At the hospital, you cannot be an advocate of recreational use. Period. Saying it's safer than alcohol or cigarettes isn't a good argument, as both those things, though legal, are horrible for you. If not for a long history those would be illegal too, for very good reason. And an employer can test you for drug use even in a state where it's legal. And the DEA, which licenses you, doesn't yet consider it legal, as mentioned.

So OP, you have to decide what's more important to you, to have a medical career or this agenda. Because you can probably find a way to get back to the former through the path described by Perrotfish, but are most likely to be successful IMHO if you are willing to flush the latter down the drain.

 

[Gastrapathy]

Being a pot doc is a short-term business. All the people getting cards for their "migraines" just want to get high. As legalization occurs, OP will be irrelevant. That's why he's coming back. I love righteous salesmen. The data for pot as a medicine is terrible.

 

[RadOncDoc21]

I'm not sure why but whenever I enter this thread I get the "munchies" and then forget why I even came here in the first place.

 

[rainbowdoctor88]

Being a pot doc is a short-term business. All the people getting cards for their "migraines" just want to get high. As legalization occurs, OP will be irrelevant. That's why he's coming back. I love righteous salesmen. The data for pot as a medicine is terrible.

Not really. Oldest, safest, best medicine on the planet. Most useful plant on the planet. Put down your lancet and wash your hands this is 2016.

 

[rokshana]

Not really. Oldest, safest, best medicine on the planet. Most useful plant on the planet. Put down your lancet and wash your hands this is 2016.

is it really possible for you to tone down the rhetoric? if not...really, going back to residency is not going to be for you...you are going to have to be able to acquiesce to an attending and your seniors...and as has been stated here many times, even if its legal in some states, its still not something you can prescribe or use...

 

[Gastrapathy]

How can a stoner be this uptight and aggressive? So confusing.

 

[dozitgetchahi]

Okay this is interesting, Thank you all for the input. I apologize for the name calling. IMPD I am sorry, and I edited my post. I understand you are trying to help, but the way it comes across to me....well I guess thats my problem. Seriously, thank all of you for your thoughts.

I made a decision and am living with the consequences. I left a lot of great people, but I did not abandon anyone. As I said, more than 6 month notice was given, and an inhouse replacement slid right into my spot. No harm, no foul, no increased workload. It all worked out for the program. I have a passion for physiatry, and cannabis has so much utility in MS, migraine, brain injury, GBM, neurodegenerative disease, pain, spasticity, seizure disorders and many more PM&R type complaints, that it was frustrating to me, not being able to use a safe herb to treat these conditions. Patient outcomes could be greatly improved and one day they will. To say that evidence is lacking is rediculous. Life is full of problems, inequalities, and non-sense. My solution was to face this injustice head on. Mistake. Pissing in the wind.

Most people in the program where quite supportive, they did not try to stop me or change my mind. I was rather upfront about my intentions.
I decided to explore the merits of cannabis. I was just naive and foolish to think that I knew everything. It has been an education, one patient at a time. Have I helped people and the community? Do I have thousands of happy patients? Have you heard of the endocannabinoid system? CBD? terpinoids? Have I found a niche that will be of value and provide me an enduring livelyhood? So many questions.

When it comes to cannabis, everyone has a unique viewpoint. Basically I have the opportunity to recommend an effective, safe herb with countless uses. Unless you have worked in this field, you really dont understand what it is like to be able to utilize this treatment modality. I may be one-dimensional, but wow, this herb helps with so many conditions. Most of my days are happy and it is a fullfulling job. I treat sick people and healthy people, men and women, old and young, diabetic and brain damaged, lost and forgotten, poor and rich, famous and infamous, and most of them are appreciative. I have recommended cannabis to thousands of patients, and they have taught me that this herb does have tremendous power in treating a vast range of conditions. Believe it or not, cannabis is an extremely versatile, safe herb, that can be grown virtually anywhere for very little cost. I will never back down from that. It's just the truth. I have heard over and over in life that once you find your truth, you do your best to share it, regardless of who is ready to accept it. Most of the world uses plant based medicine.

So most people are saying that I if I want to get back into residency, I have a hole to dig myself out of, a mountain to climb and brownies to bake for many program directors. I have a huge gap after graduation, I was a below average student, my scores are crap, I made a sketchy choice, and I might have to pee in a cup. Life could be worse.

Honestly some people throw their stones and disrespect me, but being a cannabis doctor has been a dream come true.

Why you want to abandon this 'specialty' if you feel it is a 'dream come true'?

Setting my personal feelings about cannabis aside, it sounds like you've worked yourself into the type of niche (and lifestyle) that lots of docs out there claim to want - I bet you have good hours, don't need to take insurance etc etc etc.

Why give this up? Is this 'cannabis doctor' niche limiting you somehow?

 

[Perrotfish]

is it really possible for you to tone down the rhetoric? if not...really, going back to residency is not going to be for you...you are going to have to be able to acquiesce to an attending and your seniors...and as has been stated here many times, even if its legal in some states, its still not something you can prescribe or use...

I think the OP would probably do best in a state where Marijuana is completely prohibited, including for medical use. It would be easy enough for the OP to steer clear of this argument during training if its just theoretical, and once he's an attending he can practice how he likes. On the other hand if he's in the half of America where Medical Marijuana is legal he's going to have to choose between protecting his career and being true to his principles every time someone comes in with a migraine.

 

[22031 Alum]

I think the OP would probably do best in a state where Marijuana is completely prohibited, including for medical use. It would be easy enough for the OP to steer clear of this argument during training if its just theoretical, and once he's an attending he can practice how he likes. On the other hand if he's in the half of America where Medical Marijuana is legal he's going to have to choose between protecting his career and being true to his principles every time someone comes in with a migraine.

This is a good point, but I have my doubts about OP being able to transition back into resident life, anywhere. In my experience, the type of programs that tend to take people with that many red flags, tend to also want residents who just shut up and do as they're told.

 

[Goro]

It's not just the pre-Allo or WAMC forums that people come to SDN for hugs and kisses, not for realistic advice.

What an incredibly rude response to an honest helpful answer. Nowhere in his post did he denigrate medical marijuana or even let you know his viewpoint on it (for all you know he is in favor of it). He simply pointed out that not everyone agrees with it and even those that do are still going to have an issue with the fact that you abandoned training to be an herb mill provider and now appear have a very narrowly focused agenda aside from wanting to finish your training. Ignore that if you want and be rude to more people if you wish but that isn't going to help you get in anywhere.

And good for hangnails too!

I have a passion for physiatry, and cannabis has so much utility in MS, migraine, brain injury, GBM, neurodegenerative disease, pain, spasticity, seizure disorders and many more PM&R type complaints, that it was frustrating to me, not being able to use a safe herb to treat these conditions.

An excellent spot remover too!

Not really. Oldest, safest, best medicine on the planet. Most useful plant on the planet. Put down your lancet and wash your hands this is 2016.

 

[Perrotfish]

In my experience ... programs ... want residents who just shut up and do as their told.

Fixed that for you. Anyway I don't think it would be an issue in a state with Marijuana prohibition. His views wouldn't affect his work, so they would be a loveable oddity rather than a problem.

There is a weird dichotomy in medicine when it comes to weed. The pseudo-liberal academic milieu that we all train in means that pretty much every academic physician is in favor of legalizing at least medical marijuana, and usually recreational marijuana as well. However the core of crazy Glenn Beck conservatism that lies at the heart of every attending means that no academic physician is actually in favor of prescribing medical marijuana, for anything, ever. So its great to be in favor of medical marijuana, as long as no one has access to it.

 

[22031 Alum]

Fixed that for you. Anyway I don't think it would be an issue in a state with Marijuana prohibition. His views wouldn't affect his work, so they would be a loveable oddity rather than a problem.

There is a weird dichotomy in medicine when it comes to weed. The pseudo-liberal academic milieu that we all train in means that pretty much every academic physician is in favor of legalizing at least medical marijuana, and usually recreational marijuana as well. However the core of crazy Glenn Beck conservatism that lies at the heart of every attending means that no academic physician is actually in favor of actually prescribing medical marijuana, for anything, ever. So its great to be in favor of medical marijuana, as long as no one has access to it.

1) Why you gotta quote me and not fix my stupid their/they're typo??!!

2) I was alluding to programs I've seen where residents are nothing but workhorses who aren't supposed to think and have their own opinions. In my experience, those tend to be lower-tier programs that take all comers, which is where I think OP is likely to end up given the Step scores/failure, history of quitting a prior residency and the gap in training. Nothing to do with opinions on marijuana. But, if that's the only subject that makes him obnoxious when he hears something he doesn't agree with, he might be fine. If he's going to respond similarly in multiple different circumstances, it's gonna be a problem.

 

[Raryn]

Fixed that for you. Anyway I don't think it would be an issue in a state with Marijuana prohibition. His views wouldn't affect his work, so they would be a loveable oddity rather than a problem.

There is a weird dichotomy in medicine when it comes to weed. The pseudo-liberal academic milieu that we all train in means that pretty much every academic physician is in favor of legalizing at least medical marijuana, and usually recreational marijuana as well. However the core of crazy Glenn Beck conservatism that lies at the heart of every attending means that no academic physician is actually in favor of prescribing medical marijuana, for anything, ever. So its great to be in favor of medical marijuana, as long as no one has access to it.

Plenty of academic oncologists prescribe/recommend/whatever weed to their chemo patients. But in my opinion, end stage cancer patients can have whatever the ---- they want, ranging from weed to fistfuls of morphine.

 

[j4pac]

Plenty of academic oncologists prescribe/recommend/whatever weed to their chemo patients. But in my opinion, end stage cancer patients can have whatever the ---- they want, ranging from weed to fistfuls of morphine.

If you are dying and in severe pain...at least you can be high as a kite while you live out the rest of your life. There is some intrinsic value to that I suppose...even if the pain studies are skeptical about weed.

 

[Raryn]

If you are dying and in severe pain...at least you can be high as a kite while you live out the rest of your life. There is some intrinsic value to that I suppose...even if the pain studies are skeptical about weed.

The studies for chemo related nausea are better than most weed studies as well.

 

[j4pac]

The studies for chemo related nausea are better than most weed studies as well.

And increasing appetite/wt gain. In regards to pain control...the studies suck. But whatever...if someone is left with no other options and we aren't humane enough to allow euthanasia...let them get high.

 

[Apollyon]

cultivate

Haha - you said "cultivate"!

IMPD, Thank you for the valuable input and the pro-tip.

How is my story such a "doozy"? The idea of cannabis as a medicine? Or of an MD having the balls to step up and say so? You sound like a nice person, smell the herb, it helps.

What is your preferred remedy for Migraine? Insomnia? Nausea? Epilepsy? Pain?

If I limit my applications to cannabis friendly states how am I screwing myself? By being true to my beliefs? By being able to recommend a safe herb with unlimited uses?

Okay this is interesting, Thank you all for the input. I apologize for the name calling. IMPD I am sorry, and I edited my post. I understand you are trying to help, but the way it comes across to me....well I guess thats my problem. Seriously, thank all of you for your thoughts.

I made a decision and am living with the consequences. I left a lot of great people, but I did not abandon anyone. As I said, more than 6 month notice was given, and an inhouse replacement slid right into my spot. No harm, no foul, no increased workload. It all worked out for the program. I have a passion for physiatry, and cannabis has so much utility in MS, migraine, brain injury, GBM, neurodegenerative disease, pain, spasticity, seizure disorders and many more PM&R type complaints, that it was frustrating to me, not being able to use a safe herb to treat these conditions. Patient outcomes could be greatly improved and one day they will. To say that evidence is lacking is rediculous. Life is full of problems, inequalities, and non-sense. My solution was to face this injustice head on. Mistake. Pissing in the wind.

Most people in the program where quite supportive, they did not try to stop me or change my mind. I was rather upfront about my intentions.
I decided to explore the merits of cannabis. I was just naive and foolish to think that I knew everything. It has been an education, one patient at a time. Have I helped people and the community? Do I have thousands of happy patients? Have you heard of the endocannabinoid system? CBD? terpinoids? Have I found a niche that will be of value and provide me an enduring livelyhood? So many questions.

When it comes to cannabis, everyone has a unique viewpoint. Basically I have the opportunity to recommend an effective, safe herb with countless uses. Unless you have worked in this field, you really dont understand what it is like to be able to utilize this treatment modality. I may be one-dimensional, but wow, this herb helps with so many conditions. Most of my days are happy and it is a fullfulling job. I treat sick people and healthy people, men and women, old and young, diabetic and brain damaged, lost and forgotten, poor and rich, famous and infamous, and most of them are appreciative. I have recommended cannabis to thousands of patients, and they have taught me that this herb does have tremendous power in treating a vast range of conditions. Believe it or not, cannabis is an extremely versatile, safe herb, that can be grown virtually anywhere for very little cost. I will never back down from that. It's just the truth. I have heard over and over in life that once you find your truth, you do your best to share it, regardless of who is ready to accept it. Most of the world uses plant based medicine.

So most people are saying that I if I want to get back into residency, I have a hole to dig myself out of, a mountain to climb and brownies to bake for many program directors. I have a huge gap after graduation, I was a below average student, my scores are crap, I made a sketchy choice, and I might have to pee in a cup. Life could be worse.

Honestly some people throw their stones and disrespect me, but being a cannabis doctor has been a dream come true.

Dude - honest question - how many more times can you say "herb"? I'm wondering if "meow" is next.

 

[ThoracicGuy]

How can a stoner be this uptight and aggressive? So confusing.

 

[j4pac]

OP...if your legal name is Rainbow Doctor. I would change it before applying to residency.

 

[exsanguination]

Why you want to abandon this 'specialty' if you feel it is a 'dream come true'?

Setting my personal feelings about cannabis aside, it sounds like you've worked yourself into the type of niche (and lifestyle) that lots of docs out there claim to want - I bet you have good hours, don't need to take insurance etc etc etc.

Why give this up? Is this 'cannabis doctor' niche limiting you somehow?

Would love to hear the answers to these questions. It seems like it was a goldmine when the legislation first allowed for MMJ recommendations. Why leave it now other than the slightly "unfortunate" timing of likely legalization within the next 5 years?

It really sounds like the ideal gig: cash based practice, can easily schedule multiple visits per day, and fairly stress-free lifestyle.

Again, I assume it's because of an inundated market, most people already have their cards at this point, or don't need them since marijuana is ubiquitous, and near legalization. Either way, it would be interesting to hear your side Rainbowdoc.

 

[KnuxNole]

There is no evidence of MJ helping with neuro diseases tho...

 

[rainbowdoctor88]

Fun and lively discussion. I want to go back to residency. I made a choice, at the time it was the right one.
I left residency because I was interested in treating patients with cannabis, which I have done for the last three years. I also wanted to live in California. I also had family stressors and other factors. Everything pointed me west. I was interested in the history of its use, its safety profile, lack of side effects, potential to treat a wide range of diseases and symptoms, the therapeutic effects of cultivating of your own medicine, and it personally helped my pain and depression. (before residency obviously)

My job is great. I do have great hours. I don't deal with insurance. Almost every patient leaves happy. I can focus my time on what I think is important. However, it is isolating, I don't get to treat the very sick people in the hospital who really need it, and I have other treatment interests and skills that I am not able to share.

I am not a perfect person and medicine is not a perfect art. Never has been, never will be. A lot of well meaning people have done questionable things in the name of "science". I am not interested in maintaining the status quo, or in pushing the agenda of a multi-national corporation. Lets just relieve suffering. Right?

Is it possible that I am wrong about cannabis? Sure. Maybe all these thousands of people are all lying to me, just to get high. Oh well, at least they arent in jail for it, are sleeping better, eating better, are off their RX meds, laughing and interacting with a plant intelligence that might help them connect with the natural world.
Sorry to be rude to so many, but damn, I have heard the rhetoric a hundred times, and it gets old. Reefer madness, fetal birth defects, schizophrenia, brain changes, laziness, stupidity, doesnt work for pain, gives you boobs, no evidence for effectiveness in this or that, etc. Bullsheet. It works and it is safe. First do no harm? What is preferred for intractable epilepsy? A trial of a safe herb? Or a temporal lobotomy?

How many times have I have heard a patient tell me that their Primary doctor is unsupportive of their cannabis use, or are contractually obligated NOT to discuss? This is why I have a job. And I will have a job after legalization. When did we stop listening to our patients? These patients are already using cannabis and they know it helps! They dont want to take RX meds, or at least they want to minimize their use of them. Don't you? These are successful people, parents, executives, dentists, doctors, movie stars, mega-millionaires, as well as homeless, forgotten meth addicts. No one can tell me that cannabis does not help. Maybe 4 years ago. People need cannabis, and those standing in the way of access need to get out of the way.

It helps with so many conditions, it IS somewhat ridiculous, check out the endocannabinoid system to understand why.
Cannabis is one of the most diverse plant species cultivated. It grows in all 50 states, all over the world and it produces hundreds of compounds, depending on genetics, cultivation techniques, and the way it is used (what temperature it is vaporized, applied topically, ingested, transdermally applied, eye drops, rectally, vaginally, hashish, wax, dabbed).
All weed is not the same, and not all patients are the same. Most think of cannabis as one thing. Nope. Not by a long shot. Thousands of varieties all with unique cannabinoid and terpinoid profiles. It's not just the THC, it's not just the CBD. Its the whole plant. Just as vitamin C by itself is not as effective as Vitamin C with bioflavinoids. The problem with cannabis is that is challenges the single molecule hypothesis that works with FDA approval of pharmaceuticals. Its cheap and easy to produce and process, impossible to patent, it smells great, and it dissolves boundaries.
If I was expounding on the virtues of oxycontin or clonezepam, obviously we would have a problem as these substances have real potential for harm, addiction, abuse and overdose. But we are talking about an ancient plant, utilized for thousands of years without a single case of overdose. Sure, it can be abused. I can use a hammer to smash my thumb, or I can drive a nail. This plant is a powerful tool, always has been, always will be.

So can I tone down my "agenda" so that I can further my career? It does not make sense to my patients or to me, but who says life makes sense?
If I lived in the 1960s and was in love with a person of a different skin tone, would I stop loving them because the laws of my state said I was commiting a crime? No, but I would move to a place where people are cool with that and wait for everyone else to catch up.

I hope that this gives some understanding of why I am doing what I am doing.
It is a goldmine of wellness for patients. It is only growing. Its not even used in the hospital yet. Someday soon it will be vaporized in the hospital for pain, anxiety, asthma, and more. But as an herbal remedy it is tough to standardize and dose. Its no cure-all, and we do need more research, but if it helps, why block access?

I dont think it will be legalized nationally in the next five years. Its all about money. Money to be gained in locking people up, money that will be lost as people don't need their valium, oxy, benzos, sleeping pills or back surgery.

 

[VA Hopeful Dr]

Almost every patient leaves happy.

I bet they do

 

[Law2Doc]

Fun and lively discussion. I want to go back to residency. I made a choice, at the time it was the right one.
I left residency because I was interested in treating patients with cannabis, which I have done for the last three years. I also wanted to live in California. I also had family stressors and other factors. Everything pointed me west. I was interested in the history of its use, its safety profile, lack of side effects, potential to treat a wide range of diseases and symptoms, the therapeutic effects of cultivating of your own medicine, and it personally helped my pain and depression. (before residency obviously)

My job is great. I do have great hours. I don't deal with insurance. Almost every patient leaves happy. I can focus my time on what I think is important. However, it is isolating, I don't get to treat the very sick people in the hospital who really need it, and I have other treatment interests and skills that I am not able to share.

I am not a perfect person and medicine is not a perfect art. Never has been, never will be. A lot of well meaning people have done horrible things in the name of "science". I am not interested in maintaining the status quo, or in pushing the agenda of a multi-national corporation. Lets just relieve suffering. Right?

Is it possible that I am wrong about cannabis? Sure. Maybe all these thousands of people are all lying to me, just to get high. Oh well, at least they arent in jail for it, are sleeping better, eating better, are off their RX meds, laughing and interacting with a plant intelligence that might help them connect with the natural world.
Sorry to be rude to so many, but damn, I have heard the rhetoric a hundred times, and it gets old. Reefer madness, fetal birth defects, schizophrenia, brain changes, laziness, stupidity, doesnt work for pain, gives you boobs, no evidence for effectiveness in this or that, etc. Bullsheet. It works and it is safe. First do no harm? What is preferred for intractable epilepsy? A trial of a safe herb? Or a temporal lobotomy?

How many times have I have heard a patient tell me that their Primary doctor is unsupportive of their cannabis use, or are contractually obligated NOT to discuss? This is why I have a job. And I will have a job after legalization. When did we stop listening to our patients? These patients are already using cannabis and they know it helps! They dont want to take RX meds, or at least they want to minimize their use of them. Don't you? These are successful people, parents, executives, dentists, doctors, movie stars, mega-millionaires, as well as homeless, forgotten meth addicts. No one can tell me that cannabis does not help. Maybe 4 years ago. People need cannabis, and those standing in the way of access need to get out of the way.

It helps with so many conditions, it IS somewhat ridiculous, but take a minute or two to familiarize yourself with the endocannabinoid system.
Cannabis is one of the most diverse plant species cultivated. It grows in all 50 states, all over the world and it produces hundreds of compounds, depending on genetics, cultivation techniques, and the way it is used (what temperature it is vaporized, applied topically, ingested, transdermally applied, eye drops, rectally, vaginally, hashish, wax, dabbed).
All weed is not the same, and not all patients are the same. Most think of cannabis as one thing. Nope. Not by a long shot. Thousands of varieties all with unique cannabinoid and terpinoid profiles. It's not just the THC, it's not just the CBD. Its the whole plant. Just as vitamin C by itself is not as effective as Vitamin C with bioflavinoids. The problem with cannabis is that is challenges the single molecule hypothesis that works with FDA approval of pharmaceuticals. Its cheap and easy to produce and process, impossible to patent, it smells great, and it dissolves boundaries.
If I was expounding on the virtues of oxycontin or clonezepam, obviously we would have a problem as these substances have real potential for harm, addiction, abuse and overdose. But we are talking about an ancient plant, utilized for thousands of years without a single case of overdose. Sure, it can be abused. I can use a hammer to smash my thumb, or I can drive a nail. This plant is a powerful tool, always has been, always will be.

So can I tone down my "agenda" so that I can further my career? It does not make sense to my patients or to me, but who says life makes sense?
If I lived in the 1960s and was in love with a person of a different skin tone would I stop loving them because the laws of my state said I was commiting a crime? No, but I would move to a place where people are cool with that and wait for everyone else to catch up.

I hope that this gives some understanding of why I am doing what I am doing.
It is a goldmine of wellness for patients. It is only growing. Its not even used in the hospital yet. Someday soon it will be vaporized in the hospital for pain, anxiety, asthma, and tons of other things. But as an herbal remedy it is tough to standardize and dose. Its no cure-all, and we do need more research, but if it helps, why block access?

I dont think it will be legalized nationally in the next five years. Its all about money. Money to be gained in locking people up, money that will be lost as people don't need their valium, oxy, benzos, sleeping pills or back surgery.

"It works and it's safe" are conclusions that can only be made following clinical and laboratory trials for each indication. None of these studies have yet been done, largely because in 99.99% of cases this is really about recreational use. But that's irrelevant.

If you want to get into residency you are going to have to wear the hat of an evidenced based medical doctor, not the hat of a pot advocate. You won't be allowed to proscribe or recommend pot to your patients during your training and you may well be subject to drug testing and discipline for drug metabolites in your serum/urine at various points during your training. Because of your vocal position, employers could even be considered negligent if they don't periodically drug check you. And as mentioned you'd actually be a much more compelling applicant for training if this was something you regretted or were embarrassed about, rather than advocating. I wasn't joking when I suggested that doing anti-MJ research might make you a more intriguing applicant. Nobody gives the reigns to a stoner but we all admire the success story who overcomes a habit and works to help others from making the same mistake.

At any rate I see no likelihood for you to get from point a to point b while espousing this agenda, so this whole thread is moot. I personally don't care if people get high in the privacy of their own homes, but I sure wouldn't hire anyone whose advocacy goals are more important to them than the conduct expectations of the job I have to offer.

 

[RangerBob]

Like others, I'm pretty skeptical that you're for real considering you're coming across, as Law2Doc points out, more as a one-sided pot advocate than an evidence-based medicine practitioner. Did you really recommend cannabis to brain injury patients? It's just about the last thing any of them should be using... I hope the brain injuries were at least a number of years old--I just can't believe any physician would do that. You're literally causing more harm than good and impairing their recovery.

I grew up in CA and consider myself a liberal independent. I'm fine with people doing MJ in their own home and I'd certainly be open to patients using it for medicinal purposes if the research was there (which as everyone points out, it's not except for weight gain and nausea in oncology patients). But if I were a PD and saw your postings here I think I would honestly prefer my residency go unfilled than match someone who's putting their political agenda above everything else.

I understand you feel very strongly about MJ, but your primary goal should be doing what's best and what's right for your patient and their health. As a physician that should always be your first priority, not advocating for the use of pot. That means finishing residency to further your medical knowledge. Listen to the advice of people here that know what will best improve your odds of making that happen--you've gotten recommendations from quite a few big names.

 

[KnuxNole]

Seriously, EVERY attending you'll ever encounter in your residency will laugh at your face if you tell them about positive uses of MJ. You can be "that guy", and get pooped on every waking second, or just get a damn residency.

Or just stick with what you are doing now. Make a post without talking about pot.

 

[Doctor4Life1769]

Perfect example of the OP not learning to play the game.
You can have your pro-MJ dreams and habits, advocacy all you want. The idea is to not express them when applying or during your training. Do whatever you want when you finish because after that it's your own license and DEA on the line.

 

[deleted480308]

I do think it's important to note that once recreational weed goes legal that "pot docs" are largely out of business. OP, if you want a residency the cost of that residency will likely be shutting up about weed for a few years.

 

[Doctor4Life1769]

Those marijuana mills are tempting, but not worth it long-term.
OP has now realized that.