Contract non-renewal :{

[oofline]

Hi,

I had been matched in my program in June 2015. On day 1 I had a panic attack and went to ED. I put my effort got back but I wasn't diagnosed yet. I worked in ED for a month. Tried my best but couldn't pass it. I started IM but couldn't make it far and had to take LOA. Again started yet had to take another LOA as I was still sick and the only psychiatrist I had wasn't convinced I have a problem and termed it adjustment disorder. I restarted again in Sep but on the first day I couldn't make it, had to be admitted to the hospital for severe depression. I remained on LOA for 2.5 months and joined back in Dec. I did my best and tried to grasp everything, I was still in remission and was trying mine best. I was put on remediation and later probation. Program escalated me slowly and I started as PGY-1 in April 2016. I worked through and was back on remediation. I worked since then to December when program put me back in probation saying we want to see if you can become a PGY-2. I worked hard and did whatever I can. My resident advisor's only advice was always to impress us. He never gave me any other input to help me improve. He was more of a newscaster than an advisor to me. At the end of March rotation, he wasn't much happy with me in the rotation as he was my supervising attending. I was told that I won't be given a contract renewal. I tried looking for PGY-2 positions and sending my application. I haven't had many replies yet. The program did not write it officially. Initially, they were also thinking to not to give me 1st-year credit either as they had the concern that I will go to some other state and start practicing e.g in Wisconsin. But being an IMG I cannot as they ask for 24-month credit at least. Now they have decided in meeting that they will give me the credit for 12 months but they don't "think" I am suitable for patient interaction and want me to go to a residency where I have less patient interaction. I have improved a lot and I do not have any difficulty now but they are not convinced yet.
I have asked for an LOR that if they are ok that I go to FM or neuro at least as they do not have as complicated patients as in IM, but they don't seem to be convinced for that either. What options fo I have now?
My PD gave me a pathology elective for next month so I can see if I adjust there. I am getting out of options here. If I opt for pathology I'd be playing a 2018 match and complete my residency in 2022 and may need a fellowship. If I get PGY-2 FM position or psych I can complete them in next 2 years. Which way shall I go? Also is there any other option?
Thanks

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[ThoracicGuy]

Hi,

I had been matched in my program in June 2015. On day 1 I had a panic attack and went to ED. I put my effort got back but I wasn't diagnosed yet. I worked in ED for a month. Tried my best but couldn't pass it. I started IM but couldn't make it far and had to take LOA. Again started yet had to take another LOA as I was still sick and the only psychiatrist I had wasn't convinced I have a problem and termed it adjustment disorder. I restarted again in Sep but on the first day I couldn't make it, had to be admitted to the hospital for severe depression. I remained on LOA for 2.5 months and joined back in Dec. I did my best and tried to grasp everything, I was still in remission and was trying mine best. I was put on remediation and later probation. Program escalated me slowly and I started as PGY-1 in April 2016. I worked through and was back on remediation. I worked since then to December when program put me back in probation saying we want to see if you can become a PGY-2. I worked hard and did whatever I can. My resident advisor's only advice was always to impress us. He never gave me any other input to help me improve. He was more of a newscaster than an advisor to me. At the end of March rotation, he wasn't much happy with me in the rotation as he was my supervising attending. I was told that I won't be given a contract renewal. I tried looking for PGY-2 positions and sending my application. I haven't had many replies yet. The program did not write it officially. Initially, they were also thinking to not to give me 1st-year credit either as they had the concern that I will go to some other state and start practicing e.g in Wisconsin. But being an IMG I cannot as they ask for 24-month credit at least. Now they have decided in meeting that they will give me the credit for 12 months but they don't "think" I am suitable for patient interaction and want me to go to a residency where I have less patient interaction. I have improved a lot and I do not have any difficulty now but they are not convinced yet.
I have asked for an LOR that if they are ok that I go to FM or neuro at least as they do not have as complicated patients as in IM, but they don't seem to be convinced for that either. What options fo I have now?
My PD gave me a pathology elective for next month so I can see if I adjust there. I am getting out of options here. If I opt for pathology I'd be playing a 2018 match and complete my residency in 2022 and may need a fellowship. If I get PGY-2 FM position or psych I can complete them in next 2 years. Which way shall I go? Also is there any other option?
Thanks

You don't have many options here. Your PD obviously does not feel that you are cut out for direct patient work. He's giving you a lifeline with the pathology rotation. Go into it with everything you have. It's likely your only shot at completing a residency. It doesn't sound like they will give you a lor for applying to fm or psych. It doesn't matter how long pathology takes to finish, you career is hanging off the edge of a cliff right now.

 

[deleted480308]

At this stage (fair or not due to medical) you only have the options they say you do. Do whatever you can to make them happy

 

[Shinken]

...if they are ok that I go to FM or neuro at least as they do not have as complicated patients as in IM...

You might want to speak to FM and neurology residents. You will be surprised to find out our patients are just as "complicated."

 

[IM2GI]

Did you have none of these performance related mental health issues during clinical work as a med student?

Honestly seems like direct patient care might not be the best fit for you. Agree that I dont think FM or neurology will be any different. They are so worried about you that they want to make sure you can't get a license to practice medicine in any state. That is pretty damning, regardless of you think you are improving. I've rarely seen a program go to such efforts to make sure someone cant legally treat a patient.

Not sure how you could feel blindsided, as you took multiple LOA, were on formal remidiation and probation. Goodluck to you and your mental health issues. I think your best strategy would have been to get right mentally and not start until that point. I think the multiple start/stops/LOA in addition to poor performance were probably too much.

 

[AdmiralChz]

If I'm reading correctly, it looks like your current program has really tried to make this work. To recap - they've let you stretch out PGY-1 to essentially an April start for mental health reasons, but after a year of remediation and close supervision it looks like they aren't comfortable promoting you to PGY-2 and giving you additional clinical responsibilities.

They might seem mean, but it sounds like they are being honest with you about your ability to care for patients. They are being generous with the Pathology rotation offer. I would get as much feedback from your attending school and PD as possible - a clinical, patient-based career is certainly not out of the question but you need more information about your poor performance. Pathology might be the only option for you.

Finally, I'm a little surprised you do not yet have Step 3. If you apply to path through ERAS this year, I would consider taking it this summer and aiming for a high score to help boost your application.

Real last point - you must get your mental health situation under control. Your health needs to be the first priority BEFORE you embark on another residency. Multiple LOAs are significant red flags and programs will be very interested in knowing that this is a resolved situation before taking a chance on you.

 

[bannie22]

Your situation is tough because even I had a hard time comprehending your post...

All the best

 

[PistolPete]

You might want to speak to FM and neurology residents. You will be surprised to find out our patients are just as "complicated."

Same for psychiatry...

 

[icd22]

Long term, an extra 2 years of residency won't make that much of a difference. I think you should focus primarily on finding the right specialty. I would give path a fare try, especially if you think it will be better for your mental health. Plus, starting as a PGY-2 at a new place, especially when your program is questioning your skills as a PGY-1, on top of having to become familiar with a new system, new staff, new responsibility of supervising interns, might push you over the edge again. You really can't afford as an IMG to not make it again.

 

[NotAProgDirector]

When you say "look for a PGY-2 position", I'm not sure I understand what you mean.
If you're looking for an IM PGY-2 position, that's a big mistake. Your program doesn't feel you're ready for one at their program. Starting a PGY-2 spot at a new program where you know no one, don't know the system, nor the EMR, is a huge mistake. First of all, if your current program says you're not ready, no other program is going to take you as a PGY-2. Second, if you actually did find a program to take you, you're at very high risk of running into problems. This is a bad idea.

If you're looking for an FM PGY-2, that's also a big mistake. Mostly because your IM PGY-1 year probably won't count for FM board certification. And also because of the above. Plus FM includes peds and OB, of which you'll have no experience. Another bad idea.

So, your options are:
1. Pathology. Your IM PGY-1 will count for the IM / prelim parts of a path residency, so you might finish faster.
2. Neuro. A Neuro PGY-2 is basically another PGY-1 like year, so this is a safe plan.
3. IM PGY-1, perhaps for 6 months, at a new program. If you can find a program to take you.
4. FM PGY-1 for 12 months, probably in the match.

 

[oofline]

Did you have none of these performance related mental health issues during clinical work as a med student?

Honestly seems like direct patient care might not be the best fit for you. Agree that I dont think FM or neurology will be any different. They are so worried about you that they want to make sure you can't get a license to practice medicine in any state. That is pretty damning, regardless of you think you are improving. I've rarely seen a program go to such efforts to make sure someone cant legally treat a patient.

Not sure how you could feel blindsided, as you took multiple LOA, were on formal remidiation and probation. Goodluck to you and your mental health issues. I think your best strategy would have been to get right mentally and not start until that point. I think the multiple start/stops/LOA in addition to poor performance were probably too much.

I never had these issues before. I had good LORs from my previous attending in medical school. I have been stable since I came back and working without any problem. It was a disease that struck me. Anybody can have any disease. There was no clinical or professional or behavioral issues


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[oofline]

When you say "look for a PGY-2 position", I'm not sure I understand what you mean.
If you're looking for an IM PGY-2 position, that's a big mistake. Your program doesn't feel you're ready for one at their program. Starting a PGY-2 spot at a new program where you know no one, don't know the system, nor the EMR, is a huge mistake. First of all, if your current program says you're not ready, no other program is going to take you as a PGY-2. Second, if you actually did find a program to take you, you're at very high risk of running into problems. This is a bad idea.

If you're looking for an FM PGY-2, that's also a big mistake. Mostly because your IM PGY-1 year probably won't count for FM board certification. And also because of the above. Plus FM includes peds and OB, of which you'll have no experience. Another bad idea.

So, your options are:
1. Pathology. Your IM PGY-1 will count for the IM / prelim parts of a path residency, so you might finish faster.
2. Neuro. A Neuro PGY-2 is basically another PGY-1 like year, so this is a safe plan.
3. IM PGY-1, perhaps for 6 months, at a new program. If you can find a program to take you.
4. FM PGY-1 for 12 months, probably in the match.

For path: Prelim year of IM is not required for patho and probably won't count for it.

For Neuro: I am applying in programs but the PD and advisor are not willing to give me LOR for those including FM. Although they say you might fit in there.

For IM they won't do it either.
Patho and radio are the 2 options they put in front of me that they can support me in. Then they describe that radio is hard to get and you are stuck with patho only.




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[oofline]

Long term, an extra 2 years of residency won't make that much of a difference. I think you should focus primarily on finding the right specialty. I would give path a fare try, especially if you think it will be better for your mental health. Plus, starting as a PGY-2 at a new place, especially when your program is questioning your skills as a PGY-1, on top of having to become familiar with a new system, new staff, new responsibility of supervising interns, might push you over the edge again. You really can't afford as an IMG to not make it again.

Makes sense. I'm going for patho elective from May 1. Will give my best to it.


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[ThoracicGuy]

For path: Prelim year of IM is not required for patho and probably won't count for it.

For Neuro: I am applying in programs but the PD and advisor are not willing to give me LOR for those including FM. Although they say you might fit in there.

For IM they won't do it either.
Patho and radio are the 2 options they put in front of me that they can support me in. Then they describe that radio is hard to get and you are stuck with patho only.




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If your PD won't support you for neurology or family medicine, the chances of you getting a spot there approaches zero. Pathology is likely your best chance for completing residency.

 

[Dog_luver]

I never had these issues before. I had good LORs from my previous attending in medical school. I have been stable since I came back and working without any problem. It was a disease that struck me. Anybody can have any disease. There was no clinical or professional or behavioral issues


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I'm a bit confused. So on day one of your residency you had a panic attack and went to the ED? I'm not sure what you mean by I worked at the ED for one month. Then you took LOA. You came back to the program and on day one you were hospitalized again? And then you took 2.5 months of LOA. I'm surprised the program would allow that for one, that right there seems like almost 5 months of LOA. So about half the year was missed. I'm not sure how they could promote you even if they wanted to. Then you were remediated, put on probation, remediated again and put on probation again. That's what I'm understanding. Please correct me if I'm wrong. I think that if patient care is so anxiety provoking for you non clinical work might be best.

 

[j4pac]

Life's too short. Don't do something that is going to make you that stressed and miserable.

 

[oofline]

I'm a bit confused. So on day one of your residency you had a panic attack and went to the ED? I'm not sure what you mean by I worked at the ED for one month. Then you took LOA. You came back to the program and on day one you were hospitalized again? And then you took 2.5 months of LOA. I'm surprised the program would allow that for one, that right there seems like almost 5 months of LOA. So about half the year was missed. I'm not sure how they could promote you even if they wanted to. Then you were remediated, put on probation, remediated again and put on probation again. That's what I'm understanding. Please correct me if I'm wrong. I think that if patient care is so anxiety provoking for you non clinical work might be best.

It was 4 blocks of LOA in first 6 blocks. It was not just the anxiety. I was going through a lot of things, during my whole interview season I was going through legal separation and divorce and the process was still continuing while I started residency. For which I had to take multiple trips back and forth from midwest to northeast in between my duty period. Lack of sleep, anxiety, work load and going through rough period of life were all the contributors in that situation. I was living alone as well so nobody was there to point out any change in me which I could tell to my psychiatrist. I was rather interested in getting her clearance letter that I am healthy to work instead of thinking that I might be sick and need help.


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[MediCane2006]

If your PD won't support you for neurology or family medicine, the chances of you getting a spot there approaches zero. Pathology is likely your best chance for completing residency.

Yeah, unfortunately sounds like the PD is going out of his way to ensure this resident doesn't have patient contact (which speaks volumes). I can't imagine a FM or neuro program taking a resident with that background (multiple LOA's, probation) without talking to their prior program first.

Pathology sounds like a no-brainer here

 

[MediCane2006]

I would suggest that you do whatever you can to rectify your situation and get back on track. Trying to match into pathology because you can't handle clinical medicine is not a reason to do pathology and will not do you any service in applying to or practicing pathology. Sounds harsh but that's reality.

Unfortunately it sounds like his/her PD has concerns grave enough that they don't want OP taking care of patients at all. That may make "getting back on track" an insurmountable obstacle.

 

[BoardingDoc]

I would suggest that you do whatever you can to rectify your situation and get back on track. Trying to match into pathology because you can't handle clinical medicine is not a reason to do pathology and will not do you any service in applying to or practicing pathology. Sounds harsh but that's reality.

Account created nearly 6 years ago, first post today. Hi there!

 

[rokshana]

Although we don't physically see our patients, our diagnoses dictate patient management decisions. If the concerns are that severe that they don't want them taking care of patients at all, pathology would not be ideal.

there is a difference between having the skills to interact with patients vs aiding in management decisions... the OP may have the knowledge base to make medical decisions but not excel at personal interaction, hence the pathology push...i mean diagnostic radiology very well could have been an option here, but probably a bit more competitive than the OP could realistically achieve.

 

[Neurologo]

For path: Prelim year of IM is not required for patho and probably won't count for it.

For Neuro: I am applying in programs but the PD and advisor are not willing to give me LOR for those including FM. Although they say you might fit in there.

For IM they won't do it either.
Patho and radio are the 2 options they put in front of me that they can support me in. Then they describe that radio is hard to get and you are stuck with patho only.

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Neurology service will be highly stressful and cause recurrent panic attacks to you as we deal with acute strokes and other obscure and very complex cases. You will be woken up in the middle of the night multiple times by the ED for a large stroke in a young patient or a large brain hemorrhage in an elderly. You will need to think and act rapidly to stop the status epilepticus. ICU RNs will be constantly paging you about unequal pupil sizes, or acute neuro changes suspicious of impending brain herniation or edema. You will have to do a quick exam and make a diagnosis on a young patient with sudden paralysis below the waist and decide quickly what to do next. You will have to do brain death eval in a comatose cardiac arrest patients. You may get a job as a remote EEG reader with zero patient contact, but to get there you need to go through the residency which is filled with the above cases daily. Your panic disorder will suffer more in neurology.

I do not think your PD and attendings are against you but rather trying their best to help you find the best suitable place. They are correct in preventing you from going into neurology.

 

[oofline]

I had some problems at that time but I have been stable since then. My knowledge base is good and I did better than almost all the residents in ITE. Program recognizes all the qualities that I have. It's only that they were not satisfied. And they have funding issues as well. My evaluations were only bad from Med Ed department and no single thing was consistent. All the consultants, community physicians and hospitalists gave me good remarks. Also their concern was most that I won't be able to supervise 2 interns and PD said you'd do okay if you practice alone without supervising anyone. They don't have one single best answer to this situation that they mentioned to me and every time they would point out different thing. Sometimes it's about that you took too much time for the patient other times it would be that you weren't thorough enough. There were no lapse in patient care ever. Neither were any serious events that ever happened. There were minimum calls on my patients overnight and I'd handle most of the stuff in the morning that night team don't have to worry about my patients. I didn't bribe to pass the medical school. It was that I had this health problem which intervened and made me sick enough and getting out of this disease is not that easy. There is no single best test to tell that it's been cured neither there is a full recovery. You have generalized issues which affect you like your memory isn't that sharp as it used to be. Your thinking process is not that rapid and you do feel difficulty. Shouldn't make it that I can't do nothing. Nobody comes this far easily and without hard work.
Everybody have to face difficulties in their life. May be this is for a better thing. Who knows?


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[AdmiralChz]

I had some problems at that time but I have been stable since then. My knowledge base is good and I did better than almost all the residents in ITE. Program recognizes all the qualities that I have. It's only that they were not satisfied. And they have funding issues as well. My evaluations were only bad from Med Ed department and no single thing was consistent. All the consultants, community physicians and hospitalists gave me good remarks. Also their concern was most that I won't be able to supervise 2 interns and PD said you'd do okay if you practice alone without supervising anyone. They don't have one single best answer to this situation that they mentioned to me and every time they would point out different thing. Sometimes it's about that you took too much time for the patient other times it would be that you weren't thorough enough. There were no lapse in patient care ever. Neither were any serious events that ever happened. There were minimum calls on my patients overnight and I'd handle most of the stuff in the morning that night team don't have to worry about my patients. I didn't bribe to pass the medical school. It was that I had this health problem which intervened and made me sick enough and getting out of this disease is not that easy. There is no single best test to tell that it's been cured neither there is a full recovery. You have generalized issues which affect you like your memory isn't that sharp as it used to be. Your thinking process is not that rapid and you do feel difficulty. Shouldn't make it that I can't do nothing. Nobody comes this far easily and without hard work.
Everybody have to face difficulties in their life. May be this is for a better thing. Who knows?


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I think you are starting to realize how different "book" or "test" knowledge is compared to the ability to make quick, informed clinical decisions which appears to be a problem here. A number of years ago my program had to let go a junior resident who consistently scored > 90-95% on all standardized tests, my specialty was a very poor fit and that individual could not act appropriately in an emergency.

Focus on your next steps, and hopefully you can move into pathology which may be less stressful to you. But like any other specialty it has a very important place in the overall healthcare scheme and I would absolutely take the potential career seriously or risk being shut out of clinical medicine altogether.

 

[NRAI2001]

How did you even get into residency???

Like others have said you probably should not have even gotten into your first residency.. it maybe have been better if you didn't get into residency and had time to sort out your mental problems then gotten into a residency at a later date.

I think your program is being very very nice... most would have kicked you out without letting you finish the year. Then they would have contacted the medical board to tell them you are unfit to be a doctor... even after 2 years of residency the PD/residency has to basically give the OK to the board that you are fit to practice before you get any license.

Before I even finished your original post I was thinking you should go for path...it is relatively non-competitive and you are lucky enough that you will finish your PGY1 so you will have more options than others. Take this option before you piss off your program enough that they will no longer support you in this route.

I wish you the best and hope you improve/recover from your mental issues. Remember as long as you are moving forward in your career you ll be ok. There are literally tens of thousands of applicants (IMGs especially) that will kill just to get any residency any location. You could end up liking path (there is no guarantee you would even get into path, I would never take an applicant with so many red flags) or if you don't like it you could attempt to do something else after a few years.

 

[SitraAchra]

How did you even get into residency???

Like others have said you probably should not have even gotten into your first residency..

No one said that, just you. Your "tough talk" isn't necessary. Other than assuming FM and neuro have less complicated patients than IM, the OP seems to have reasonable insight that this is their last chance.

The way you type and make certain phrases bold lets me know the kind of person you are. Total big shot who came here to put down a struggling intern.

 

[Light at end of tunnel]

Does the idea that this particular OP's PD playing god bother anyone else? Last I checked, PD's were in charge of their own particular program type. It seems like a bit of a stretch to assume that simply bc a resident cannot meet one field's criteria, then he or she must somehow be able to complete another field's competencies working under the necessary assumption that the bars are set lower on the other side of the fence.

Additionally, since when did pathology and radiology become the dumping grounds for other program's damaged goods? Strongly implicit in the PD's decree (and it is nothing short of a decree) is that pathology as a field functions just fine without the necessary interpsonal skills that other types of doctors need to succeed. If I were in path, Id take offense to that, but no one seems willing to speak up here.

I am sure someone is offended by the suggestion that any subpar resident (even those with unaddressed mental disabilities) can become a pathologist. Thoughts?

 

[Gastrapathy]

Not playing god, stating what he would support. It's his name on the letter.

 

[Light at end of tunnel]

Not playing god, stating what he would support. It's his name on the letter.

I guess gastra...but I remain a bit taken aback by this especially if the PD also suggested he/she would support a transition to radiology, because, anyone that knows anything about radiology will tell you that it is an interpsonally heavy speciality where you interact with all levels of other specialties on a daily basis.

Im not sure the PD has thought this one out all too well. Simply because they are the PD and have absolute power doesnt mean they are actually right.

Radiologists are real time consultants.

For path: Prelim year of IM is not required for patho and probably won't count for it.

For Neuro: I am applying in programs but the PD and advisor are not willing to give me LOR for those including FM. Although they say you might fit in there.

For IM they won't do it either.
Patho and radio are the 2 options they put in front of me that they can support me in. Then they describe that radio is hard to get and you are stuck with patho only.

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[Winged Scapula]

I guess gastra...but I remain a bit taken aback by this especially if the PD also suggested he/she would support a transition to radiology, because, anyone that knows anything about radiology will tell you that it is an interpsonally heavy speciality where you interact with all levels of other specialties on a daily basis.

Im not sure the PD has thought this one out all too well. Simply because they are the PD and have absolute power doesnt mean they are actually right.

Radiologists are real time consultants.

He (PD) is suggesting the OP consider a field with "less patient interaction" not less interpersonal/interspecialty interaction.

Radiology meets the grade on that one (and yes, there is patient interaction but it is much much less than others) as does Pathology.

 

[oofline]

You can't embark on my position and my abilities by just looking at my post @NRAI2001. If my PD has seen and observed me working me for more than a year he knows BETTER what my abilities and my qualities are than YOU. Just because I am hesitant doesn't mean I am disable. It was better if you didn't comment at all if you don't have anything positive to say.


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[rokshana]

You can't embark on my position and my abilities by just looking at my post @NRAI2001. If my PD has seen and observed me working me for more than a year he knows BETTER what my abilities and my qualities are than YOU. Just because I am hesitant doesn't mean I am disable. It was better if you didn't comment at all if you don't have anything positive to say.


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you are obviously new to sdn if you are expecting any of the above

by your own admission in your original post, your PD thinks you are not cut out for clinical medicine but thinks you could do well elsewhere and recommends pathology...either you agree with your PD or not...if you feel your PD has a better grasp of your abilities than someone on a public forum, then you would follow his advice and look for a path position (which i suspect your PD will be supportive and help with a good LoR), or you don't and you take your chances in trying to find a PGY 2 position...which m/l your PD will not support and at best will give you a neutral letter (which speaks volumes to other PDs) and not be supportive...you have to decide on which way you want to go.

 

[Light at end of tunnel]

you are obviously new to sdn if you are expecting any of the above

by your own admission in your original post, your PD thinks you are not cut out for clinical medicine but thinks you could do well elsewhere and recommends pathology...either you agree with your PD or not...if you feel your PD has a better grasp of your abilities than someone on a public forum, then you would follow his advice and look for a path position (which i suspect your PD will be supportive and help with a good LoR), or you don't and you take your chances in trying to find a PGY 2 position...which m/l your PD will not support and at best will give you a neutral letter (which speaks volumes to other PDs) and not be supportive...you have to decide on which way you want to go.

The danger with taking this particular PD's advice as biblical scripture is that the PD can very well have missed the mark in their assessment of this resident.

What happens if you get into pathology and hate it? Will you be better off there simply because the almighty PD has this crazy idea that it would be a good field for you given your interpersonal shortcomings?

I still think this should have been better thought out.

PD = absolute power, maybe, but that doesnt mean they are good at their jobs, or that their will is your best option.

Last I checked, the only real qualification needed to ascend to the PD throne is being a faculty member.

Be careful.

 

[gutonc]

Crayola? Is that you?

 

[rokshana]

The danger with taking this particular PD's advice as biblical scripture is that the PD can very well have missed the mark in their assessment of this resident.

What happens if you get into pathology and hate it? Will you be better off there simply because the almighty PD has this crazy idea that it would be a good field for you given your interpersonal shortcomings?

I still think this should have been better thought out.

PD = absolute power, maybe, but that doesnt mean they are good at their jobs, or that their will is your best option.

Last I checked, the only real qualification needed to ascend to the PD throne is being a faculty member.

Be careful.

you are missing the point...the OP was fussing at NRAI about know his (the OP) qualifications and abilities and he said that his PD knows him and his abilities than NRAI does...if that is the case, then the OP should go with that, if not , then he needs to make his own decisions, but realize that there can be consequences to that action...and yes, here the PD has the power to make or break you (i sense you have had some experience with that since you seem to have a chip on your shoulder about PDs and the power the wield).

IMO, the OP needs to do what he can to stay in a residency to be able to become a licensable, board eligible, practicing physician and if that means utilizing the support his current PD is willing to give him to get a path residency, so be it...IF the OP's desire is to be in a more clinically oriented residency, then he can try again after completion of the path residency (or do a path fellowship that has more pt interaction) where he won't be as reliant on this PD's recommendation. If what the OP writes is accurate, he will not be able to continue at his current residency and while the OP thinks he is better (which,frankly, is lack of insight on the part of the OP) the consensus seems to be that the higher ups (not just his PD but other attendings, including his own advisor) do not and will not be supportive of him...so whether the OP likes it or not, his choice really is between a possibility of getting a path spot or the improbability of getting a pgy2 spot in his current field (or neuro or FM)...so if he wants a medical career, his "choice" is to go with what his current PD et al will support.

 

[Light at end of tunnel]

you are missing the point...the OP was fussing at NRAI about know his (the OP) qualifications and abilities and he said that his PD knows him and his abilities than NRAI does...if that is the case, then the OP should go with that, if not , then he needs to make his own decisions, but realize that there can be consequences to that action...and yes, here the PD has the power to make or break you (i sense you have had some experience with that since you seem to have a chip on your shoulder about PDs and the power the wield).

IMO, the OP needs to do what he can to stay in a residency to be able to become a licensable, board eligible, practicing physician and if that means utilizing the support his current PD is willing to give him to get a path residency, so be it...IF the OP's desire is to be in a more clinically oriented residency, then he can try again after completion of the path residency (or do a path fellowship that has more pt interaction) where he won't be as reliant on this PD's recommendation. If what the OP writes is accurate, he will not be able to continue at his current residency and while the OP thinks he is better (which,frankly, is lack of insight on the part of the OP) the consensus seems to be that the higher ups (not just his PD but other attendings, including his own advisor) do not and will not be supportive of him...so whether the OP likes it or not, his choice really is between a possibility of getting a path spot or the improbability of getting a pgy2 spot in his current field (or neuro or FM)...so if he wants a medical career, his "choice" is to go with what his current PD et al will support.

We give people in authority too much implicit trust and authority. PD's put their pants on one leg at a time like everypne else. We should be weighing all options and doing due diligence, not simply moving with swift haste to bend to others' will just because thats what the medical hierarchy has forcibly ingrained in us.

I question admin on SDN, does that mean I have an SDN chip on my shoulder? (Please refer to the recent @Jalby fiasco if you would like documented proof), but I can honestly say mods and admin have been good to me. I still question their decisions openly on a regular basis, simply because some things seem uneven to me, not because of a chip.

 

[Light at end of tunnel]

Crayola? Is that you?

Yes.

 

[LucidSplash]

The danger with taking this particular PD's advice as biblical scripture is that the PD can very well have missed the mark in their assessment of this resident.

What happens if you get into pathology and hate it? Will you be better off there simply because the almighty PD has this crazy idea that it would be a good field for you given your interpersonal shortcomings?

I still think this should have been better thought out.

PD = absolute power, maybe, but that doesnt mean they are good at their jobs, or that their will is your best option.

Last I checked, the only real qualification needed to ascend to the PD throne is being a faculty member.

Be careful.

Actually a program has to have ACGME approval to change the program director. You can't just appoint anyone. However you slice it, regardless of you feel about the power of the PD, the point of this thread is to give advice to the OP based on how the system works, how it IS, not how you might wish it would be different. I submit that if you'd like to discuss how you'd change the system if you were in charge, a new thread might be a better way to go about starting that discussion. There is no utility in this thread of discussing anything other than how the OP can work within the system that exists.

 

[Light at end of tunnel]

Actually a program has to have ACGME approval to change the program director. You can't just appoint anyone. However you slice it, regardless of you feel about the power of the PD, the point of this thread is to give advice to the OP based on how the system works, how it IS, now how you might wish it would be different. I submit that if you'd like to discuss how you'd change the system if you were in charge, a new thread might be a better way to go about starting that discussion. There is no utility in this thread of discussing anything other than how the OP can work within the system that exists.

I really like your post. Per usual, I find myseld agreeing with just about everything you say.

But Lucid, if you were forced into path by your PD, and you knew youd hate it, wouldnt you at least think things through a bit more and maybe try to continue to work the system?

Finally, I would add that the ACGME has never been known to turn down PDs applicants. They effectively rubber stamp these types of decisions if we want to be honest here. If anyone in SDN world is aware of ACGME turning down a PD for a post please share, would be interested to learn details.

 

[Gastrapathy]

I really like your post. Per usual, I find myseld agreeing with just about everything you say.

But Lucid, if you were forced into path by your PD, and you knew youd hate it, wouldnt you at least think things through a bit more and maybe try to continue to work the system?

Finally, I would add that the ACGME has never been known to turn down PDs applicants. They effectively rubber stamp these types of decisions if we want to be honest here. If anyone in SDN world is aware of ACGME turning down a PD for a post please share, would be interested to learn details.

I'm aware of a scenario where a PD didn't meet the minimum years criteria and the institution petitioned the acgme for an exception and was denied (same person ended up PD 12 months later). So...kinda

 

[Light at end of tunnel]

Thank you! @Gastrapathy

 

[NotAProgDirector]

As a PD, I can tell you that this is one of the most difficult and heart wrenching situations to be in. A resident is struggling, and we decide that continued training is not an option. I mention "we", because programs are now required to have committee based decisions on resident promotion, evaluation, and termination. So technically it's not at the sole discretion of the PD, but of course their opinion counts heavily.

When it happens, the question of what the next best step for this resident would be. Can they continue in the same field, but in a different program? Do they need a different field? Or can they not be a physician at all?

We sometimes consider a different program. Perhaps a program with less ICU, or a community (rather than univ based) program because the patients might be less ill. Or a program with no 24 hour call, if that's an issue. Etc. But as you can see, these decisions are not easy and full of potholes. Who says that community programs have "less sick" patients? Perhaps some of the most complicated patients would end up at Univ programs instead, but it's also possible that another program might have less clinical decision support / ancillary support than the resident's current program, which might make the experience "harder".

Getting a program in the same field to accept a resident to repeat a year is very difficult. Most PD's don't want to hire someone who is high risk of not doing well -- that's just asking for more trouble and problems for the program.

So how about a new field? This happens commonly -- a surgical resident seems good at managing patients, but doesn't have the 3D spacial orientation to work in the OR (or, to put it more bluntly, is a klutz). Can they instead end up as an IM resident? Perhaps. Or in this case, where the program is concerned about the resident's ability to function in the clinical environment -- recommending Rads or Path. Unfortunately, these types of decisions are often driven by bias -- that a resident who can't manage well on the clinical service will be fine on the Path bench because there are no patient interactions there. It's similar to the surgical PD thinking that because their resident is "fine" on the wards and a klutz in the OR, that they will be fine in my program. I've taken residents like this before (only from my own surgical program), and usually the problems run deeper -- they all ultimately graduated, but it wasn't smooth sailing. So, a success from their end, perhaps less so from mine (although I'm always happy when a resident completes training and goes off into the world).

It's a very difficult decision. Rather than tell a resident "you can't do clinical medicine", I'd usually tell them "Your problems are the following: ..." and "Because of this, I think your skills might be best utilized in XYZ field". I would not write in an LOR that a resident couldn't do clinical patient care unless the issues were egregious, but I have to document their deficiencies, and once I do that I can tell them that their chances of getting a spot in (insert field) might be very poor.

In this case, we have a resident that began residency and had a long LOA. Ultimately started internship around december, but sounds like they were on reduced duty until April, and then advanced to full duty but again ran into trouble and placed on remediation/probation. In my view, the program has been very generous and seems to have tried to help -- they could have let the OP go a long time ago, really gave them a fair chance to succeed. To the OP, I totally understand that your illness (depression/panic disorder) is serious and is impacting your performance -- you mention that your memory isn't as sharp, thinking isn't as rapid -- and that's unfortunate. But the program can't change their promotion criteria for you, you might be able to claim ADA status, but that would get you accommodations to meet standards, not a lowering of those standards.

On top of this, the OP is an IMG and clearly English isn't their 1st language, which makes this more of an uphill climb. I wish you the best of luck, this is going to be difficult. As mentioned already on this thread, Path may be less competitive but they really hate to be seen as the dumping ground for residents who were unable to succeed in other programs. If you can't demonstrate a real love for path, they may not be interested -- and if you don't like the work, you will be miserable there.

 

[LucidSplash]

I really like your post. Per usual, I find myseld agreeing with just about everything you say.

But Lucid, if you were forced into path by your PD, and you knew youd hate it, wouldnt you at least think things through a bit more and maybe try to continue to work the system?

Finally, I would add that the ACGME has never been known to turn down PDs applicants. They effectively rubber stamp these types of decisions if we want to be honest here. If anyone in SDN world is aware of ACGME turning down a PD for a post please share, would be interested to learn details.

I would think things through and come here like the OP asking about my options from a different source than my PD. I don't have an issue with that part. But the experienced in the crowd here have clearly delineated the options available to the OP. Continuing to focus on your perspective that they system is unjust and should be bucked (here and in other threads) is not helpful to the OP because it is never the person already in the OP's position that has the power to change the system. The OP has to deal with the reality of what it is right now and that's what this thread is about. It may be hard from the perspective of someone viewing the residency process from the outside in to understand.

I really do recommend you start a thread in the medical student forum on this issue that seems most concerning to you. You may find you have better discussion there since it will be the thread topic and not a side issue/derailing of the OP like it can be in other threads. Residents and attendings do peruse that forum and I would suspect you could have a lively discussion.

 

[ThoracicGuy]

Crayola? Is that you?

Not wordy enough!

 

[Goro]

Crayola? Is that you?

Crayola isn't that salty or resentful. And also would have have written a Stephen King-length novella!

 

[cbrons]

As a PD, I can tell you that this is one of the most difficult and heart wrenching situations to be in. A resident is struggling, and we decide that continued training is not an option. I mention "we", because programs are now required to have committee based decisions on resident promotion, evaluation, and termination. So technically it's not at the sole discretion of the PD, but of course their opinion counts heavily.

When it happens, the question of what the next best step for this resident would be. Can they continue in the same field, but in a different program? Do they need a different field? Or can they not be a physician at all?

We sometimes consider a different program. Perhaps a program with less ICU, or a community (rather than univ based) program because the patients might be less ill. Or a program with no 24 hour call, if that's an issue. Etc. But as you can see, these decisions are not easy and full of potholes. Who says that community programs have "less sick" patients? Perhaps some of the most complicated patients would end up at Univ programs instead, but it's also possible that another program might have less clinical decision support / ancillary support than the resident's current program, which might make the experience "harder".

Getting a program in the same field to accept a resident to repeat a year is very difficult. Most PD's don't want to hire someone who is high risk of not doing well -- that's just asking for more trouble and problems for the program.

So how about a new field? This happens commonly -- a surgical resident seems good at managing patients, but doesn't have the 3D spacial orientation to work in the OR (or, to put it more bluntly, is a klutz). Can they instead end up as an IM resident? Perhaps. Or in this case, where the program is concerned about the resident's ability to function in the clinical environment -- recommending Rads or Path. Unfortunately, these types of decisions are often driven by bias -- that a resident who can't manage well on the clinical service will be fine on the Path bench because there are no patient interactions there. It's similar to the surgical PD thinking that because their resident is "fine" on the wards and a klutz in the OR, that they will be fine in my program. I've taken residents like this before (only from my own surgical program), and usually the problems run deeper -- they all ultimately graduated, but it wasn't smooth sailing. So, a success from their end, perhaps less so from mine (although I'm always happy when a resident completes training and goes off into the world).

It's a very difficult decision. Rather than tell a resident "you can't do clinical medicine", I'd usually tell them "Your problems are the following: ..." and "Because of this, I think your skills might be best utilized in XYZ field". I would not write in an LOR that a resident couldn't do clinical patient care unless the issues were egregious, but I have to document their deficiencies, and once I do that I can tell them that their chances of getting a spot in (insert field) might be very poor.

In this case, we have a resident that began residency and had a long LOA. Ultimately started internship around december, but sounds like they were on reduced duty until April, and then advanced to full duty but again ran into trouble and placed on remediation/probation. In my view, the program has been very generous and seems to have tried to help -- they could have let the OP go a long time ago, really gave them a fair chance to succeed. To the OP, I totally understand that your illness (depression/panic disorder) is serious and is impacting your performance -- you mention that your memory isn't as sharp, thinking isn't as rapid -- and that's unfortunate. But the program can't change their promotion criteria for you, you might be able to claim ADA status, but that would get you accommodations to meet standards, not a lowering of those standards.

On top of this, the OP is an IMG and clearly English isn't their 1st language, which makes this more of an uphill climb. I wish you the best of luck, this is going to be difficult. As mentioned already on this thread, Path may be less competitive but they really hate to be seen as the dumping ground for residents who were unable to succeed in other programs. If you can't demonstrate a real love for path, they may not be interested -- and if you don't like the work, you will be miserable there.

So, what would you say the most common reason residents are put on probation? A second question is, what is the most common reason an intern/PGY-1 gets into trouble?

 

[NotAProgDirector]

1. Clinical deficiencies - unable to manage complex patients with multiple, competing problems.
2. Communication difficulties - unable to work well with others, especially nurses
3. Professionalism issues - not showing up for work regularly, lying

 

[gutonc]

So, what would you say the most common reason residents are put on probation? A second question is, what is the most common reason an intern/PGY-1 gets into trouble?

1. Clinical deficiencies - unable to manage complex patients with multiple, competing problems.
2. Communication difficulties - unable to work well with others, especially nurses
3. Professionalism issues - not showing up for work regularly, lying

I'm not going to argue with aPD, but...

1. Lying
2. Lying
3. Lying
4. All that other stuff he mentioned

 

[j4pac]

Mental health and personality is probably a significant reason. You can scam your way through medical school rotations that are a month each. It's much more difficult to do with an extended period of time with the same people overlooking you. In the cases that I've witnessed of residents failing...mental health concerns played a part of all of them.


Sent from my iPhone using SDN mobile

 

[NotAProgDirector]

Yes, agreed. Let's add Personality Disorder to the list. To be fair, it's really a Personality Trait -- it's an Axis II issue that is well enough compensated such that the person can function in society, but problematic enough that it creates issues in a residency.

1. Professionalism issues - not showing up for work regularly, lying
2. Personality Disorder / Trait - Usually Cluster B
3. Clinical deficiencies - unable to manage complex patients with multiple, competing problems.
4. Communication difficulties - unable to work well with others, especially nurses

There's obvious overlap here. Someone with a Narcissistic Personality might not show up for work and think it's not a big deal, for example.

Clinical deficiencies can often be fixed, hence they are more common overall, but less common as a cause for termination.

Communication deficiencies have to be severe and repetitive to get you terminated. Trying to remediate these is difficult because the situations that tend to trigger problems are often rare, so long blocks of time can go by with no issues and then there can be an eruption.