Fellowship termination

[jlm2yb]

Lots to say on this topic but I’ll try to be brief with my situation. Wondering if it is even worth reapplying elsewhere in the future or exiting medicine completely at this point?

MD PhD from MSTP matched to research/fast track for heme/onc in a pretty good program. Worked my butt off to get here - inner city public school kid, first gen graduate with blue collar parents. Finished first year of fellowship with outstanding reputation on track for faculty position with a basic science project on novel leukemia therapy with pharm dept chair. Then I got pneumonia and raging systemic lupus or as my PD called it - my mystery illness. PD dealt with my situation very very inappropriately and poorly.

End result, I got fired under hospital bylaws for taking too much time. HR/PD refused any accommodations even with my having full support from her clinic boss, cofellows and dept chair. I just wanted call nights off for a month or 2 until I got symptoms controlled. Been dealing with this for about 10 yrs now without diagnosis so I know what I am and am not capable of at this point.

So do I punish myself and reapply in the future? Would any programs really try to support my continuing if I prove my worth in intellectual property and recommendations? Or do I default into consulting? ☹️ Some guidance from the wise would be greatly appreciated.

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[IM_applicant]

Sorry to hear. Sounds like you are in a very tough spot. I hope you feel better and can recover from your illness. I would probably try to meet with other faculty / adviser / GME people to see if there is a solution to be found. They will know much more about your situation, institution, PD/HR etc than people here.

Some thoughts:

Is there any chance to find a solution that your PD/HR would accept? I am assuming firing a fast tracker (or any fellow for that matter) is pretty bad for a program's reputation. Maybe they are willing to work with you on a solution that may be suboptimal but better than firing you? Trying to think creative here. Taking time off without pay for those two months so you can fully recover, or anything that would help you avoid being fired. If you already finished one year the majority of your clinical duties should be behind you right?

If that doesn't work and you want to be a hematologist why not reapply? You won't know if someone would support you until you try. You'd obviously have to apply broadly as you'd have a red flag on your app, unfortunately.

Another option: if you're already a year into fellowship that means that you can become board certified in IM and get a permanent license right? If most of your research is basic science anyway, you could always practice in another/related field. Maybe Geri for Geri/onc, pall care or even Genetics. Those are all fellowships that are much easier to get in to. And you could do one day of any clinic and continue your basic science stuff.

 

[jlm2yb]

Unfortunately, I was actually fired 6 mos ago. Fought for 6 mos trying to get reinstated with my Dept chair at the helm. Even had CFO and President of hospital call on my behalf. Since I fast tracked, I was not board eligible. I fought for this and just took boards a couple weeks ago. Woo! However, by taking boards I forfeit my fellowship spot. I chose job security over further punishment.

Problem is my PD lied to HR. I had to get HR involved once I had lupus on my dx list. So her lies are permanently on my record and ultimately why I was fired based on these. Other females also had similar issues just not as pronounced as mine. Said I bashed the program and her name on a blog (posted below). Both untrue. ACGME survey also showed <50% across the board placing the program on probation.

A loss of physician support at a time of need

I fear burnout and lack of ingenuity will transform physicians into pariahs ripe for the firing.

www.kevinmd.com

Even worse, the chair of dept wanted PD demoted but medicine chair won’t sign off. I am told he has been blinded by her lies. It’s just a very malignant program and I’d be better served elsewhere. I’m just wondering if programs would in any way facilitate my success even though I’m a high risk high reward candidate. I did finish first year of fellowship without issue and only had something like 4 mos of clinical to finish. Both my chair and malignant heme director offered to write me LoR stating they’d make sure I’d have my pick.

I’m just so tired of all this BS that I just want to quit before I even got a chance to start. I feel like I have so much to offer cancer research and patients. My mindset is heme/onc or bust. I do very well with cancer patients aka I’ve been told that I have great bedside manner. Just sad and a shame. I wasn’t lazy or a bad fellow. I just got sick for a little.

 

[bobsmith]

Both my chair and malignant heme director offered to write me LoR stating they’d make sure I’d have my pick.

This makes me think you really do have a chance if you apply again. If you have people who are intimately familiar with your situation able to really advocate for you, then I definitely think it's worth trying. I think in a lot of "red flag" cases, people have kind of burned a lot of bridges and it's much harder to unflag that erythema

Just a terrible situation, though. Sorry you're going through it, and good luck

 

[jlm2yb]

This makes me think you really do have a chance if you apply again. If you have people who are intimately familiar with your situation able to really advocate for you, then I definitely think it's worth trying. I think in a lot of "red flag" cases, people have kind of burned a lot of bridges and it's much harder to unflag that erythema

Just a terrible situation, though. Sorry you're going through it, and good luck

Thanks Bob. I’m just wondering if it’s worth it. I probably could have finished from where I was situated. I’d only have a few clinical months to finish then 2 yrs of research. I love medicine and taking care of people. I’m also being realistic. I know lupus doesn’t get any better with time. Repeating a whole two years of indentured servitude just doesn’t sound appealing. I know it doesn’t get easier. I’m trying to understand if the lack of support I received is common or if some programs would actually put in the effort to help me succeed. I’d be a high risk high reward candidate. I’m highly intelligent and know what I’m capable of. It’s hard for me to accept that residents/fellows can be disposed of like this. We aren’t labor. We are learners.

I’ve come to terms with maybe life is pushing me down another path but many many faculty have urged me to keep going and reapply. I’m so torn most of the time. The logical choice would be to get out while I can but I know I’ll miss it.

 

[IM_applicant]

Thanks Bob. I’m just wondering if it’s worth it. I probably could have finished from where I was situated. I’d only have a few clinical months to finish then 2 yrs of research. I love medicine and taking care of people. I’m also being realistic. I know lupus doesn’t get any better with time. Repeating a whole two years of indentured servitude just doesn’t sound appealing. I know it doesn’t get easier. I’m trying to understand if the lack of support I received is common or if some programs would actually put in the effort to help me succeed. I’d be a high risk high reward candidate. I’m highly intelligent and know what I’m capable of. It’s hard for me to accept that residents/fellows can be disposed of like this. We aren’t labor. We are learners.

I’ve come to terms with maybe life is pushing me down another path but many many faculty have urged me to keep going and reapply. I’m so torn most of the time. The logical choice would be to get out while I can but I know I’ll miss it.

I don't think anyone can tell you if it's worth it because no one can predict what will happen when you apply or what will happen with your health.

There are very supportive programs out there. That being said, if you apply I would probably think about it from the motivation side (I want to help cancer patients) and not the high reward (highly intelligent and competent) both for you and the programs you want to consider you.

In any case sorry again that this has happened for you and good luck!

 

[thisampgoestoeleven]

I am going from ignorance here, but I was not aware a PD could unilaterally fire without due process per ACGME. But I don't know the details of your case.

Some thoughts on options:
1) Appeal to head of GME at your institution
2) Schedule meeting with dept chair again, to ask for help/guidance.
3) Appeal / write complaint to ACGME (nuclear option)
4) retain a lawyer for wrongful dismissal (you would have to consult with a lawyer to see if you have a case, but it seems like the story you are stating raises issues of retaliation, discrimination, or not following own policies)
5) reapply to another program

 

[jlm2yb]

I am going from ignorance here, but I was not aware a PD could unilaterally fire without due process per ACGME. But I don't know the details of your case.

Some thoughts on options:
1) Appeal to head of GME at your institution
2) Schedule meeting with dept chair again, to ask for help/guidance.
3) Appeal / write complaint to ACGME (nuclear option)
4) retain a lawyer for wrongful dismissal (you would have to consult with a lawyer to see if you have a case, but it seems like the story you are stating raises issues of retaliation, discrimination, or not following own policies)
5) reapply to another program

Love the spinal tap reference. All good points listed above. I’ve done 1, 2 and 4. Medicine chair sides with PD trumps dept chair. Scandalous. 4 would take years and lots of money. Tried 3 lawyers. Couldn’t get contingency. Healthcare/learner employment is complicated.

Scared to do 3 as it hurts my cofellows. I want to stay in academia. This years ACGME survey bought the program probation. That’s good enough for me.

So that makes 5 the winner. Took boards. Will try my luck again next year.

 

[thisampgoestoeleven]

Well, it sounds like you are no stranger to adversity. I guess treat this like every other bump in the road / on the nose that you have ever had, and persevere.

If you have certification in IM, you can always work as a hem onc hospitalist to get your foot in the door in an institution, and then be a shoe in for fellowship. Or just reapply for fellowship if you don't want to go that route. I don't see that you need to quit Medicine entirely, but this does speak to culture of the institution, and that you need to be someplace more supportive.

 

[jlm2yb]

Well, it sounds like you are no stranger to adversity. I guess treat this like every other bump in the road / on the nose that you have ever had, and persevere.

If you have certification in IM, you can always work as a hem onc hospitalist to get your foot in the door in an institution, and then be a shoe in for fellowship. Or just reapply for fellowship if you don't want to go that route. I don't see that you need to quit Medicine entirely, but this does speak to culture of the institution, and that you need to be someplace more supportive.

Exactly. This is all I’m trying to point out. No one is protected. Not even our learners. It debases the institution of medicine. I’ll land on my feet somewhere. Wouldn’t be life without failures and obstacles.

 

[thisampgoestoeleven]

Yes, it's well known that people can go through this whole fifteen year process with the sword of damocles hanging over them. Count yourself fortunate that you got this far and with your MD and certification. One person I know was fired from ophthalmology residency during an eye exam because his elbow brushed up against a patient's breast. Another nearly got unilaterally fired for leaving a surgical log (which is required, btw) in his backpack, and the backpack got stolen. The only sin he committed was to be honest and tell GME that it happened.

Not sure I would advise my children to go into Medicine in the future. Maybe law school or business school, or medicine as a 2nd career once they ruled out everything else.

 

[jlm2yb]

Not sure I would advise my children to go into Medicine in the future. Maybe law school or business school, or medicine as a 2nd career once they ruled out everything else.

I’d trade my PhD for MBA any day of the week.

 

[holaback]

Exactly. This is all I’m trying to point out. No one is protected. Not even our learners. It debases the institution of medicine. I’ll land on my feet somewhere. Wouldn’t be life without failures and obstacles.

Yes I think the hospitalist option is a good one if you're board certified at least. You can get back in the clinical realm, and then reapply for fellowship later if you're still interested.
Another option would be to reapply to a different specialty fellowship, one that maybe has less of a clinical load or less nights - due to your illness.

I would say also that since your program has read and identified you in your "anonymous" posts online, that you should quit bashing them online. That will definitely NOT help you in future. Any future program you apply to will call your old program to ask what happened - you can bank on that. Bashing them online does not encourage them to have any type of compassion for you, and may be seen as unprofessional behavior.

 

[jlm2yb]

Yes I think the hospitalist option is a good one if you're board certified at least. You can get back in the clinical realm, and then reapply for fellowship later if you're still interested.
Another option would be to reapply to a different specialty fellowship, one that maybe has less of a clinical load or less nights - due to your illness.

I would say also that since your program has read and identified you in your "anonymous" posts online, that you should quit bashing them online. That will definitely NOT help you in future. Any future program you apply to will call your old program to ask what happened - you can bank on that. Bashing them online does not encourage them to have any type of compassion for you, and may be seen as unprofessional behavior.

No one identified me. HR went through my email and found an article that they thought my name would be on. They couldn’t even find the article online because the title was different and had no name. It’s not unprofessional to save future candidates from a bad, malignant program. No one knows where I came from. My department chair understands what they did to me is cause for scorched earth policy. No one blames me. I burned no bridges upon departure. Faculty were fully supportive of my stance. The PD will do what the chair requests.

It’s people like you that make me never want to go back to medicine. Sometimes you have no choice but to stand up for yourself. I’m doing them a favor by not suing. I’m choosing purpose over perceived quick riches. That’s professional enough for me.

 

[holaback]

No one identified me. HR went through my email and found an article that they thought my name would be on. They couldn’t even find the article online because the title was different and had no name. It’s not unprofessional to save future candidates from a bad, malignant program. No one knows where I came from. My department chair understands what they did to me is cause for scorched earth policy. No one blames me. I burned no bridges upon departure. Faculty were fully supportive of my stance. The PD will do what the chair requests.

It’s people like you that make me never want to go back to medicine. Sometimes you have no choice but to stand up for yourself. I’m doing them a favor by not suing. I’m choosing purpose over perceived quick riches. That’s professional enough for me.

I don't think I understand why you are upset at me. I was only trying to give you advice that I thought would be helpful.
(a) You say no one identified you. Well, it doesn't matter whether it was through HR or whether someone pointed you out. My point was that - they know it's you posting, so stop posting. It doesn't matter how they found out.
(b) You burned no bridges upon departure? Are you sure about that? Then why aren't they actively trying to help you get a new spot?
(c) "It's people like you that make me never want to go back to medicine". Guess what? This applies throughout life. It's a basic principle that you can't publicly bash your old job and expect great references from them. But maybe there are some career paths where this principle doesn't apply, or maybe you can work for yourself.

 

[jlm2yb]

I don't think I understand why you are upset at me. I was only trying to give you advice that I thought would be helpful.
(a) You say no one identified you. Well, it doesn't matter whether it was through HR or whether someone pointed you out. My point was that - they know it's you posting, so stop posting. It doesn't matter how they found out.
(b) You burned no bridges upon departure? Are you sure about that? Then why aren't they actively trying to help you get a new spot?
(c) "It's people like you that make me never want to go back to medicine". Guess what? This applies throughout life. It's a basic principle that you can't publicly bash your old job and expect great references from them. But maybe there are some career paths where this principle doesn't apply, or maybe you can work for yourself.

I’m peeved with you because you don’t seem to really understand what life is actually about. You seem young to me with that idealistic picture of what doctoring should be like. I can post whatever I want. It is a forum and there is always the first amendment. I can’t apply now for fellowship. That ship has long sailed and I have to be better health wise to redo all of fellowship all over again.

If you’re paranoid about who reads what where then you are setting yourself up for failure. I have no regrets. I may decide to publicly blast my program in due time and start my own business. This is indeed another option. I had plenty of help trying to get reinstated. President of the cancer center, CFO of the hospital, Heme/onc dept chair, director of the malignant heme center. They offered me jobs for after I get board certified. I was told to pick where I want to go and they’ll also make it happen for me. If that isn’t support, I don’t know what is. Also, this is where my PD’s career ends/last ladder rung unless they seek out another job else where. I’ll settle with that. You keep trying to cut me down/admonish me for no wrong doing other than voicing what’s wrong with medical education. I hope one day you’ll understand. The days of yore when doctors were respected are gone. Luckily I have no debt but to those who are 200-300k in the hole, this would be a tragedy.

The place I worked pretty much runs all things healthcare around here. I desire not to go back into that place. Life also includes family so in order to work, I must move elsewhere with my family and this is a feat in itself. My husband has to find a new job. I also have to wait 3 mos to see if I’m board certified. It takes 5-6 mos to get a license in another state not to mention anywhere from $500-2000.

You make switching, moving and reapplying sound so simple. I’d really like to know where in your training you are because I’m guessing nowhere near finished or else you’d have a much more realistic understanding of things.

Not being mean nor have a lack of understanding. But I think you are and do. If you say stop posting one more time, I’ll probably post again. Good day to you!

 

[thisampgoestoeleven]

Maybe I am biased because I am sympathetic to this OP, but for devil's advocate, there were many who thought (and still think, as he was at the BIDMC at the time) that Samuel Shem was being wildly unprofessional for writing and publishing the House of God. In retrospect, he blew the whistle on a dehumanizing training process that was going across the entire country at the time (some elements of it still exist, clearly). He has since been compared to Sinclair Lewis (author of The Jungle, which led to reforms of meatpacking industry).

The idea that trainees should take their licks and like it, and then say nothing when they are disposed of, is ridiculous to me.

 

[jlm2yb]

Maybe I am biased because I am sympathetic to this OP, but for devil's advocate, there were many who thought (and still think, as he was at the BIDMC at the time) that Samuel Shem was being wildly unprofessional for writing and publishing the House of God. In retrospect, he blew the whistle on a dehumanizing training process that was going across the entire country at the time (some elements of it still exist, clearly). He has since been compared to Sinclair Lewis (author of The Jungle, which led to reforms of meatpacking industry).

The idea that trainees should take their licks and like it, and then say nothing when they are disposed of, is ridiculous to me.

Both great books and two that currently sit on my bookshelf. Your point is well taken. I’ve been told by mentors that my moral and ethical standards are strong. They may not lead to favorable outcomes in the end. When residents had problems or morale was low, many would ask me to speak to supervisors on their behalf. Apparently I had a way with diplomacy sans anger/frustration.

I think all doctors deserve more than becoming another cog in the healthcare machine. We go to school for so long and sacrifice so much to succeed here in the US. Not to mention that we are some of the brightest, most intelligent people in the world. We are being slowly suffocated and no one under the age of 60 seems to care. It scares the career right out of me.

Could I make a larger impact in another industry? Sure. Do I want to? That’s what I’m trying to decide. I like being a doctor and helping others. As a cog, Lupus definitely makes this more difficult. Maybe I have to find a machine with complementary notch sizes on its wheels.

 

[holaback]

I’m peeved with you because you don’t seem to really understand what life is actually about. You seem young to me with that idealistic picture of what doctoring should be like. I can post whatever I want. It is a forum and there is always the first amendment. I can’t apply now for fellowship. That ship has long sailed and I have to be better health wise to redo all of fellowship all over again.

If you’re paranoid about who reads what where then you are setting yourself up for failure. I have no regrets. I may decide to publicly blast my program in due time and start my own business. This is indeed another option. I had plenty of help trying to get reinstated. President of the cancer center, CFO of the hospital, Heme/onc dept chair, director of the malignant heme center. They offered me jobs for after I get board certified. I was told to pick where I want to go and they’ll also make it happen for me. If that isn’t support, I don’t know what is. Also, this is where my PD’s career ends/last ladder rung unless they seek out another job else where. I’ll settle with that. You keep trying to cut me down/admonish me for no wrong doing other than voicing what’s wrong with medical education. I hope one day you’ll understand. The days of yore when doctors were respected are gone. Luckily I have no debt but to those who are 200-300k in the hole, this would be a tragedy.

The place I worked pretty much runs all things healthcare around here. I desire not to go back into that place. Life also includes family so in order to work, I must move elsewhere with my family and this is a feat in itself. My husband has to find a new job. I also have to wait 3 mos to see if I’m board certified. It takes 5-6 mos to get a license in another state not to mention anywhere from $500-2000.

You make switching, moving and reapplying sound so simple. I’d really like to know where in your training you are because I’m guessing nowhere near finished or else you’d have a much more realistic understanding of things.

Not being mean nor have a lack of understanding. But I think you are and do. If you say stop posting one more time, I’ll probably post again. Good day to you!

Please, by all means, keep posting.
Also, I'm an attending with years of experience.
Good luck to you.

 

[bobsmith]

Thanks Bob. I’m just wondering if it’s worth it. I probably could have finished from where I was situated. I’d only have a few clinical months to finish then 2 yrs of research. I love medicine and taking care of people. I’m also being realistic. I know lupus doesn’t get any better with time. Repeating a whole two years of indentured servitude just doesn’t sound appealing. I know it doesn’t get easier. I’m trying to understand if the lack of support I received is common or if some programs would actually put in the effort to help me succeed. I’d be a high risk high reward candidate. I’m highly intelligent and know what I’m capable of. It’s hard for me to accept that residents/fellows can be disposed of like this. We aren’t labor. We are learners.

I’ve come to terms with maybe life is pushing me down another path but many many faculty have urged me to keep going and reapply. I’m so torn most of the time. The logical choice would be to get out while I can but I know I’ll miss it.

Well, you could also start the reapplication process and as more information comes in (where you get interviews, what the programs are like, and what your life situation is like a year from now), you may be able to make a better decision on if things are "worth it" when the options are more concrete.

If you do apply again...there are probably some important things to figure out / confirm:
(1) which of your faculty members are really going to go to bat for you, reach out and make phone calls, etc [seems like you have this]
(2) which programs they think you have a chance at (realistically, places where they know people / have connections / can explain the situation)
(3) how are you going to explain what happened without saying "basically, my PD was a jerk"

While it seems like you got a totally raw deal and none of this is really your fault...nonetheless, very reasonable people could still ask you questions like "well what did you learn from this experience and what would you do differently?"