Fired from residency program. What do I do now?

[eosinophilic]

It's shocking to me how this board is so supportive of addicts who practice medicine and call "Phoenix's that rise from the ashes", but every IMG is doomed to failure. This is from an IMG who treats addicts (including impaired physicians).


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The board being supportive versus being supported in the real world are two very different things. I have had to go out on my own to find success and support. The help I have received from the medical community has been getting me to rehab and obtaining a license to practice medicine...which are two very huge things dont get me wrong but it has definitely not been easy trying to get back on the track I was on previously.

Hopefully OP is in treatment now and getting in with the PHP.

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[gutonc]

It's shocking to me how this board is so supportive of addicts who practice medicine and call "Phoenix's that rise from the ashes", but every IMG is doomed to failure. This is from an IMG who treats addicts (including impaired physicians).

Nice false equivalency. Are you SDN's Kellyanne Conway?

 

[bannie22]

As mentioned above, if he had an alcohol problem at home and came in for treatment, then he would go out on medical leave and would be ADA protected. Unfortunately, coming to work drunk changes the situation significantly, and usually leads to termination. An argument can be made that his alcohol use was not under his full voluntary control. Another argument is that he clearly states that he made the choice to drink to decrease hand tremors -- and that's unacceptable and clearly a voluntary decision.

Fair enough. But addicts dont always have competency so I personally believe he should be given a chance at rehab.

 

[gutonc]

Fair enough. But addicts dont always have competency so I personally believe he should be given a chance at rehab.

I don't think anyone is arguing that the OP (who is long gone from this thread BTW) doesn't deserve a chance at rehab and returning to medicine in the future.

But he showed up to work drunk. And, at least in my residency contract, that is an offense which results in immediate termination.

Could the OP potentially go back to his original program, after treatment, and get his job back? Sure. Highly unlikely of course, but not impossible.

 

[GonnaBeADoc2222]

It's shocking to me how this board is so supportive of addicts who practice medicine and call "Phoenix's that rise from the ashes", but every IMG is doomed to failure. This is from an IMG who treats addicts (including impaired physicians).

Because mental illness represents real pathology and instead of casting down our colleagues who seek help, we should build them back up.

The comparison makes absolutely zero sense.

I have no idea regarding the specifics of the OPs seemingly arduous path back to a career in medicine, but I truly wish them the best.

 

[chicagochildpsych]

Nice false equivalency. Are you SDN's Kellyanne Conway?

No, I'm not a fan of alternative facts. But as someone who treats these patients I can assure you that narcissistic and sociopathic traits go hand in hand with a great deal of addicts. A person who struggles and comes before the board admitting they have a problem will have my full support. But if that person operates on my mom while intoxicated I will be less forgiving. My comment is about the tone of the response. The vast majority of the comments directed towards aspiring physicians who train abroad are negative. This is despite the fact that the majority of IMG docs find success. The exact opposite is true of those who suffer from addiction. Personally, I would take the guy with high board scores from abroad over giving a second chance to a physician who downed some vodka right before going into the OR. I only ask that the compassion and caring that has been espoused for this struggling physician be shown to those who are fighting for a chance to practice in America.

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[rokshana]

Personally, I would take the guy with high board scores from abroad over giving a second chance to a physician who downed some vodka right before going into the OR. I only ask that the compassion and caring that has been espoused for this struggling physician be shown to those who are fighting for a chance to practice in America.

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wow....you really shouldn't be taking care of these people that you dislike so much.

as for the "lack" of support for some of the IMGs that post here...maybe if they were more realistic about their chances, then there may be more support....you get people who think somehow they are going to be able to waltz on into a dermatology spot because they practiced it in their country...nevermind that they have not the scores or the interaction with the US system to make this a possibility..

 

[chicagochildpsych]

I don't dislike them, I'm among the few in the medical community who make them a focus of my practice. But, as a psychiatrist I know sociopathic traits when I see them. And I am not unaware of the over confident IMG from Caribbean (you may remember me as "finishingfifth" on valuemd). Addicts play a role in their illness, they are not completely hapless victims.That's like saying someone with obesity and subsequent DM2 has no culpability in their illness. I genuinely care for these patients, I am on call 24/7 for their needs when they are tossed aside from endless ER's. I'm among the few who will medically detox an adolescent who's on Medicaid. So hop off your high horse where you tell me I don't like these people. I care for all of my patients, I'm just not going to excuse an impaired MD who knowingly put patients at risk, much less tell them how awesome they are.


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[rokshana]

I don't dislike them, I'm among the few in the medical community who make them a focus of my practice. But, as a psychiatrist I know sociopathic traits when I see them. And I am not unaware of the over confident IMG from Caribbean (you may remember me as "finishingfifth" on valuemd). Addicts play a role in their illness, they are not completely hapless victims.That's like saying someone with obesity and subsequent DM2 has no culpability in their illness. I genuinely care for these patients, I am on call 24/7 for their needs when they are tossed aside from endless ER's. I'm among the few who will medically detox an adolescent who's on Medicaid. So hop off your high horse where you tell me I don't like these people. I care for all of my patients, I'm just not going to excuse an impaired MD who knowingly put patients at risk, much less tell them how awesome they are.


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sorry i don't actually...but are you calling me overconfident? I had my eyes WIDE open for what were the possiblities were for me as an IMG...and frankly would categorize myself as fairly successful as an IMG...I applied to a specialty that I was fairly competitive for, applied to (at that time ) a great number of programs, both academic and community, matched at a university program and subsequently got the fellowship in the specialty I wanted...

sorry, but you are the one that put it out there that these people don't deserve our support...don't be surprised when you get call on it.

 

[chicagochildpsych]

Absolutely not, I am aware of others who are overconfident. The kid with a 2.7 gpa and 22 McVay who is suddenly going to be a surgeon after a miraculous academic turnaround.

And I never said they don't deserve support. Hell, I'm the one actually supports these patients. How many free clinics for addiction do you donate your time to, I'm up to 3 so far. It may be viewed as a false equivalence but I saw nothing but vitriol towards people who remotely considered studying abroad and nothing but unabashed gushing support for an addict who made terrible choices. And if you are so concerned about addiction, I hope you have an Illinois license, we have multiple free clinics on the south side of Chicago that need your help. It's easy to be supportive on a message board, you up for helping these folks in real life?


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[eosinophilic]

Im fairly certain I am getting passed over for residency interviews and positions left and right by IMGs considering the number of interviews Ive gotten. Not saying thats wrong or that Im bitter about it but its not like opportunities are pouring in for addicts. Fear of these consequences make it all the more likely for someone like the OP to allow their disease progress to the point it had.

 

[chicagochildpsych]

I treat several physicians in recovery who self reported, got help, and are safely seeing patients again. I have no issue with this, in fact I applaud it. The distinction is practicing medicine while impaired is usually a conscious decision, and that level of impairment of judgement/hubris puts the public at risk.


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[eosinophilic]

I treat several physicians in recovery who self reported, got help, and are safely seeing patients again. I have no issue with this, in fact I applaud it. The distinction is practicing medicine while impaired is usually a conscious decision, and that level of impairment of judgement/hubris puts the public at risk.


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Fighting the enormous ego that all addicts posess is one of the primary purposes of AA and recovery. Most addicts have been impaired on the clock. In my opinion, there isnt much if a distinction. Active addicts habitually cross the line of normal and acceptable behavior. Your patients are most likely not being honest with you if theyre telling you something else.

 

[chicagochildpsych]

In most instances i am not doing active therapy, but rather managing medication in an accute setting. It's absolutely possible this has led to a less than forthright relationship with some patients.


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[IlDestriero]

One thing has nothing to do with the other. I'm not sure why you even bring the FMG stuff up here.
FMGs have to prove they are the equivalent caliber as a US educated student. High USMLE scores aren't enough. Very competitive academic programs get huge numbers of applicants. My home program gets over 50 applicants per residency spot if you include FMGs, who are actually evaluated separately. If you're an FMG you need one of three things, a solid in house connection, significant research history and potential, or previous or experience and expertise from a career abroad with LORs from your colleagues stating you basically walk on water. When you've got so many applications to screen for a very limited number of interviews, you cut deep on the first round and pretty much any red flag makes you DoA.
Nobody owes FMGs anything, and to be honest, a former drug addict is almost certainly DoA in anesthesia as well. It's a dangerous field for an addict.


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Il Destriero

 

[Shikima]

Nice false equivalency. Are you SDN's Kellyanne Conway?

No, it's Rachael Maddow.

 

[Psycologieest]

My husband is a psych resident pgy3 and I found out he has been having an affair with a medical student for over a year. Do you think if the medical student reports him he will get kicked out of residency? Please help I am desperate. I have work so hard for us to get to this level now he is about to screw this up.

 

[SouthernSurgeon]

My husband is a psych resident pgy3 and I found out he has been having an affair with a medical student for over a year. Do you think if the medical student reports him he will get kicked out of residency? Please help I am desperate. I have work so hard for us to get to this level now he is about to screw this up.

It's scary that you seem more concerned about his job and your status "level" than about the fact that he has been carrying out a prolonged affair.

 

[HereWeGo17]

It's scary that you seem more concerned about his job and your status "level" than about the fact that he has been carrying out a prolonged affair.

The other thread this person started is titled "Will I get dismissed?" So maybe this person is the cheating Psych resident who is pretending to be the wife.


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[Shikima]

'Like sands through the hourglass, so are the Days of our Lives'

 

[AdmiralChz]

My husband is a psych resident pgy3 and I found out he has been having an affair with a medical student for over a year. Do you think if the medical student reports him he will get kicked out of residency? Please help I am desperate. I have work so hard for us to get to this level now he is about to screw this up.

Infidelity, while a bummer for sure and morally not that great, is not grounds for immediate dismissal. Might get some eye rolls around the wards and in residency meetings and maybe even a discussion with the PD if it gets out, but that's all.

 

[colbgw02]

If there's proof that the affair occured when the medical student was assigned to a service with the resident, then I could see how that could be an issue.

Overall, I'm sure there's a great degree of variability in how departments and hospitals handle these situations. I wonder if hospitals with religious affiliations include morality clauses in their contracts.

 

[Winged Scapula]

This was not an uncommon occurrence during my residency between resident s and even attendings and medical students.

I recall that our program director addressed it and said that while some may consider it immoral, if one of the parties was married, the residency program and the GME office would not care as long as that student was not being supervised by the attending or resident.

that being said, if his plan is to break it off with the student, they could certainly make things difficult for him even if the end result is a stern lecture. I think you have bigger concerns such as whether your marriage will survive this.

 

[Danbo1957]

... that being said, if his plan is to break it off with the student, they could certainly make things difficult for him even if the end result is a stern lecture. I think you have bigger concerns such as whether your marriage will survive this.

True... but, I would think that in this case the marriage would not survive being kicked out of residency, though not likely as he's a PGY3 (unless he violated training rules, or lied through his teeth to everybody). Spouses will put up with a lot difficulties in their doctor's life...

Just as an anecdote, with the increase in the numbers of women in medical education over the last thirty years, there has been an equal proportional increase in women MDs committing spousal adultery... and the fallout that I've seen of some of those ending affairs have been incredibly messy.

 

[chicagochildpsych]

I remember a case where a surgeon had an affair with a Med student (both parties were male, in the closet, in the deep south). Med student with terrible grades matches general surgery at home institution and is driving a new Mercedes convertible on match day. Med student cheats, surgery dept tries to rescind match. Shenanigans ensue. In the end, no one got in trouble. You will be fine.


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[sux2Bintl]

I read so many of these fired from residency posts, and each of them very gloomy

Whats stopping the OP from opening his own private practice? He still has an unlimited medical license in most states right? Do cash business if you cant get on insurance

 

[BoardingDoc]

I read so many of these fired from residency posts, and each of them very gloomy

Whats stopping the OP from opening his own private practice? He still has an unlimited medical license in most states right? Do cash business if you cant get on insurance

Maybe creating a new post to ask this one question would have been a better approach than copying and pasting the same question into 3 different posts.

 

[LucidSplash]

I read so many of these fired from residency posts, and each of them very gloomy

Whats stopping the OP from opening his own private practice? He still has an unlimited medical license in most states right? Do cash business if you cant get on insurance

Agreed with BoardingDoc. That being said, private practice doing what? He can't get privileges to do surgery. He will have trouble with credentialing anywhere because they ask questions about being fired and drug/alcohol use. He can't get board certified in anything. He'll need money to open an office/private practice and he'll have difficulty securing a loan for that with his background, even if he could figure out what he might practice.

 

[IlDestriero]

He can open a cash only anti aging clinic and hire all midlevels and techs. Offer hgh, testosterone, laser treatment, etc. He'll retire with millions more than any of us.


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Il Destriero

 

[fhockey13]

But, as a psychiatrist I know sociopathic traits when I see them. And I am not unaware of the over confident IMG from Caribbean (you may remember me as "finishingfifth" on valuemd). Addicts play a role in their illness

As you stated, addicts have an illness. Being an IMG is not an illness. This thread was originally about substance abuse/mental health disorder in a struggling colleague. Using it as a platform to preach about your injustices of being an IMG seems like a narcissistic and sociopathic thing to do.

 

[chicagochildpsych]

As you stated, addicts have an illness. Being an IMG is not an illness. This thread was originally about substance abuse/mental health disorder in a struggling colleague. Using it as a platform to preach about your injustices of being an IMG seems like a narcissistic and sociopathic thing to do.

Well, add a little orange bronzer and some hair dye and I guess I can be President.


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[exsanguination]

He can open a cash only anti aging clinic and hire all midlevels and techs. Offer hgh, testosterone, laser treatment, etc. He'll retire with millions more than any of us.


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Il Destriero

I don't get how this works. Can any doctor with a license in any state open up a clinic offering these treatments?

 

[deleted480308]

I don't get how this works. Can any doctor with a license in any state open up a clinic offering these treatments?

Yes

 

[exsanguination]

Yes

Then why aren't more people doing it? Are most market already super saturated? Cash paying patients can be difficult and sometimes just as stressful at the Medicaid patient?

 

[DrfluffyMD]

How many free clinics for addiction do you donate your time to, I'm up to 3 so far

It's been like years since I studied psych factoids but this seems like a perfect vignette for reaction formation no? Instead of "a woman with sexual thoughts became a nun" we can do "a psychiarist who absolutely despite impaired physicians volunteer their time in a free clinic caring for those who are impaired"

 

[mestielest]

Enough said by several colleagues under the topic. I hope you get well by the time and get a good rehab.

 

[chicagochildpsych]

It's been like years since I studied psych factoids but this seems like a perfect vignette for reaction formation no? Instead of "a woman with sexual thoughts became a nun" we can do "a psychiarist who absolutely despite impaired physicians volunteer their time in a free clinic caring for those who are impaired"

I guess I "despite" autistic people, people with schizophrenia, and bipolar disorder. I donate my time because I genuinely believe in serving the poor who don't have access to care in our ridiculous health care system. I don't despise impaired physicians, I recognize that an impaired physician who knowingly puts others in harms way has culpability for their actions. Just like an alcoholic who drives while intoxicated. We understand that the poor drunk drives has in illness, but we hold her accountable for her actions when she has an accident and kills someone. I would expect an even higher standard for a physician. I know that the idea of personal responsibility is often gone in today's society and shielded by the veil of illness, I just don't agree with it. If that makes me a sociopath then so be it....hey isn't narcissistic personality disorder an illness, shouldn't you guys be supporting me as a colleague who has been ravaged by a terrible illness?


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[LucidSplash]

Then why aren't more people doing it? Are most market already super saturated? Cash paying patients can be difficult and sometimes just as stressful at the Medicaid patient?

Because most of us want to be actual doctors not glorified estheticians shilling B12 injections.

For those who can't complete residency, there are still the hurdles of startup costs, business loans, etc. most people who go to medical school aren't necessarily business-minded.

 

[DrfluffyMD]

I guess I "despite" autistic people, people with schizophrenia, and bipolar disorder. I donate my time because I genuinely believe in serving the poor who don't have access to care in our ridiculous health care system. I don't despise impaired physicians, I recognize that an impaired physician who knowingly puts others in harms way has culpability for their actions. Just like an alcoholic who drives while intoxicated. We understand that the poor drunk drives has in illness, but we hold her accountable for her actions when she has an accident and kills someone. I would expect an even higher standard for a physician. I know that the idea of personal responsibility is often gone in today's society and shielded by the veil of illness, I just don't agree with it. If that makes me a sociopath then so be it....hey isn't narcissistic personality disorder an illness, shouldn't you guys be supporting me as a colleague who has been ravaged by a terrible illness?


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Glad to hear you care for those folks, rather than despite them.

How does IMG issue factor in though? Despite the fact that I am an AMG and I don't always bring up where one went to med school in unrelated discussions...despite.

Despite

 

[chicagochildpsych]

I've made my point, you disagree and see it as a false equivalency. You really need it rehashed? No one will change their mind and the endless loop of arguing will continue.


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[rokshana]

Then why aren't more people doing it? Are most market already super saturated? Cash paying patients can be difficult and sometimes just as stressful at the Medicaid patient?

because most people who go into medicine have a conscience and morals...

 

[DrElliotReid]

I'm really surprised (although should I really, given this is SDN and there are unfortunately questionable people on here) and saddened that some people have used this thread for themselves on topics that have nothing to do with what the original post was about? Stop derailing this thread for your own purposes and make your own if you have a question to ask. ::gets off soapbox::

This poor guy (or girl) needs help. Haven't seen a post from you OP in a while. Hope you're doing ok and have been able to find the help you need. SDN should be last on your list of things to do, but if you have any updates I would like to know that you're alright. The silence is a little worrisome.

 

[Light at end of tunnel]

I'm really surprised (although should I really, given this is SDN and there are unfortunately questionable people on here) and saddened that some people have used this thread for themselves on topics that have nothing to do with what the original post was about? Stop derailing this thread for your own purposes and make your own if you have a question to ask. ::gets off soapbox::

This poor guy (or girl) needs help. Haven't seen a post from you OP in a while. Hope you're doing ok and have been able to find the help you need. SDN should be last on your list of things to do, but if you have any updates I would like to know that you're alright. The silence is a little worrisome.

I agree 100 percent on this. As a community, we absolutely need to make it easier for folks such as this instant OP to come forward and offer their stories. This isn't going to happen if we continue to promulgate the high and mighty impression that only disgruntled/incompetent/wrong-career-choice makers ever run into issues during their training.

 

[Dakota45]

Hello. It has been long time (nearly 10 months) since I last checked out this forum. Seeing how much attention this thread got, I thought I would offer an update to my situation. I did ultimately go to rehab about 1 month after getting fired. Unfortunately, it was an almost immediately failure and I washed out in just a couple of days. After another several months of self-pity and continued destruction, I entered a more intensive treatment program and was released about 3 months ago. Thankfully, I have been alcohol free for the first time since I was in my teens. I have been through a lot over the last couple of months (nearly dying from delirium tremens, losing my home, having my parents and other family disown me, having to declare bankruptcy due to my insurmountable medical school/undergraduate debts, and attempting suicide). Sadly, after much research and investigation, there does not seem to be anything that I can do at this point to salvage my former career. I have been working with alcoholics anonymous for the past 2 months visiting high schools and youth centers to tell my story and dissuade people from using drugs and alcohol. If anything, I hope this thread encourages people at all stages of their medical training who currently abuse alcohol to kick the habit before it too late. I am now 30 years old and have nothing to show for all the work I have done in college, medical school and residency except a big pile of debt. I wouldn't wish this fate on my worse enemy, and I truly hope that nobody ever has to go through what I have. If you are struggling from addiction, quitting is easier than you may initially think. Get help while you can, as it is not with ruining your entire life/career over it.

 

[PlutoBoy]

Hello. It has been long time (nearly 10 months) since I last checked out this forum. Seeing how much attention this thread got, I thought I would offer an update to my situation. I did ultimately go to rehab about 1 month after getting fired. Unfortunately, it was an almost immediately failure and I washed out in just a couple of days. After another several months of self-pity and continued destruction, I entered a more intensive treatment program and was released about 3 months ago. Thankfully, I have been alcohol free for the first time since I was in my teens. I have been through a lot over the last couple of months (nearly dying from delirium tremens, losing my home, having my parents and other family disown me, having to declare bankruptcy due to my insurmountable medical school/undergraduate debts, and attempting suicide). Sadly, after much research and investigation, there does not seem to be anything that I can do at this point to salvage my former career. I have been working with alcoholics anonymous for the past 2 months visiting high schools and youth centers to tell my story and dissuade people from using drugs and alcohol. If anything, I hope this thread encourages people at all stages of their medical training who currently abuse alcohol to kick the habit before it too late. I am now 30 years old and have nothing to show for all the work I have done in college, medical school and residency except a big pile of debt. I wouldn't wish this fate on my worse enemy, and I truly hope that nobody ever has to go through what I have. If you are struggling from addiction, quitting is easier than you may initially think. Get help while you can, as it is not with ruining your entire life/career over it.

I'm so sorry to hear that a colleague of mine had to go through this but at the same time I am glad that you are overcoming your demons. Your work at AA and youth centers is greatly appreciated. You are doing good and much needed social work.

You made an unfortunate mistake but that doesn't define you.

Hopefully this doesn't offend you if you are not religious but I believe that sometimes God allows us to go through pain so we can help others by sharing our experience.

You are valuable. I'll be praying for you. That's a promise!

 

[Gastrapathy]

What research has lead you to determine your degree and training have no value? You have completed the minimum training to get licensed. You've been to rehab. I'm no expert but I've seen resident physicians get licensed and eventually back into training after being arrested for writing fentanyl rxs to feed their own addiction.

 

[Gastrapathy]

You could get a job working in clinical trials. You could see if you can get licensed and work somewhere no one wants to be doing Primary care.

Why not try?

 

[NotAProgDirector]

I'm very happy you were able to get help and get sober. However, I disagree with two of your statements, one in a good way, and one in a bad way.

First, is this:

I am now 30 years old and have nothing to show for all the work I have done in college, medical school and residency except a big pile of debt.

This is not true. Sure, you're no longer in a residency program. But as already mentioned you might be able to take your prior training, get a license, and do something medical. And you certainly might get back into a residency program.

Second:

If you are struggling from addiction, quitting is easier than you may initially think.

This is simply not true. Quitting is hard. It's this hard:

nearly dying from delirium tremens, losing my home, having my parents and other family disown me, having to declare bankruptcy due to my insurmountable medical school/undergraduate debts, and attempting suicide

Moving forward:

As I mentioned earlier in the thread, sober you will find that you're a different person. You may, or may not, want to be a physician. And, being a physician might be a bad idea for your health. Or it might be fine. You'll need to explore this.

You've been sober for a few months now. This may seem like a long time to you, but it's a very short time for us. Few programs will consider you unless you have sustained sobriety -- at least 6 months, but more likely at least 1-2 years. So you need to look at this using a long, slow timeline. What you need to do is get back into some sort of medical work -- ideally clinical. Might be a scribe somewhere. Or volunteer in a clinic. Etc.

Then you'll need a job to help pay the bills. As mentioned, you could try to get a license with your past training and ongoing alcohol monitoring -- it's possible that would help you get clinical experience. This will depend upon the state -- some are notoriously more hard to get a license in. You could work doing insurance reviews / prior auths / chart reviews. There are options, you'll need to hunt for them. Plan for many people to turn you down -- you need to take each rejection, use it as fuel for the next application.

Or, you need to walk away from medicine and find a new plan. This isn't failure, it's success of a different flavor. The long hours and stress of medicine might make it more difficult to maintain your sobriety, easier to slip up. You're smart, you can do something else also.

It's scary. Prior to all of this, your life/career was on a straight track. Now you've jumped the rails, and the direction forward isn't so clear. But you can move forward, you need to choose a direction, make a plan, and take it one step at a time.

 

[MedMan80]

I would argue that you're 30 and have your whole life ahead of you. I am aware of some residencies and fellowships that may even prefer physicians who have gone through addiction and overcame it. Keep it up wo(man)!

 

[Crayola227]

I want to thank the OP for the courage to bring their story forward, to seek help on SDN, and to bring us an update.

I also want to thank them for surviving everything they have survived, and choosing to stay with us. Metaphorically. On planet Earth. If you get what I mean.

I won't argue with the OP - not completing a residency is crushing. The job prospects aren't zero, but they don't feel good when you felt like you had everything going for you and you were within grasp of everything you'd ever wanted/achieved in your adult life. To act like buck up, hey now you can get work denying prior auths, is frankly insulting to the blow the OP has had. Coming that close to your dreams only for them to die can be just as painful as a loved one dying. It's something you love, it's part of you, it's loss of identity.

OP, I know physicians in your shoes. And remember, the fact you have completed medical school makes you a physician, you don't need a license or residency to claim that profession as your own, or the title. Doctor, means teacher in Latin. Your medical school experience, surgical training, and life experiences still make you qualified to teach and be involved in health care in other ways.

This might not seem comforting, and it is small comfort, but physicians that I know, that get thrown away by the modern medical establishment, deserved or no, often find fulfillment in helping people who have suffered as they have.

It isn't my current signature, but you likely recognize this quote from the Big Red Book, "Cling to the thought that, in God's hands, the dark past is the greatest possession you have--the key to life and happiness for others. With it you can avert death and misery for them." What more can a doctor hope to achieve?

OP, I understand that this isn't the type of doctor you envisioned yourself being, and you've lost a lot. But it sounds like you are on track to building a better life. It's so so so so so hard to imagine life outside clinical medicine and as better, but it can be. You're sober, for one. You can move forward in health, build new relationships built on a healthy foundation, possibly repair old ones. What you've been through and lost hasn't been for nothing; far from it. What you have best to offer the world has just changed a bit. Some things in life chooses us, and we have to go through the pain of trying to learn to accept it.

I wish you well in your recovery, I know it isn't easy.