Guidance Terminated from Residency PG-Y 3

[Jobless and Dreamless]

Hello,

I need guidance. I was in a FM Residency program and learnt yesterday i was asked to step down either be terminated or resign.

This was based on medical knowledge. I tried a number of things and the residency helped me giving me chances. i don’t want to sue anyone, i accept my responsibility in this.


My questions is what do i do now. I was three years and few months in, have a MPH degree, received commendations in form of award recognition by residency as resident of the year last year. i have my state’s medical license.

Staff have told me i should apply to other residencies i am heartbroken and unsure what is the next step. My question is:

1. are there any mentoring programs or such i can utilize to figure out what’s next for me?

2. i am debating leaving clinical medicine and getting into hospital administration/public health. i am debating about getting a drph degree vs MBA.
what would hold more utility ?

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[shaggybill]

You have your state's independent medical license? If so that is huge. There are still jobs out there where board certification is not required. You don't have to work in family medicine. You have to look hard for these jobs, and they aren't usually the most glamorous (think Dept of Corrections, cash-based clinics in elective medical treatments, etc) , but at least you can make a decent living and stay in clinical medicine. If you play your cards right, you may even be able to get back into residency. Do you think your program director will write you a decent LOR?

I'm confused how you go from Resident of the Year to being asked to resign though.

 

[Jobless and Dreamless]

Yes, in my State, being in the third year of residency and having finished Step 3 makes you eligible to get a license, so I have a License.
The transition happened due to my poor performance in the Internal Medicine rotation and poor ITE performance. I have struggled, and I do not blame anyone but me. I tried multiple different learning methods, but nothing helped.
For instance,
1. I did not feel a somnolent patient could have had low blood sugar during admitting them.
2. I developed a feeding plan that exacerbated a baby's feeding difficulty instead of recognizing they could benefit from supplementing.
These are two more recent situations; however, these are only things in a pattern. Though nothing I did caused death in any patient, I understand their perspective.

As for Resident of the Year,
I started a pediatric book program during well-child visits
I helped create a curriculum for pediatric outreach
I finished my MPH during my residency
I was well-liked by most of my patients and staff.
I am also a strong advocate for my patients and their needs.
I also participated in several Community Outreach programs and would often help out in covering for my colleague's shifts.
I went a distance in teaching medical students

I am interested in residency. I do not want to start a job instead I want to finish training. I am looking for something 1-2 years I can do.

What I am thinking is residency via
1. Transitional Year residency
2. Transfer somewhere
3. Preventative Medicine residency

What do you think?

 

[gutonc]

Yes, in my State, being in the third year of residency and having finished Step 3 makes you eligible to get a license, so I have a License.
The transition happened due to my poor performance in the Internal Medicine rotation and poor ITE performance. I have struggled, and I do not blame anyone but me. I tried multiple different learning methods, but nothing helped.
For instance,
1. I did not feel a somnolent patient could have had low blood sugar during admitting them.
2. I developed a feeding plan that exacerbated a baby's feeding difficulty instead of recognizing they could benefit from supplementing.
These are two more recent situations; however, these are only things in a pattern. Though nothing I did caused death in any patient, I understand their perspective.

As for Resident of the Year,
I started a pediatric book program during well-child visits
I helped create a curriculum for pediatric outreach
I finished my MPH during my residency
I was well-liked by most of my patients and staff.
I am also a strong advocate for my patients and their needs.
I also participated in several Community Outreach programs and would often help out in covering for my colleague's shifts.
I went a distance in teaching medical students

I am interested in residency. I do not want to start a job instead I want to finish training. I am looking for something 1-2 years I can do.

What I am thinking is residency via
1. Transitional Year residency

A TY is not an option for you. You've already done >2/3 of a residency, a TY is for new interns going to an advanced specialty. It would not get you anything you don't already have.

2. Transfer somewhere

IIRC, ABFM requires that you complete your final 2y of residency in one program. So while you might be able to find a program to pick you up, you're going to need to repeat PGY2 (which may not be a bad idea for you anyway). But are you sure that clinical medicine is the right thing for you at this point?

Which brings me to....

3. Preventative Medicine residency

This, or Occ Med, or Med Genetics, may be an option for you if you want to be clinical-ish but not as fully clinical as FM would be.

Step 1 in all of this is figure out what you want to be when you grow up.

 

[shaggybill]

Agree with gutonc about Prev Med or Occ Med. You already have an MPH so that would look good on an Occ Med application since that's a requirement for BC in that field. There's a LOT you can do in Occ Med that can be ether clinical or not-so-clinical. It may be difficult to get back into a FM residency since you were asked to leave your current program, but maybe not impossible. What area of the country are you in?

 

[Jobless and Dreamless]

Upstate New York

 

[90sportsfan]

I’ve never heard of this scenario to be so close and to have gotten resident of the year the previous year….I would probably first try by any means to see if there is any opportunity to finish up your FM residency somewhere. You are so close, that it would be a shame to let all that training go. If that fails, then you could look at Preventive Medicine/Occ Medicine. But it seems with some networking, some mentoring, being able to articulate how you’ve learned from your experience, there should be an opportunity somewhere to finish up. Especially if you are flexible with location.

 

[Apollyon]

I’ve never heard of this scenario to be so close and to have gotten resident of the year the previous year….I would probably first try by any means to see if there is any opportunity to finish up your FM residency somewhere. You are so close, that it would be a shame to let all that training go. If that fails, then you could look at Preventive Medicine/Occ Medicine. But it seems with some networking, some mentoring, being able to articulate how you’ve learned from your experience, there should be an opportunity somewhere to finish up. Especially if you are flexible with location.

As was said above, ABFM requires the last 24 months to be at the same program.

 

[NotAProgDirector]

The list of options:

1. Try to stay at your current program. Appeal the decision. In IM, the ITE is not allowed to be used for decisions like this. May be different in FM (You have already mentioned you don't want this option, but might as well make the list complete).
2. Transfer to a different FM program. As mentioned, you'd need to restart as a PGY-2. Getting a spot could be very difficult.
3. Find a spot in a different field. Options would be the ones above (PM, Occ Med), and maybe neurology. And EM - but if you're struggling at all in an FM program, I would not recommend going to a crappy EM program that can't fill.
4. Work in primary care with the training you have. You might be able to get a job without completing a full residency, options likely to be very limited. You might be able to open your own practice, although getting medmal might be a challenge. indian Health Service and Corrections may be willing to hire you.
5. Find a niche that needs to be filled. If you live somewhere with very limited Bup clinic options, you could try to do that with your license. There's a thread somewhere here on SDN about a poster who didn't complete a residency and opened a wound care practice, went to nursing homes and takes care of wounds, ended up being very successful. The key is to find a small, focused niche that needs filling.
6. Find something medicine-adjacent. This is very complicated and involves you selling yourself. Just collecting more degrees may be a waste of money. An MBA from a top B-school is great, but "just any" MBA won't open lots of doors.

 

[Reeses4Life]

As was said above, ABFM requires the last 24 months to be at the same program.

I was told by a lawyer that there’s a waiver you can use to bypass this requirement

 

[Apollyon]

I was told by a lawyer that there’s a waiver you can use to bypass this requirement

I can't speak to that. However, I can't imagine how. Then again, I'm not FM.

 

[wholeheartedly]

Your resident of the year activities seemed to include a lot of outreach and education. With that in mind and your MPH, if you enjoy that stuff like you seem to, I think you might consider preventive med, finishing something, and then doing something in public health. Lots of community and county health departments need medical directors. You’ll use your clinical training, but in a different context. Might be a good fit.

 

[Dral]

I like the ideas of Occ med or Preventive med (also it's preventive, not prevenTAtive)

 

[Goro]

You have your state's independent medical license? If so that is huge. There are still jobs out there where board certification is not required. You don't have to work in family medicine. You have to look hard for these jobs, and they aren't usually the most glamorous (think Dept of Corrections, cash-based clinics in elective medical treatments, etc) , but at least you can make a decent living and stay in clinical medicine. If you play your cards right, you may even be able to get back into residency. Do you think your program director will write you a decent LOR?

I'm confused how you go from Resident of the Year to being asked to resign though.

Add teaching to the list of things OP can do

 

[Goro]

FYI, OP

SDN Article: 5 Steps to Take If You Are Fired From Your Residency Program

The Student Doctor Network publishes articles weekly. Check out this article or other articles about residency and the Match at Student Doctor Network. No matter where you are in your residency training, a dismissal (or suspension, non-renewal, non-promotion, or even probation) threatens the...

forums.studentdoctor.net

 

[90sportsfan]

As was said above, ABFM requires the last 24 months to be at the same program.

Ah ok. I missed that. I’m not in FM. That stipulation definitely makes the situation look less optimistic.

 

[IonClaws]

Sorry to hear about the problems you've been having, OP.
Medicine is the only profession I'm aware of where you find out you aren't cut out for it AFTER fighting to be admitted to and graduating from medical school.

 

[mistafab]

Hey OP - just wanted to say your life isn't over and there are lots of options for you. So off the bat, this is tough but defnitely somethign you can make through.

In your posts, it seems to me you may have overextended yourself. You got involved in lots of projects not related to actual doctoring. In residency, you are training to be a doctor, and that is hard to do if a lot of hours are being spent on other activites/projects.

My question is - are those projects/activities more important to you than doctoring? If so, then I would say follow fate and go into a path that will let you do more of those things (such as occ health, prev med). Or you could even do a research fellowship such as in obesity, and put yourself more towards a career in research/public health.

If you feel those things were important, but doctoring is more important, than you have several options (as outlined above). You can start a practice since you have an unrestricted license (very hard). You could hunt for jobs (correctionals, possibly urgent care), you could possibly find PRN gigs and build a local reputation for yourself if you do a good job. Or, you could start looking to apply into residency again.

So I wanted to wish you best of luck. Lots of options for you - you aren't out of the running yet!

 

[Lee Ik-jun MD]

try to secure a PGY2 position in family medicine , so can meet the ABFM requirement of last 24 months on the same program. I know it wasn't on your post , but was there any politics involved in your scenario? like a faculty or assistant program director determined to let you go? I find it unusual that they want to terminate you/ have you resign right away. In other specialities where I trained ( OB-GYN and Gen Surgery residents) they repeat a year if they have problems in medical knowledge. I don't think a low ITE score is enough to kick you out.

 

[IonClaws]

try to secure a PGY2 position in family medicine , so can meet the ABFM requirement of last 24 months on the same program. I know it wasn't on your post , but was there any politics involved in your scenario? like a faculty or assistant program director determined to let you go? I find it unusual that they want to terminate you/ have you resign right away. In other specialities where I trained ( OB-GYN and Gen Surgery residents) they repeat a year if they have problems in medical knowledge. I don't think a low ITE score is enough to kick you out.

It kinda seems like unless it's something illegal and/or drug-related or ethics-related, the subjectivity of a resident's performance and confirmation bias therein makes the majority of such terminations political.

 

[NotAProgDirector]

It kinda seems like unless it's something illegal and/or drug-related or ethics-related, the subjectivity of a resident's performance and confirmation bias therein makes the majority of such terminations political.

This is a very complicated topic. I realize you have had bumps in your own training road that may have flavored your opinion, which doesn't make it invalid.

The assessment of clinical skills is subjective. No amount of "milestones" or whatever crap the ACGME decides to focus upon next will change that. We will never have some objective tool that tells us whether someone is competent or not. So in the end it's a subjective evaluation from local "experts".

When a resident is felt to not be meeting standards, it's possible that there is a real deficit, fuzzy standards, biased/flawed assessments, or some combination. Skipping the real deficit to discuss the problems:

Fuzzy standards - exactly what level of performance is required to prove competence? Good enough that the home institution would hire the grad, or good enough that they could work somewhere? What if they were felt to be OK in an outpatient experience but not inpatient? Or vice versa? Or only working with lower acuity patients? Or only certain procedures? Current board / ACGME rules don't allow for this type of variation -- to graduate someone means they are fully competent in all areas. But any program that takes this seriously recognizes that competence / non-competence is not boolean but a spectrum, and hence some residents will fall into a grey zone and programs will decide what they will do.

Biased assessments - all subjective assessments are subject to cognitive biases. The most common is confirmation bias -- specifically focusing on what you expect to find. Once a resident has been placed in some sort of remediation, there is the concern that increased scrutiny will find more issues that otherwise would go unnoticed and not be of concern. And residents can end up in a negative feedback loop, concern over poor evaluations --> poorer performance --> poor evaluations.

So I think it depends upon what you mean by "political". It's subjective, and that's open to being impacted by your likeability and interpersonal skills. It also depends upon how much you engage with the improvement process. Not all programs will give a resident a fair shake, and that's unfortunate (and honestly unacceptable). But forcing programs to graduate all residents regardless of their clinical skills and only terminating if they break the law is unreasonable.

 

[brianmartin]

something seems off here. the examples given of making some clinical mistakes on rotations and struggling with ITE, for an otherwise high performing person... it just doesn't add up to "termination or resign" to me. Something else must have happened.

 

[FutureDoctor5000]

something seems off here. the examples given of making some clinical mistakes on rotations and struggling with ITE, for an otherwise high performing person... it just doesn't add up to "termination or resign" to me. Something else must have happened.

Agree, none of the examples given are that egregious, and I have never heard of someone being terminated due to an ITE score. There’s is definitely much more to this story

 

[Crayola227]

Agree, none of the examples given are that egregious, and I have never heard of someone being terminated due to an ITE score. There’s is definitely much more to this story

Those mistakes are unacceptable for a 3rd year on the cusp of completely independent practice. They are also just examples, and if there are more, and there probably is, a pattern like that...

If they don't think he can practice and they don't think he can be remediated with more time (assuming they can have him repeat a year)...

What else can they do? You'd have to steer someone to something with much lower potential of harm.

I've seen people like this in medicine... they get to and through medical school mostly on exceptional work ethic and good people skills... but they just can't practically apply it in clinical situations independently.

I have heard stories of marginal PGY2 (the most confusing thing here is the aware for resident of the year... although I don't know the basis of how the awardee is chosen) being promoted because a repeat PGY2 isn't in the cards, and there is hope for them. Or they just don't want to be short staffed? Even a resident like this might still be useful under close supervision?

The real question to OP would be, when did this pattern start? Did you know your program was worried about you before 3rd yr?

It does feel a little off and like there must be more to the story, at the same time, as described it is still in the realm of plausibility.