If You Resigned or Got Terminated

[BornToLose98]

What are you all up to right now? Did you find success after resignation/termination? How did you get past that phase?

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[abc2019]

Applying again, in the middle of interview season and hoping i match!

 

[BornToLose98]

Are you applying to the same specialty? My program director doesn't want to write me a neutral letter and I haven't gotten a single LOR from my attendings, so I can't reapply.

 

[deleted480308]

What happened?

 

[BornToLose98]

What happened?

Long story short: I was in a pathology (ap/cp) community program in the Northeast. Had some performance issues in the frozen section room as a PGY1 so I was put on probation for a few months after which I was successfully remediated and promoted to PGY-2. The old PD used to call me into her office every other day to sign something. She even referred me to a social worker (who I continued to see for a couple of months) through the EAP office because she thought I was having trouble adjusting to the system. This PD was manipulative to say the least - I didn’t realize this till it was too late. Mid second year I started losing interest in the day-to-day work (it felt repetitive) so I made grossing errors that apparently impacted patient care (not major errors but lots of minor ones that sort of snowballed with time eg. not submitting enough lymph nodes on a ca case, not following the grossing protocol for a reduction mammoplasty because there was no protocol in place, submitting a thick tissue section on a breast case leading to poor tissue fixation so the tissue had to be reprocessed, misplacing a specimen container once - it was actually in my pocket the whole time so it wasn’t really lost, not giving enough hx when signing out with an attending). One attending even said I skipped sign out - she was signing out her own cases when I went to her office so I decided to go back to the resident's room and wait for her to call, only she didn't. Some neurosurgeon thought I was being rude to him over the phone (not sure where that came from). I was even accused of losing a tray full of slides when in reality the fellow was the one who took the tray (I tried to explain that to the PD but she wouldn’t believe me). There were also some professionalism issues raised - not staying for the whole lecture (this literally happened only once), not participating in unknown conferences etc..if I recall correctly they mentioned the words ‘avoidant behavior’ in the letter. I didn’t mesh well with the residents and fellows, mostly because I kept to myself. I didn't trust the residents either because anything I used to say in the resident's room was immediately communicated to the PD. After that I was under constant scrutiny and almost everyone was watching my every move. They were pretty much documenting everything I was doing or saying. I felt even more alone than I did when I first started residency. Then, without any verbal warning, I was handed a letter of deficiency with adverse action which I decided to appeal. I didn’t seek any legal advice at this point because I didn’t know any better. I presented my case to the appeal panel but it was denied and the decision was made to uphold the LOD with adverse action. This was after I asked one of the fellows to vouch for me. When I became suspicious of what the fellow had said at the meeting with the appeal panel, I confronted her (I didn’t yell or anything but this was documented and considered unprofessional behavior on my part). At that point the PD called me into her office again and said the appeal panel was concerned about my wellbeing and wanted me to contact the EAP office again. I then deliberately proceeded to call EAP in the resident’s room out of frustration. Turns out one of the residents overheard the conversation and reported it to the PD, saying it made her feel uncomfortable. After that incident, I was forced to go on a medical leave of absence for 3 months and was referred to PHP because they thought I might be depressed. PHP sent me to another facility to undergo psychiatric and neuropsychological testing - no formal diagnosis was given but I was asked to seek counseling on the regular to work on things like communication and interpersonal effectiveness which I complied with. I had a formal meeting with the PD and hospital director and 3 months later, I was back on surgical pathology. They had way too many PAs in the frozen section room helping with the grossing because they felt I couldn’t handle the workload (not true, I was just a little rusty from not doing anything for 3 months straight). I made 2 more grossing mistakes (honest ones) which were reported to the PD so I was asked to go home again. The following day, I was notified of their decision to terminate me but they gave me the option of resigning, so I did. I’m back home now and feeling lost as ever. I was pretty good at the scope. Sadly I was on a J1 visa and I had no interest in anything else besides path. That’s the condensed version.

 

[deleted480308]

I’m sorry you didn’t feel supported but it does seem like you made some pretty significant contributions to ending that job. If you are on the ropes, you cannot miss simple things like staying for lecture.

I don’t know of a path forward career wise besides trying to personally get to know some transitional year pd or fm in the middle of nowhere

 

[BornToLose98]

I’m sorry you didn’t feel supported but it does seem like you made some pretty significant contributions to ending that job. If you are on the ropes, you cannot miss simple things like staying for lecture.

I don’t know of a path forward career wise besides trying to personally get to know some transitional year pd or fm in the middle of nowhere

Thanks. I started attending all their lectures after they gave me the LOD with AA but I guess by then it was too late.

 

[doctorKAT]

Long story short: I was in a pathology (ap/cp) community program in the Northeast. Had some performance issues in the frozen section room as a PGY1 so I was put on probation for a few months after which I was successfully remediated and promoted to PGY-2. The old PD used to call me into her office every other day to sign something. She even referred me to a social worker (who I continued to see for a couple of months) through the EAP office because she thought I was having trouble adjusting to the system. This PD was manipulative to say the least - I didn’t realize this till it was too late. Mid second year I started losing interest in the day-to-day work (it felt repetitive) so I made grossing errors that apparently impacted patient care (not major errors but lots of minor ones that sort of snowballed with time eg. not submitting enough lymph nodes on a ca case, not following the grossing protocol for a reduction mammoplasty because there was no protocol in place, submitting a thick tissue section on a breast case leading to poor tissue fixation so the tissue had to be reprocessed, misplacing a specimen container once - it was actually in my pocket the whole time so it wasn’t really lost, not giving enough hx when signing out with an attending). Some neurosurgeon thought I was being rude to him over the phone (not sure where that came from). I was even accused of losing a tray full of slides when in reality the fellow was the one who took the tray (I tried to explain that to the PD but she wouldn’t believe me). There were also some professionalism issues raised - not staying for the whole lecture, not participating in unknown conferences etc..if I recall correctly they mentioned the words ‘avoidant behavior’ in the letter. I didn’t jive well with the residents and fellows, mostly because I kept to myself (not really a people’s person). After that I was under constant scrutiny and almost everyone was watching my every move. They were pretty much documenting everything I was doing or saying. I felt even more alone than I did when I first started residency. Then, without any verbal warning, I was handed a letter of deficiency with adverse action which I decided to appeal. I didn’t seek any legal advice at this point because I didn’t know any better. I presented my case to the appeal panel but it was denied and the decision was made to uphold the LOD with adverse action. This was after I asked one of the fellows to vouch for me. At that point the PD called me into her office again and said the appeal panel was concerned about my wellbeing and wanted me to contact the EAP office again. I then deliberately proceeded to call EAP in the resident’s room out of frustration. Turns out one of the residents overheard the conversation and reported it to the PD, saying it made her feel uncomfortable. After that incident, I was forced to go on a medical leave of absence for 3 months and was referred to PHP because they thought I might be depressed. PHP sent me to another facility to undergo psychiatric and neuropsychological testing - no formal diagnosis was given but I was asked to seek counseling on the regular to work on things like communication and interpersonal effectiveness which I complied with. I had a formal meeting with the PD and hospital director and 3 months later, I was back in the grind. They had way too many PAs in the frozen section room helping with the grossing because they felt I couldn’t handle the workload (not true, I was just a little rusty from not doing anything for 3 months straight). I made 2 more grossing mistakes (honest ones) which were reported to the PD so I was asked to go home again. The following day, I was notified of their decision to terminate me but they gave me the option of resigning, so I did. I’m back home now and feeling lost as ever. I was pretty good at the scope. Sadly I was on a J1 visa and I had no interest in anything else besides path. That’s the condensed version.

I am sorry this happened to you. I think you should apply to Path again. do some observerships and get new LORs. Path is not very competitive. I know multiple ppl with red flags similar to you applying this cycle and getting many interviews. What state s PHP program did you go to? I know some states php program report all patients to medical boards and thus ruining your chances of getting residency again

 

[BornToLose98]

I am sorry this happened to you. I think you should apply to Path again. do some observerships and get new LORs. Path is not very competitive. I know multiple ppl with red flags similar to you applying this cycle and getting many interviews. What state s PHP program did you go to? I know some states php program report all patients to medical boards and thus ruining your chances of getting residency again

Thanks. I'll try to look for observerships in Path and ask for new LORs. I was thinking about getting an MS in a related field and taking the doctoral route in case my residency plan doesn't pan out. Would having the MS degree help mitigate the red flags in my application? I graduated in 2013 (I guess that makes me an old grad). One thing I forgot to mention is that the program made me fill out resident remediation and LOA forms which were submitted to ECFMG before referring me to PHP. They did everything in their power to ensure I never practice medicine in the US. Before I left the country, ECFMG sent an email saying they are unlikely to entertain J1 visa sponsorship again given the circumstances surrounding my resignation. My fate is sealed, it seems. It's quite depressing.

 

[GoSpursGo]

Thanks. Connecticut. I'll try to look for observerships in Path and ask for new LORs. I was thinking about getting an MS in Cancer Biology and taking the doctoral route in case my residency plan doesn't pan out. Would having the MS degree help mitigate the red flags in my application? I graduated in 2013 (I guess that makes me an old grad). One thing I forgot to mention is that the program made me fill out a resident remediation form which was submitted to ECFMG before referring me to PHP. They did everything in their power to ensure I never practice medicine in the US. Before I left the country, ECFMG sent an email saying they are unlikely to entertain J1 visa sponsorship again given the circumstances surrounding my training. My fate is sealed, it seems. It's quite depressing.

Without passing judgment on you or how the circumstances of your termination was handled, I have to say that the bolded really makes it sound like resuming training in the US will be impossible--even if you find a program that is willing to overlook a negative review from your prior PD, it doesn't sound like you're going to be able to get a visa. I know that's not what you want to hear, but I fear trying to do observerships and get new letters would be a further waste of your time.

 

[doctorKAT]

Thanks. Connecticut. I'll try to look for observerships in Path and ask for new LORs. I was thinking about getting an MS in Cancer Biology and taking the doctoral route in case my residency plan doesn't pan out. Would having the MS degree help mitigate the red flags in my application? I graduated in 2013 (I guess that makes me an old grad). One thing I forgot to mention is that the program made me fill out a resident remediation form which was submitted to ECFMG before referring me to PHP. They did everything in their power to ensure I never practice medicine in the US. Before I left the country, ECFMG sent an email saying they are unlikely to entertain J1 visa sponsorship again given the circumstances surrounding my training. My fate is sealed, it seems. It's quite depressing.

your program sounds very malignant. have you thought about taking legal actions against them?

 

[BornToLose98]

Without passing judgment on you or how the circumstances of your termination was handled, I have to say that the bolded really makes it sound like resuming training in the US will be impossible--even if you find a program that is willing to overlook a negative review from your prior PD, it doesn't sound like you're going to be able to get a visa. I know that's not what you want to hear, but I fear trying to do observerships and get new letters would be a further waste of your time.

Thanks. The reason isn't clear though (why ECFMG stated that in the email).

 

[BornToLose98]

your program sounds very malignant. have you thought about taking legal actions against them?

Yes. I am now in the process of starting a lawsuit against the program. Numerous people have left in the past year or so (not residents although one resident transferred but PAs, lab assistants, histotechs, and attendings). The attendings over there were incredibly difficult to work with. I would say that the program was scut-heavy (as are all programs) but it was really all about getting the grossing done and nothing else. I didn't fit into the mold of the program so they wanted me gone.

 

[Dave1980]

your program sounds very malignant. have you thought about taking legal actions against them?

There are 2 sides to every story. Programs don't like kicking out residents...it's a huge hassle.

 

[BornToLose98]

There are 2 sides to every story. Programs don't like kicking out residents...it's a huge hassle.

When I got back from the LOA, they extended my LOD with AA for 60 days. They terminated me on the 15th of November. Technically I had until December 20th to improve.

 

[BornToLose98]

Without passing judgment on you or how the circumstances of your termination was handled, I have to say that the bolded really makes it sound like resuming training in the US will be impossible--even if you find a program that is willing to overlook a negative review from your prior PD, it doesn't sound like you're going to be able to get a visa. I know that's not what you want to hear, but I fear trying to do observerships and get new letters would be a further waste of your time.

Thanks. I wasn't ready to get back on the residency bandwagon anyway. It was hard enough the first time.

 

[Gastrapathy]

It’s America, anyone can sue anyone. But, if you’re really “in the process of starting a lawsuit”, I hope you are getting good legal advice before you spend too much money. Your version of your performance doesn’t leave much room for proving that they acted in bad faith. I don’t know anything about path but it seems unlikely that your error rate was close to the norm.

There’s a lot to unpack in your description of events but you acknowledge “lots” of technical errors over several years, interpersonal conflicts, loss of interest in the job, not being present for required events and an attempt, at least on paper, at remediation after a leave of absence with further errors thereafter.

You also make several statements that suggest you still kinda don’t get it. A fellow vouching for you is utterly irrelevant. The fact that your final series of errors were “honest mistakes” is irrelevant. Your phone call from the residents room that was “out of frustration” and made someone uncomfortable shows a lack of insight into your situation. You’d had a ton of feedback before your LOD but somehow feel you were entitled to another verbal warning.

I point this all out because there’s always this validation on SDN for legal action but you’ll be the one footing the bill. it’s just my totally non-expert opinion as someone with no legal background, but I think this is a big hill to climb.

That said, getting kicked out of residency and the country is truly terrible and I hope you are able to salvage a future that fulfills you.

 

[BornToLose98]

It’s America, anyone can sue anyone. But, if you’re really “in the process of starting a lawsuit”, I hope you are getting good legal advice before you spend too much money. Your version of your performance doesn’t leave much room for proving that they acted in bad faith. I don’t know anything about path but it seems unlikely that your error rate was close to the norm.

There’s a lot to unpack in your description of events but you acknowledge “lots” of technical errors over several years, interpersonal conflicts, loss of interest in the job, not being present for required events and an attempt, at least on paper, at remediation after a leave of absence with further errors thereafter.

You also make several statements that suggest you still kinda don’t get it. A fellow vouching for you is utterly irrelevant. The fact that your final series of errors were “honest mistakes” is irrelevant. Your phone call from the residents room that was “out of frustration” and made someone uncomfortable shows a lack of insight into your situation. You’d had a ton of feedback before your LOD but somehow feel you were entitled to another verbal warning.

I point this all out because there’s always this validation on SDN for legal action but you’ll be the one footing the bill. it’s just my totally non-expert opinion as someone with no legal background, but I think this is a big hill to climb.

That said, getting kicked out of residency and the country is truly terrible and I hope you are able to salvage a future that fulfills you.

Thanks Gastrapathy (for being brutally honest). I was very much well-adjusted to living there. I was learning a ton too. It was sad to see it all go to waste. I don’t think I’ll be able to afford it so scratch that. I didn’t really have any interpersonal conflicts as I’m a pretty harmonious person but the environment was hostile, so it was hard to keep my cool sometimes.

 

[deleted480308]

Thanks Gastrapathy. I don’t think I’ll be able to afford it so scratch that. I didn’t really have any interpersonal conflicts as I’m a pretty harmonious person but the environment was hostile, so it was hard to keep my cool sometimes.

If it was hard to keep your cool, you had interpersonal conflicts

 

[Gastrapathy]

Thanks Gastrapathy. I don’t think I’ll be able to afford it so scratch that.

Just to be clear, I’m not passing any judgement. It’s just that your description of events makes it hard for me to see how you’d be likely to win and I’d hate for some predatory attorney to take what money you have left and waste it. But, truly this is just my opinion from the cheap seats and I wish you success.

 

[dpmd]

your program sounds very malignant. have you thought about taking legal actions against them?

Really, all those significant errors they admit to (and who knows how much they don't admit to) and you think it is the program's fault?

 

[BornToLose98]

I think I may have misoriented a prostate once. Cleanliness was never an issue although in Path it’s almost impossible to not get your scrubs soiled (we deal with excreted waste and bloody specimens on a daily basis). I guess I never really cared much for grossing. Another surgeon complained that my tumor board PowerPoint slide was too ‘crowded’.

Anyway, all is lost. Thanks everyone for chiming in. I appreciate all the comments.

 

[Mass Effect]

I think in your case, the visa thing complicates the matter. We all make mistakes and I get that you were a resident and these mistakes happened. But I think what I get from your post is perhaps either a lack of interest or lack of motivation (possibly because of the environment) to improve and get better. I think most people who graduate med school are capable of succeeding at residency and I'm sure you have the scientific acumen to be one of them, but it's just unfortunate that you're in this situation while on a Visa. I am sorry that you're in this position. If your finances can stand it, you can try again to get another residency with observorships, etc, but I would first contact the ECFMG again and discuss your case with them. Let them hear you out and give you their decision before you look into pursuing another program.

 

[BornToLose98]

Thanks Mass Effect. I was devoted to the specialty when I first started but as time went on I slowly started to lose motivation because I was unhappy there.
My performance was above average in other areas (diagnosis/previewing cases, in-service exams, in-house conferences/presentations, I even managed to publish once) based on their evaluations of me but clearly there were deficiencies, albeit not glaring ones. I wasn’t terrible at grossing, just not as skilled as let’s say, the PAs. I tried to transfer but I guess I didn't try hard enough. In that program, residents don’t perform the eviscerations on autopsy cases (the diener does). Learning how to perform autopsies proficiently should take precedence over grossing biopsies. In retrospect, I should have picked the AP only track (less downtime) but the number of AP only programs are few and far between. I'll have to call ECFMG on Monday and double-check but I'm not too hopeful.

 

[BornToLose98]

Really, all those significant errors they admit to (and who knows how much they don't admit to) and you think it is the program's fault?

To err is human but I guess I was making more mistakes on average than my peers and drawing undue attention to myself. Some people are good at flying under the radar - others not so much. I fall under the later category.

 

[BornToLose98]

There are 2 sides to every story. Programs don't like kicking out residents...it's a huge hassle.

That’s not entirely accurate. There are actually 3 sides to every story (my side, their side and the truth). All of that isn’t important in the grand scheme of things. There’s no denying that people are subjective by nature even though they are inclined to be objective when dealing with work-related matters (hence their perceptions of you tend to be skewed). This is just something I’ve noticed over the years (I guess you could call it experiential learning). I’ll never understand why things are the way they are.

 

[BornToLose98]

Hi admins,

Please close the thread. Thanks

 

[gutonc]

Locked at OP request.