Is there a logistical framework for quitting residency after PGY-1?

[ExcaliburPrime1]

I am feeling incredibly burned out, to the extent that I'm seriously considering tendering my resignation. I am not in any sort of trouble and I would wager to think that many of my colleagues think me to be a "safe pair of hands". I just don't think that I'll be able to keep grinding until the end of residency and rather than limp on, it might be best to quit now.

Now, this is probably not a common event, and yet I'm sure there have been psychiatry residents who have quit in the past. I was looking at my contract and it says to give 30-days notice and participate in an exit interview, both of which I'm happy to do. I would also want my PD to write me a letter summarizing my work for the past 15 months or so, such that I have that option available in case I want to reapply for residency in the future. We are on good terms (who knows after this, but at least at present on good terms) that I doubt this would be a problem.

So I guess I'm asking, is there anything else I'm forgetting or missing? I put in the notice, keep doing my job, and make myself available if they want to do an exit interview. If I want to reapply in the future, I do it through the match I guess, or maybe by directly contacting programs to see if they have a PGY-2 spot open.

I guess this thread is if there is anything else glaring that I'm missing. I would appreciate any insight. Thanks.

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[splik]

Never quit to escape without a backup plan in place. If you're burnt out, this is not the time to be making these kinds of decisions. If you are truly burnt out (i.e. can no longer feel empathy for patients, find everything annoying, dread going to work everyday, fantasize about quitting, feel disconnected from everything that's going on) then you shouldn't be working and should take a leave of absence to recharge your batteries. Srsly, typically every year of residency is better than the last. Intern yr sucks. Hell, residency sucks. It is supposed to. If you think this is a program specific thing that's getting to you by all means apply for PGY-2 openings, but dont just hand in youe resignation without a clear exist strategy. Please discuss your feelings with your advisor, a therapist, and anyone who can provide you some guidance. Also when is your next vacation?

If you quit now, your chances of successfully matching again in the future (at least at any good program) is very low. If you mean completing PGY-1 and then applying for PGY-2 that is a separate thing.

If your program is any good they should be able to work on some kind of leave of absence for you.

If you so choose you can non-renew. Your position is only for 1 yr so you will have to accept a position for the PGY-2 yr. You can choose not to sign this. Then your program will look for someone else. They will appreciate this more then if you sign the contract but then a month before PGY-2 yr quit. The trade off is if you non-renew everyone will know if and you're basically a dead (wo)man walking. On the other hand, you are more likely to get a nice reference from your PD and other people if you don't just quit with warning.

Post residency btw the opposite is true which is its always better to hand your notice in at the last possible moment. But as a resident that can hurt you more than it benefits you.

Edit: are you already a PGY-2? I am confused by your post! If so, I would see if you can take a leave of absence, and PGY-3 is typically substantially better. If you are thinking of switching specialties your program may also be able to help you do electives in that specialty so you can get letters to apply for that. At least that is what they did at my program.

 

[ExcaliburPrime1]

Never quit to escape without a backup plan in place. If you're burnt out, this is not the time to be making these kinds of decisions. If you are truly burnt out (i.e. can no longer feel empathy for patients, find everything annoying, dread going to work everyday, fantasize about quitting, feel disconnected from everything that's going on) then you shouldn't be working and should take a leave of absence to recharge your batteries. Srsly, typically every year of residency is better than the last. Intern yr sucks. Hell, residency sucks. It is supposed to. If you think this is a program specific thing that's getting to you by all means apply for PGY-2 openings, but dont just hand in youe resignation without a clear exist strategy. Please discuss your feelings with your advisor, a therapist, and anyone who can provide you some guidance. Also when is your next vacation?

If you quit now, your chances of successfully matching again in the future (at least at any good program) is very low. If you mean completing PGY-1 and then applying for PGY-2 that is a separate thing.

If your program is any good they should be able to work on some kind of leave of absence for you.

If you so choose you can non-renew. Your position is only for 1 yr so you will have to accept a position for the PGY-2 yr. You can choose not to sign this. Then your program will look for someone else. They will appreciate this more then if you sign the contract but then a month before PGY-2 yr quit. The trade off is if you non-renew everyone will know if and you're basically a dead (wo)man walking. On the other hand, you are more likely to get a nice reference from your PD and other people if you don't just quit with warning.

Post residency btw the opposite is true which is its always better to hand your notice in at the last possible moment. But as a resident that can hurt you more than it benefits you.

Edit: are you already a PGY-2? I am confused by your post! If so, I would see if you can take a leave of absence, and PGY-3 is typically substantially better. If you are thinking of switching specialties your program may also be able to help you do electives in that specialty so you can get letters to apply for that. At least that is what they did at my program.

Thanks for the feedback. Just to clarify, I am currently a PGY-2. I completed PGY-1 and PGY-2 officially started 7/1/2017.

Part of the joys of my program is no fixed vacation time. It can work out well for when you need to take a day or two off to attend a wedding (with a month's notice), but poorly if you're trying to get more than 2 days off at the same time (hard to do, and impossible to get a week.) I've already taken a couple of days off, which were glorious, but within a week or getting back I felt the same symptoms of burn out you elegantly spelled out. I took another couple of days off (I didn't put in the month's notice this time, took them off as sick days) and same thing, within a couple of days of coming back, still felt the same dread.

I guess it's better to talk to the PD rather than have the resignation letter be my first "move" so to speak. I just think that it won't fix anything, create additional burden on them without really helping me out, and we'll end up with the same outcome. Still, I think a meeting like that is the right thing to do. I just don't know when I can do it on this rotation, but I'll send an e-mail and take it from there.

I think I can last a month or so but I doubt I have it in me to stick out until PGY-3 and do the non-renew route. Plus, at least last year, we only signed our contracts in late June, so I feel like it would still have to be something that I bring up myself ahead of time.

I appreciate the feedback.

 

[splik]

what is it that is making you feel burned out? is it the program? is it the specialty? do you still want to be a doctor? do you feel like you are learning stuff? do you feel that your co-residents are on the same wavelength as you? do you have a lot of debt?

If you think that psychiatry is not your jam, then you may want to consider exploring other specialties or career options. It is much easier to find a PGY-2 spot than apply again as a PGY-2 so that is the good news if you do decide to resign and want to come back (as long as you dont leave it too long and have made a good use of your time)

If you think your program sucks then you might consider looking at other programs. There aren't usually many PGY-3 spots but no harm in sending out your CV and cover letter to programs of interest telling them to let you know if something becomes available.

Personally I would recommend taking some a leave of absence (using all your remaining sick leave) to have some space to figure things out. You shouldnt be working if you're that burned out. I would also recommend talking with a therapist about it and exploring what your motivations are for quitting and what you might do instead. Don't let people force you to stay if it's soul destroying, but it's important to think smart and don't let your emotions dictate what you do and the way you go about it.

you might consider looking into other opportunities. For example the APA has a congressional fellowship that allows residents and early-career psychiatrists to spend a year in DC working with a politician as their mental health policy wonk, you'd get paid, and it would be a year away from clinical stuff. (Jeanne Spurlock Congressional Fellowship) There are fellowships in healthcare administrations. You might consider a research fellowship. Some of the consulting firms have associateships or internships for MDs if you are of suitable pedigree. There are fellowships in education, and bioethics too potentially. You could look into doing a global mental health type thing etc.

I actually did quit my first intern year because it was such a toxic environment and I absolutely hated the people I worked with, but I already had an exit plan in place by that point and it was one of the most liberating things I have ever done and I felt wonderful. I don't think I would have felt good about it if I didn't have an exit plan in place. In my case, I went a did a masters. It was really nice to spend a year from clinical medicine. It is so unfortunate how rigid and unforgiving the system is in this country. I also flirted with the idea of taking 6 months out of residency to travel, which my wonderful PD was totally fine with saying it was no different to taking maternity leave. Unfortunately because of visa issues this wasnt realistic.

 

[psychattending]

I would strongly recommend that you start a conversation with your PD before ever getting to the point of sending in a resignation letter. There is basically zero downside to talking to your PD in order to discuss the situation and to try to problem solve the issue. Turning in a resignation letter without doing so stands a very high chance of you not getting into another program in the future. If you are hesitant to talk to the PD, then find a faculty member in whom you can confide or see if your program has an EAP.

 

[Crayola227]

read some of my past posts on leaving residency

long story short, a residency spot is like the Golden Ticket to the Willy Wonka chocolate factory

resigning will forever put the scarlet letter "R" on your chest

it will likely be the forever end of your career in clinical medicine

an MD with or without license is like a trade degree
without additional skills you have 6 figure debt and poor job prospects

just chew on that a while

 

[DJKitty]

Do not do this!

I speak as someone who was in a similar situation and while things have eventually worked out for me, it is really difficult to resign with 1.5 years. First off, there are only a handful of PGY 2 spots available and often at programs you wouldn't want to be at. Also, no matter how incredible you were to get into your program, you are automatically seen as "damaged goods"and you may not get into a program half as good as your past one. You will be at least 3 years out from graduation and that also matters. If you can't find a PGY 2, then you're stuck and will have to likely start over as a PGY 1 and you are automatically at a huge disadvantage due to not being a MS 4. Plus any new program that takes you will wonder what happens when you get burned out again?

My advice is to talk to your program director about how you are feeling. Compassion fatigue and burnout are so common in general and especially in a field like psychiatry. Sometimes having someone impartial like a therapist to talk to is helpful. If you feel like you can't work another day, ask to take a leave of absence instead of resigning. Most programs will try to keep good residents because it is a hassle to find a new one in the middle of the year. Please, again, don't do this! It is a huge risk if you ever want to be a psychiatrist.

 

[deleted736562]

Mid-way through PGY-II is really burn out time. I see it in many of my colleagues and sometimes in myself too. You need a vacation, first and foremost, and 2 days off don't count as a vacation.

 

[TexasPhysician]

PGY-3 and 4 are only easier in most places. If at all possible, keep pushing until you are done with training. Then decide what you want to do or how much you work.

 

[AD04]

I actually did quit my first intern year because it was such a toxic environment and I absolutely hated the people I worked with, but I already had an exit plan in place by that point and it was one of the most liberating things I have ever done and I felt wonderful. I don't think I would have felt good about it if I didn't have an exit plan in place. In my case, I went a did a masters. It was really nice to spend a year from clinical medicine. It is so unfortunate how rigid and unforgiving the system is in this country. I also flirted with the idea of taking 6 months out of residency to travel, which my wonderful PD was totally fine with saying it was no different to taking maternity leave. Unfortunately because of visa issues this wasnt realistic.

It seems like people who leave residencies are either the brightest and boldest or the worst. There is no middle ground.

That was real gutsy of you. Was leaving clinical medicine forever something you were willing to do or you had a guaranteed way to get back in?

 

[Psychotic]

PGY-3 and 4 are only easier in most places. If at all possible, keep pushing until you are done with training. Then decide what you want to do or how much you work.

Agreed. I am a 4th year, and it is a breeze now...