Quoted: What to disclose in the match?

[NotAProgDirector]

Ok, so I need some advice. Here's my situation:
I am currently a 5th yr med student and I am in the process of applying for residency positions in Peds and Family Medicine. Last year about this time I was all set to graduate in 4 years. But I had started abusing narcotics to deal with depression and anxiety. I ended up going to rehab and taking a few months off clinical rotations. By the time I was ready to restart school it was too late to consider graduating in 4 years and decided to extend.
Now that I am applying for residency's I am stuck as to how honest to be with the reason for my extension at interviews? I have been sober for almost a year now and I have a really good system in place to keep me accountable including weekly random drug screens. I guess I am just worried about the stigma surrounding substance abuse and addiction and I know that disclosing my past will close some doors to me. I was lucky to have no legal issues or criminal charges steaming from my using. Only one administrator at my medical school knows the full reason for my extension. They termed my time off as a medical leave of absence and did not ask any questions. So there isn't much of a paper trail to be worried about I don't think.
Has anyone personally been through something like this? Any advice as to what I should do? Or does anyone know just how personal the programs are allowed to be when it comes to info like this? Like if I just say it was medical reasons I took the time off are they allowed to ask for more info or do they have to stop at that?
Any guidance would be great!

This is an interesting situation, with no clear answer.

Usually, there would be a clear papertrail from your school. In fact, I am surprised there isn't, as narcotic addiction is a major issue and if you were using (or at least had some in your system) while being a student / interacting with patients, then I'm surprised that it didn;t end up on your academic record somewhere.

But, be that as it may, it's not on your record. So what to do?

1. I'd seriously consider disclosing it anyway. You are correct that it might close some doors. However, if you get through one of those doors and then they find out about it later (which they almost certainly will -- see below) imagine how upset they will be.

2. You're going to need to disclose it when you apply for a training license, assuming that the state you match into has a training license. Remember that the Board of Medicine doesn't have to give you a license. if they don't, you are completely screwed -- you can't start your residency. So, disclosing during the application process would allow PD's to check with their BOM to make sure it wouldn't be a problem and/or let you know if it's been a problem in the past.

3. It somewhat depends on what field you are going into. If it's anesthesia, or critical care, then it's even a bigger problem (given the exposure of residents to narcotics in those areas).

4. Last, remember that if you don't disclose it, you'll have a "medical leave" on your record without any explanation. It's illegal for me to ask you about it. If you don't tell me what it is, I'll assume the worst -- perhaps a major psychiatric issue. I have not ranked residents for this in the past, having been burned twice so far -- taking great looking residents with a medical LOA not otherwise specified, who burn out of residency in the first 4 months as their psychiatric symptoms decompensate.

If you don't disclose it, here's what happens: You'll get a medical form from your new employer, and (if applicable) a license application for a training license. You'll need to disclose it there. Getting privileged at your new program and getting a training license are purely at the discretion of the training institution and the BOM. If they are unhappy with your prior problem or don't agree with your current screening, they can simply refuse to give you a license and there is really nothing you can do. To be honest, this is unlikely if you have a very solid papertrail of sobriety (i.e. weekly drug tests, which seems somewhat overkill). Remember that if you really need weekly tests as a motivator to stay clean, you'll need to make sure your new employer / physician will do that.

My two cents, but I recognise that I am biased given my position. We'll see what others say.

---

Members don't see this ad.

 

[dragonfly99]

Wow. That was a big problem you had. Glad you are feeling better.
Please don't go back to where you were...nothing is worth giving up your career and other good things in life to a substance.

I think aprogramdirector is correct in that you will be asked if you have any history of substance abuse, any psychiatric disorders, or any medical problems that could interfere with practicing medicine, when you go to get a medical license. So it might be best, at least in theory, to own up to why you took the leave of absence. However, if there is no "paper trail" then people might have a really hard time, or an impossible time, finding out that you had a substance abuse problem, and you might get away with not disclosing it if your interviewer doesn't specifically ask. The problem will be the medical license application...you really can't lie on there because if you do and someone finds out you will be in deep ****.

One thing aprogramdirector hasn't mentioned is that there are states where getting a training license is automatic if you are accepted into a residency program. I'm not sure that in these states that the trainee has to fill out ANY paperwork to get it (i.e. any of those questions about past h/o medical, substance abuse, or psych issues). I don't remember filling out anything at all to get my training license when I started residency. I later found out that in most states you do have to do such paperwork to get a license, even the limited "training" one you use for residency. Of course in this same state I did have to eventually get a full medical license, but I only needed that to moonlight, and/or when I finished up residency. Maybe you can find a state like that...one where getting the training license isn't such an issue, and then assuming you do well in your residency and have no further problems, would think the state would be predisposed to accept you for the full medical license later.