Resign or Wait for Termination?

[IonClaws]

I'll make it short - I've been on probation in my residency for over a year and it's not going well. I haven't been pulled off rotation (yet) but I have been advised to start thinking of alternative career plans. I'm usually better in outpatient than inpatient, so I am thinking about occupational medicine residency.
It's been suggested that I should resign rather than wait for termination because it would "control the narrative" and make it look like I chose to leave to any future prospective residency. I've also read that this isn't true and program directors will see that I resigned while on probation and it will essentially be the same.

So is one actually better than the other?

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[VacheronConstantin]

How did you make it this far?

Is your program malignant or you are truly not performing?

 

[IonClaws]

How did you make it this far?

Is your program malignant or you are truly not performing?

I won't go into a huge amount of detail, because it's not the purpose of this thread, but I'll admit I've made legitimate mistakes. Patient safety concerns, basically. They tell me one of the reasons they've allowed me to go on is because I've been very receptive of criticism and have consistently tried to incorporate said criticisms into my work. It's a new and small program too, so it could be that they really don't want to fire anyone who is fairly easy to work with, and I'm thinking they may not want to burden the other residents with extra night float.

 

[Crayola227]

I still think there is a benefit to resigning over termination pretty much no matter what, and programs prefer it in almost every case because when you resign you lose various legal rights to challenge, whereas termination does theoretically open the door to certain types of actions ranging from appeals to lawsuits that most programs prefer to close the door on. It doesn't matter what you intend to do, it's just a fact what each path leaves open or closes legal liability-wise, so programs prefer the resignation in most cases. Also, theoretically it looks better for them for residents to "choose" to leave than to be the big bad program terminating. How that looks to future residents or even the ACGME. Because of that, you can potentially use the offer of resignation to negotiate some assistance for the next step.

No matter how nice your program is, I would still say "OK well it seems like the best thing for everyone involved is that I resign. I know this simplifies this process for everyone, so I ask in return a letter of recommendation to X specialty from the PD, and if these attendings agree to write one, a letter from them as well, to help me move on to a specialty that is a better fit for me."

This is a reasonable exchange. If they don't want to do this, I would consider an attorney for the purpose of getting those things in exchange for a resignation.

Don't go with the flow if the flow is them wanting to terminate you and give you no help moving on.

I have heard of WAY too many residents that went with the flow, didn't want to rock the boat, didn't want to formally ask for anything, that didn't get on paper getting these recommendations, that just signed where the program wanted for a resignation or didn't fight a termination or didn't offer to resign in exchange for letters instead of termination, basically that were relying on the "good will" and good intentions and nice words from the program, that got totally boned by their program. Anything from dragging their feet providing any proof of training to not providing a letter to badmouthing residents on the phone to other programs.

I'm not trying to say get all litigious and piss off the program. But if you don't use the chance of promises you can make on paper to get you some promises on paper, you're just at their mercy. Which could be fine for you, or could be awful. It feels better to walk away with negotiated letters in hand.

 

[ThoracicGuy]

I'll make it short - I've been on probation in my residency for over a year and it's not going well. I haven't been pulled off rotation (yet) but I have been advised to start thinking of alternative career plans. I'm usually better in outpatient than inpatient, so I am thinking about occupational medicine residency.
It's been suggested that I should resign rather than wait for termination because it would "control the narrative" and make it look like I chose to leave to any future prospective residency. I've also read that this isn't true and program directors will see that I resigned while on probation and it will essentially be the same.

So is one actually better than the other?

No matter if you resign on your own, are asked to resign, do not have your contract renewed, or are fired, any future programs will want to hear from your current PD. It would be harder to hide that circumstances leading up to your leaving.

So, the bigger question is how much longer you have to go. If you only have one more year, I would do everything in my power to make it through that last year. You have a position right now and you've mentioned that your program has been receptive and helpful towards you. That tells me that they don't think you are a lost cause.

If it were me, I would hold off on voluntary resignation until you are at the point of being asked to resign. You really don't gain much by doing it before.

 

[GoSpursGo]

No matter if you resign on your own, are asked to resign, do not have your contract renewed, or are fired, any future programs will want to hear from your current PD.

So bottom line, I think that this decision should come down to whether or not there is something tangible that you can negotiate as a benefit for voluntarily resigning. If your program is clearly articulating that you are not going to be renewed, then you may be able to negotiate your voluntary resignation in exchange for a positive letter of recommendation--in your possession, not just at some nebulous point in the future--and continued support as you seek a future position.

If it seems there is ANY chance that you could continue to remediate and hang on to the end of your residency, or if they won't commit to giving you support regardless of whether you resign, then I don't see much point in resigning. In that case you may as well continue to accrue as many months of credit as you can get and buy time to find another position.

 

[xffan624]

I'll make it short - I've been on probation in my residency for over a year and it's not going well. I haven't been pulled off rotation (yet) but I have been advised to start thinking of alternative career plans. I'm usually better in outpatient than inpatient, so I am thinking about occupational medicine residency.
It's been suggested that I should resign rather than wait for termination because it would "control the narrative" and make it look like I chose to leave to any future prospective residency. I've also read that this isn't true and program directors will see that I resigned while on probation and it will essentially be the same.

So is one actually better than the other?

What year are you in? I think if you could complete this year it would be a better narrative than leaving mid-year. I also agree with Crayola that you need to be direct with your PD and gage whether they would support you in resigning.

Occupational medicine is definitely an option to consider regardless of outcome (although a voluntary with a good LOR would definitely be preferable to a termination in applying). After you complete the residency, it should get you a job that pays a decent salary and has a decent lifestyle (especially if you angle towards a government job).

 

[IonClaws]

No matter if you resign on your own, are asked to resign, do not have your contract renewed, or are fired, any future programs will want to hear from your current PD. It would be harder to hide that circumstances leading up to your leaving.

So, the bigger question is how much longer you have to go. If you only have one more year, I would do everything in my power to make it through that last year. You have a position right now and you've mentioned that your program has been receptive and helpful towards you. That tells me that they don't think you are a lost cause.

If it were me, I would hold off on voluntary resignation until you are at the point of being asked to resign. You really don't gain much by doing it before.

So bottom line, I think that this decision should come down to whether or not there is something tangible that you can negotiate as a benefit for voluntarily resigning. If your program is clearly articulating that you are not going to be renewed, then you may be able to negotiate your voluntary resignation in exchange for a positive letter of recommendation--in your possession, not just at some nebulous point in the future--and continued support as you seek a future position.

If it seems there is ANY chance that you could continue to remediate and hang on to the end of your residency, or if they won't commit to giving you support regardless of whether you resign, then I don't see much point in resigning. In that case you may as well continue to accrue as many months of credit as you can get and buy time to find another position.

Thanks for your advice guys. So far everything is kind of nebulous. I think I'll keep on keepin' on for now...

 

[MLNS]

My heart goes out to you. The medical training system is archaic and ****ed up. The fact that perhaps all of this is stemming from a bad fit (which often these cases could be fixed given changes in fit, IMO) and that as trainees it’s near impossible to change residencies is beyond upsetting.

Keep working hard, smile, “fake it till you make it”— you’ve gotten this far and are almost an attending: don’t give up now!

 

[futureapppsy2]

Sorry to hear this. If you do better outpatient, have you considered FM? Definitely try to get a clear sense from your program/PD as to where you are—like @GoSpursGo go said, try to ensure that you can have strong PD support for switching specialties if you do have to leave.

 

[Lawpy]

I don't understand why your program wants to kick you out if you have few months remaining? Are you that much of a burden to your program? It doesn't make sense

 

[futureapppsy2]

I don't understand why your program wants to kick you out if you have few months remaining? Are you that much of a burden to your program? It doesn't make sense

The OP is in neurology, so they have one more year after this one. Also, programs are technically tasked with the duty of being "gatekeepers"--ethically, they shouldn't let the OP graduate if they have serious, well-grounded concerns about him being able to safely care for patients.

 

[MLNS]

The OP is in neurology, so they have one more year after this one. Also, programs are technically tasked with the duty of being "gatekeepers"--ethically, they shouldn't let the OP graduate if they have serious, well-grounded concerns about him being able to safely care for patients.

Give me a break

we have 24 year old nps practicing medicine illegally all throughout this country

your stance is as boorish and archaic as it is unethical (o the irony)

 

[futureapppsy2]

Give me a break

we have 24 year old nps practicing medicine illegally all throughout this country

your stance is as boorish and archaic as it is unethical (o the irony)

The failure of other fields at gatekeeping is not an argument for gatekeeping being unnecessary.

 

[MLNS]

The failure of other fields at gatekeeping is not an argument for gatekeeping being unnecessary.

So you pigeonhole yourself into philosophical arguments over the reality of situations

**** no wonder nurses are practicing medicine

 

[futureapppsy2]

So you pigeonhole yourself into philosophical arguments over the reality of situations

**** no wonder nurses are practicing medicine

Didn't say that... Midlevels definitely need much, much, much, much better gatekeeping--but that doesn't mean that medicine doesn't need any. As a faculty member, we always ask ourselves "Are we doing the right thing by giving this student the greenlight to practice--can they be minimally competent to safely treat patients?" If not, it becomes a liability and an ethical issue.

 

[wholeheartedly]

Since your program has been willing to try to help you have you considered asking them where you might be a good fit (ie like occ med) and see if they’d be willing to help you transition to that?

 

[NotAProgDirector]

Please - let's stop the sniping about training and NP's in this thread. There's plenty of threads for that. Let's keep this focused on the OP.

I am very sad to hear this. You've had a couple of threads here on SDN asking for help. Last you posted, it seemed things were going better -- your training had been extended / continued, you had gotten treatment for your medical issue, and it seemed that good forward progress was being made.

If this represents a relatively rapid development, then you should ask yourself what's different -- what changed? If this is more of a "slow burn" and things have just been getting worse, then it may simply be that as you move up in the PGY system you're just having more trouble meeting the standards of a more senior resident.

Occ med may be a great fit for you. You have an internship completed, so would start as a PGY-2. It's (essentially) all outpatient and consult work. It has a much more narrow focus which may be helpful given your struggles. And the acuity is much lower. All of this might fit your skills better than neuro.

I agree with the other advice in this thread. Don't burn bridges with your program. Get a good letter from your PD -- you didn't succeed in this field, but they think your skills would fit something else.

As far as your actual question, there is some benefit to resigning. Some licensing forms will ask you if you were ever terminated, some will ask if you resigned in lieu of termination -- which, at this point, you can probably still answer no. As far as another residency program, there really isn't a difference. But avoiding hassles when trying to get licensed in the future may be well worth it. As already mentioned, by resigning you give up all right to appeal, and also to unemployment (although this is very state dependent).

Best of luck. Take care of yourself. Don't let this moment define you.

 

[Goro]

Give me a break

we have 24 year old nps practicing medicine illegally all throughout this country

your stance is as boorish and archaic as it is unethical (o the irony)

Whataboutisms aren't going to help the OP. Save the NP issues for the SPF.

 

[Splenda88]

The OP is in neurology, so they have one more year after this one. Also, programs are technically tasked with the duty of being "gatekeepers"--ethically, they shouldn't let the OP graduate if they have serious, well-grounded concerns about him being able to safely care for patients.

OP can have a medical license in all US states after 3 yrs. Not sure how they will stop him/her from practicing medicine

 

[NITRAS]

OP can have a medical license in all US states after 3 yrs. Not sure how they will stop him/her from practicing medicine

The opportunities and expectations are very different from someone with a medical license that someone who is BC/BE practicing as a specialist.

The OP should probably get a medical license now in the state he/she wants to practice in. Urgent care will probably available. I have a mentor who retired as a GYN who does a weight loss clinic one day a week for decent money. The op can have a successful career, but he/she needs make a plan that might include some flexible geography and acceptance of a different future.

I will defer to others regarding the possibility of another neurology residency. . . As it isn’t in my expertise if it is even possible.

 

[VA Hopeful Dr]

Whataboutisms aren't going to help the OP. Save the NP issues for the SPF.

SPF may be a trash heap, but even we have standards

 

[Splenda88]

I think OP posted in another thread that program did not renew his contract start PGY4. It's really sad to see something like that happening. If I were a PD, I probably would have let OP repeat PGY3 year and provide robust mentorship assistance to help him get over hump. It's upsetting to see someone who is dedicated to become a neurologist won't realize him dream.

I wish OP the best of luck in pursuing a career in Preventive Medicine as he said in the other thread that what he plans to do.

 

[Goro]

I think OP posted in another thread that program did not renew his contract start PGY4. It's really sad to see something like that happening. If I were a PD, I probably would have let OP repeat PGY3 year and provide robust mentorship assistance to help him get over hump. It's upsetting to see someone who is dedicated to become a neurologist won't realize him dream.

I wish OP the best of luck in pursuing a career in Preventive Medicine as he said in the other thread that what he plans to do.

See here:

How to approach application to Occupational Medicine residency after non-renewal

Hi everyone - I've posted for some time on these forums on my struggles throughout Neurology residency and recently anticipated firing of some kind soon. Well, unfortunately, that suspicion was well founded and I was informed by my PD that my contract will not be renewed after my PGY-3 year. I...

forums.studentdoctor.net

 

[TwistedTea]

Palliative care might be good option?

 

[rokshana]

Palliative care might be good option?

HPC is a fellowship so need to have a completed residency

 

[TwistedTea]

HPC is a fellowship so need to have a completed residency

maybe they'll let him/her finish if they say they gonna do palliative after? We have one sorta weak resident our admin is sorta pushing into palliative lol. he's not bad just on the weaker end. Of Course it might just be gest im not sure.

 

[ThoracicGuy]

maybe they'll let him/her finish if they say they gonna do palliative after? We have one sorta weak resident our admin is sorta pushing into palliative lol. he's not bad just on the weaker end. Of Course it might just be gest im not sure.

If they made the decision not to renew, this won't change anything.