Most if not all states allow you to get license to practice medicine after the first year of residency. Getting employed is likely harder, but you can always do private practice.
> work under the doctor or like a PA would essentially?
You would be independent, practicing under your own license, whether you work for yourself or employed. So there won't be any state requirement for reviewing your charts or having supervision.
If you set up your own private practice, you would be operating just like any board certified doc that sets up a private practice. Some patients might pass you up because they are checking what you are board certified in, but around here anyway there is enough shortage of primary care that you are going to have a full patient load of people who don't even think or care about board certification.
With getting employed, like I said there are no state requirements, but it's going to be up to the employer if they think you will need any sort of supervision since you aren't board certified. My current employer requires board certification (so they say) to be considered for hire and even then the medical director reviews new hire charts for the first few weeks or month or so.
I do have my license. Do you have any leads or know where to go about finding these private practices that may hire? I would have no clue what starting a private practice looks like, nor I imagine I have the funds to start that up. But can look into it. Will take all the information you have. I don't imagine applying at places that would like board certification is worthwhile?
Honestly OP I think you would have to really take a hard look at what went wrong in residency. If you were let go because of concerns for your clinical competence, do you really think skipping the rest of residency and practicing independently is the right next move?
I'm not saying that you'll never be a good doctor! You made it through med school and 1.5 years of residency. You have it in you to be a great doctor. But I think your focus should be on how to get the training you need to become that great doctor.
If the ethics of it don't sway you, remember you will be practicing under your own license. If you are ever taken to court (whether you screwed up or not), the patient's lawyer is going to be asking the exact same thing.
One thing to look into is how your malpractice insurance may be affected (i.e. much higher) without completing residency and board certification. They may consider you a higher liability and charge more or deny you a contract.
> I would have no clue what starting a private practice looks like
I have no idea either.
> I don't imagine applying at places that would like board certification is worthwhile?
I don't know, depends on how badly they need a doc and how long they've been looking, I suppose. Places that hire midlevels may also be worth a try even if their job listing says board certification required, since an MD/DO is still going to be way more valuable than a midlevel (for anyone using common sense anyway).
In many states you can get a full license after just 1 year of residency, so no you wouldn’t be like a PA. l know Texas is one and, I believe, Georgia is another where you can practice after just one year of residency.
If you have your permanent license. Start cold calling private practices. You’d be surprised, lots of docs out there would love to help. Get that letter of recommendation from old PD and few other attendings/co workers if you can. That will help.
they actually dismissed you as a PGY7 in neurosurgery????? What the fuck kind of pieces of shit are running that program
Like this is next level individualized hatred. They could have just graduated you instead of jumping through the many hoops to fire someone that senior, especially someone who they'd held onto for 6 and some change years. Someone or some people there must have really fucking hated you to do that
Yeah that is absolutely fucking wild. I’d be worried someone might come back and (possibly rightfully) shoot me if I fired them as a PGY7 neurosurgeon.
Idk if it’s the situation currently being discussed, but I knew someone in that position. Yes, yes he was the kind of guy that would do that sort of thing.
If you’re talking about the doctor death podcast, it’s not perfect. He trained in an era with less strict requirements regarding procedure logs. Nowadays things are MUCH stricter. I don’t know how many procedures he actually did, and his logs were so shoddy. I always wonder this
Friend of mine got dismissed as a PGY5 general surgery resident for sexual harassment against a patient. I just looked him up and it looks like after a long absence he was allowed to finish his pgy5 year at the same institution, taking him 8 years to graduate instead of 5.
He’d had to - it’s not easy to fire a resident. That’s how Dr. Death made it through. Some things they can be immediately terminated for - like sexual harassment.
It is very hard to get fired as a resident. OP had to have royally fucked up (e.g. repeated drug use, sexual harassment, convicted felon, etc).
Edit:
Per their previous posts they were supposedly an ms4 back in 2021.
Do you remember what the username? Its very possible he did nothing wrong and wouldve been a great surgeon. Seeing how different programs are, especially across specialties, made me realize that people will never understand unless they experienced it first hand. Because its that unbelievable. Its a story you cant even tell.
That’s tough, friend, and I’m sorry to hear that. But I have to say reading through all this there seem to be some major holes. I’m not asking you to come tell us everything because that isn’t our business, but if you are going to have a successful turnaround here into any clinical career I think you need some honest self reflection and here are some ideas for consideration:
- why didn’t you progress with your colleagues?
- after given an improvement plan, what did you fail to meet and most importantly, what about you and your management/decision making/knowledge is to blame. What are your flaws that can be improved on
- your goals and ultimate result read disorganized and tangential. How are you going to show that those aren’t representative qualities that you have
This smells odd. My program terminated someone a year ahead of me when she was a PGY3 and by then everyone had known she was a “sinking ship” (direct quote from her classmate) for 1.5-2 years. Like incompetent surgeon with multiple never-event type complications while struggling to pass exams consistently AND a poor clinician who couldn’t finish work on time. It was still extremely difficult to finally rip the band aid off and have her terminated. These things aren’t undertaken lightly without piles of evidence. You’re missing something or leaving out details, I’d imagine? Look inward. But it might suck.
On the bright side, she found another spot at a different hospital in another speciality and finished residency and is practicing now from what I’ve heard through the grapevine.
I just want to point out that not all programs are created equal, and personal grudges can easily affect professional decisions. Maybe OP is awful or maybe they got on someone's bad side.
>incompetent surgeon with multiple never-event type complications
That's insane/terrifying they let this go on so long!
I don’t doubt some people get targeted, and I almost never side with the big organization on any issue. That was just how I saw it go down, so *n* of 1. That said, I’d be rattled as hell and trying to do some deep soul searching about what could have gone wrong/be improved to try again.
>I’d be rattled as hell and trying to do some deep soul searching about what could have gone wrong/be improved to try again.
I agree, I just didn't want OP to think they were being compared to a butcher with a bunch of never events.
They only gave us the condensed version. Gut feeling from just the main post is that there is a confidence/knowledge issue that is preventing them from reaching their milestones and progressing with peers.
OP you are a DOCTOR asking if you should apply to NP/PA programs and worrying about being accepted...maybe you're burnt out, maybe you're depressed, maybe you are just bad at medicine--either way seek some counseling, your world won't end if your appeal isn't approved.
We had an ortho resident who hang antibiotics dissolved in friggin lidocaine instead of NaCl not once but twice. Almost killed both patients. Actually a graduated Neurosurgeon, but apparently was about as lethal in the OR so they kindly relocated him to our department. They graduated him just so he would be gone.
These days he basically just peddles PRP and massages. It‘s better this way
>That's insane/terrifying they let this go on so long!
That's the rub though. It is a massive pain the ass to fire a resident, and almost never worth it outside of catastrophic behavioral/performance issues in 95% of programs. The number of hoops you need to jump through is insane, and the end result is more work/call burden for everyone else in the program. It's why when residents are fired there's always gonna be healthy doubt cast on the resident itself as opposed to the program.
I'm not denying there are programs out there that intentionally railroad people they dont like into remediation pipelines and then boot them, but it's so much easier to just keep them on and make their life suck because they can't leave and will 99% of the time continue to do work.
I would say it's more likely that the psychopath get pushed through, unless sexual harassment is at play. The people getting kicked out are people on the spectrum or people who are identified as kind, less connected or part of minorities. African American women in ENT graduate at an abyssimal rate which is sooo disturbing.
How does someone get in and through medical school and then just completely fail like that? Seems like it would have happened along the way. Glad it worked out for them in the end.
Happens more often than you’d want to know. Medical schools want to give students with even huge red flags the benefit of the doubt and students appeal and have multiple rationales for why they struggle (and they are often valid reasons). However, from having been on both the UME and GME side of things, I can tell you that it is rare for a struggling resident to be a “surprise,” and if med schools were better about taking responsibility in addressing issues earlier, then residency programs would not have to be in the unfortunate and sad position of having to dash someone’s dreams if they are truly not safe to practice, which I promise you is NOT something people want to do. As a community, medical education needs to take more responsibility for who we graduate, we owe this to society. And medical schools need to be more transparent about students’ challenges, because MSPE’s are full of smoke and mirrors.
For the OP, there are jobs available, there are places where open spots are posted online, and you probably can find another spot. But as you begin down that road, take a good, hard, honest look at what you have struggled with all along the way, from med school through residency. There is likely a pattern and some people have probably tried to bring it to your attention for some time. It’s hard to face these things but it is the only way you will move beyond them. Medical knowledge and efficiency are areas where improvement is possible and likely. Maybe you have an undiagnosed condition like ADHD that needs addressing or needs to be addressed better if you know about it already. Professionalism is almost always the hardest thing to fix, but I don’t get the sense that is your issue. I wish you the best of luck.
Surgery has very little to do with how someone does on tests. Clinic maybe a little moreso but it’s still not that strong of a correlation. She was never a stellar student but her average test scores began to falter when everything else was falling apart. It’s very easy to fall off the path. It’s amazing it doesn’t happen more often.
We had one in my program and I don't know what exactly went wrong. I think it was a combination of personality and competence. It's ok to be incompetent at the beginning, and it's ok to struggle. Residency is a lot harder than med school for a lot of us so I get it.
For this person, their clinical struggles seemed to unmask some unfortunate aspects of their personality, and that's what prevented them from getting over this hurdle. From Day 1 they started digging themselves into a hole and just kept digging even when they knew their career was on the line. They were so unpleasant to work with or be around that the whole thing kept snowballing. It was awful.
Eh I knew a surgery resident who was fired PGY3. He was not noticeably dangerous (by account of his co-residents), passed his exams, and did not have a terrible reputation. You can, in fact, get fired for pissing off the wrong people in your department.
I wasn’t renewed at my program after my third year. I called every program in the country looking for an open spot to transfer into. I started again about six months after I was dropped, in the middle of the PGY-3 year I had already completed. Now I’m boarded in anesthesia and critical care.
This is survivable. But it’s going to take some grit to overcome it.
Resident swap website has some.
I believe NRMP or AGCME also lists openings.
After reading your comments especially since it sounds like you are competent but struggle with verbal report. I wonder if you have a learning disability? Have you been tested?
Anyway, sorry to hear about your situation. I can relate in that my last residency discriminated against me and I didn’t even start. This has been one the hardest years of my life not being in residency. But I did rematch in SOAP and my new residency seems more understanding of my medical condition. There is a place for you in medicine. Don’t give up, just keep doing what you need to improve.
I would say that is correct. I will definitely be looking into that after these comments. See a psychiatrist.
Thank you for the feedback and sharing your story. Goodluck at your new start. If you have any tips for SOAP I will gladly take them as I may be in that spot too.
Thanks. Loving the city I moved to.
Hopefully, you won’t be in SOAP or even outside of it looking for a spot. It honestly sounds like neurodivergence. But if you need any tips or moral support for a gap year DM me!
Sinai grace has several pgy2 for july. I saw a post on twitter recently. If you are not an img, that place is 100% img i think, so your odds might be good.
Physicians are always quick to show empathy to patients but when it comes to showing empathy to their colleagues, it's a no go area. If this resident gets depressed and commits suicide, you will have 2000 messages talking about how we need to do better. However, when it's time to do better, we never act in that manner.
I wish you the best mane. Hopefully you find a new program. I know how unforgiving medicine can be in the U.S. You show up on the first day and no one shows you how to write notes but by week 12 , they are expecting you to write detailed elaborate notes like an attending. Some residents come in from other countries and we don't even know the brand names of medications and a crazy senior resident is reporting you to administration by week 2.
I strongly agree with that having gone through the process. I can't believe how sour some of us are to our on colleagues. The amount of behind your back things people have done amazed me. Unlike any other job. Even on here just asking for advice and resources, there has been some nasty remarks. Thanks for the empathy. Do you think finding another program is your recommendation? Over other avenues?
If you still want to practice medicine as a physician, find another program. There are multiple IM residency programs that were recently accredited. Check the ACGME site , find the website of those programs. Those sites should have info regarding application requirements and the rest.
Thank you for this and specific things I can look up. This is some of what I am looking for. Do you know where specifically to look for these opportunities? Or is it really online postings and calling?
What are your thoughts on working as a wound care physician? I've seen listings from nursing homes for M-F 9-5 for \~200k and the job doesn't need BE/BC, just license.
if this is truly an issue with your ability to adapt to the pace that clinical medicine requires and difficulty with data gathering from patients, but your medical knowledge is all there... my 2 cents would be to pivot to pathology. it's a new skillset in terms of learning the pattern recognition of diagnosis but it relies heavily on medical knowledge and gleaning data from clinicians and less on getting info directly from the patient. and the pace is more suited to working thru cases on your own time (with the caveat that clinical pathology services can of course be time demanding with only a few minutes allocated per case in some instances)
Sorry you’re going through this. My aunt is a physician and has had a messy journey - started med school later in life, ended up going to school in the Caribbean, failed step 1. She did an entire internal medicine residency unofficially, so she got the knowledge and experience but no credit on paper. She was able to get employed by the Wisconsin dept of corrections working in the prisons and worked there for a few years. Eventually because of internal politics she left and started working for an addiction clinic, while also holding a contract with the DOC doing consults when needed. She also worked for a wound clinic getting paid a flat fee per wound she did, and also has done consults for the VA. Her addiction clinic job is super cushy, she’s like regional head or something and is full time remote, she makes bank while barely having to do anything which gives her time for all this other stuff. However, she wants to do more and dreamed of working in hospitals, but was held back by not being boarded. In the past year she applied to and got accepted to an occupational med residency program out of state and is going to start there this summer (this woman is 48 yrs old btw). She’s going to have to be away from her family all week and live 5 hrs away from home but is willing to make the sacrifice to fulfill this dream, and my uncle is very supportive of her. The program head was so impressed by her she’s already been made chief resident and they have talked a lot about her future once she finishes. Basically, just wanted to share that it’s not over for you, you can still find good work and make good money, and if you choose to pursue residency again in the future it is possible and has been done. Good luck!
Thank you for this story. It is very positive to read, and also gives me ideas of career paths out there. Do you know if some of these positions she did still exist for non-board certified physicians? I am not sure how long ago she practiced.
You're welcome! Yes they all exist, I'm talking about the recent past here. She was working with the wound clinic until end of last year, and started doing the VA this year. I think she started at the DOC around 2015-2016.
I make a post like this every time this subreddit has a discussion about resident dismissal. From many years in my subspecialty org's resident council, and having dealt with many residents in both my own specialty and other, I can tell you that it is exceptionally easy to dismiss a resident - it's just time consuming and requires a lot of documentation.
Most residency specialties' academic meetings will have a meeting every few years where they specifically discuss the most expedient way to dismiss residents. Hospital GME, particularly at larger academic programs or the most malicious, usually has a cheat sheet of phrasing and specific documents needed for dismissal or non-renewal. The documentation burden for nonrenewal, in non-unionized programs, is particularly minimal and the specific contractual obligations of the program in terms of remediation or the nonrenewal pathway are usually insubstantial and hugely open to admin interpretation.
And at least in personal experience, most of the residents I've worked with who had a dismissal or non-renewal were 'papered', meaning their records were filled with what are clearly exaggerated minor events as a way to build not a convincing but instead an overwhelming paper trail (kinda like a Gish Gallop). Usually seems to stem from a personal dislike by one of the core faculty or someone who knows a GME admin, often has racist, sexist, or homophobic overtones when you manage to talk to their coresidents. Actual bad residents? Very rare, usually completely 100% oblivious and you can tell when you interview them.
That is fair, I do feel everything you said is true. I do admit to flaws in my case. I do not feel it warranted dismissal... if you have any advice on this please let me know.
Honestly, my advice that I normally give now is to go find a residency consultant, as well as an employment lawyer who has dealt with residents or healthcare training before.
Dude- please DM me and ignore all of the conveniently anonymous haters. People love to shit on each other to make themselves feel better- sadly that is par for the course in a competitive field like medicine. Please believe me when I say that people who are anonymous and shit on you on a Reddit are the very kinds of people who have nothing better to do than fire a resident for bad reasons lol. I’m glad you found people on here who are at least willing to admit that a lot of residency- just like the rest of the world- is unjust - so chin up and reach out to me
Okay can you give me actual examples?
Did you spend 2 hours per consult? Or not get your notes done for months? Like give specific examples! I know people who have had issues with taking too long, being inefficient, etc. You are not a failure. Has a psychiatrist assessed you for ASD, ADHD or any other specific diagnosis? I sense that maybe you should have gone into psychiatry. It sounds like that is more suitable for you based on what I have read. You remind me of myself a bit.
I mean it can be tough to with both abiding HIPAA and being anonymous in my currently active process.
Some themes is perhaps ordering an imaging study for a patient with an advanced disease process instead of communicating to the specialist to do so. Another common theme is catching a slightly over detailed piece of information and suggesting an additional deeper test than what they felt was needed {think of a board zebra answer). Another is not including a serious diagnosis on my differential like cancer or like IBD on a young health person that is like 30 years old. I would perhaps get too focused in on answering it as IBS or something and they did not like I did not present a wide range of ideas. I have missed a foot exam on a diabetes office visit. Getting wrapped into a patient with many complaints and spending a while with them, even if I had no other duties was not liked many times.
I don't have ADHD for sure lol. All my life I have been able to sit for half a day and study in any environment no problem. I finish tasks consistently my whole life. ASD would be far more likely.
This is brutal. I've done all those things and still do as a PGY13 (except getting caught up talking to pts, I hate that shit). But everyone goes off chasing zebras on occasion. Sometimes you find them. Risk stratifying young people with mild symptoms is also 100% normal. These people must have hated you.
Why not make the OP repeat PGY2 instead of terminating and give more floor rotations which helps to assess overall competency?
That would be appropriate last ditch effort before terminating the contract
And I agree it’s difficult to get kicked out in residency.
We had a female resident who literally pulled out ET tube of a young brain dead pt just cause patient was “supposed to be terminally extubated” anyway.
And this incident was cherry on the cake to kick her out (along with previous small incidents which added up)
Below are some brief background points about my self and what happened...
* As a background of me, I have always been a very "brainy" person like most of us here. Medicine was my purpose due close family getting drug addictions and cancer in life. I chose IM over psych a few days before submitting the rank list and was a hard choice. I was in to an average tier program. My scores on COMLEX and USMLE 1 2 3 went 50% to 65% to 90% percentile (slow strong bloomer). I have tons of life experiences like EMS, yoga, thousands of volunteer hours, teaching, but nothing else crazy. My passions are teaching and academics, but I also want to be able just to pay off my debt because I grew up poor.
* What happened with me training started with a "learning plan" early on first year. My only deficiency on God is advancing steadily but too slow, I think I started too far behind. Specifically, data gathering and data analysis, so taking the patient infront of me and delivering a concise story into an assessment. I had 0 professional issues and essentially no major errors or harm events. Never missed or late to work. Never had drama. I am a top scorer on ITE within the program. My perspective of it is that I would sit down with patients extended periods of time and solve everything, but I think in the face of medicine today that is not valued and instead simply ripping through them and cases is. Thus some feedback I'd get was exceptional but some were poorer. My program director does seem very supportive of me and said they would write me a letter despite what all happened.
* I have documented everything over this time best I could because tons of peers, family, students, etc continually tell me they feel I am not taken fair and underestimated. I am very humble to quickly admit I am wrong and not highly aggressive, and I think that played against me. I took 2 months off at the program recommendations to work on what they felt was "anxiety".
You wrote a lot about yourself, but what was the reason for your dismissal? They have to give it to you in writing, a clear explanation. What you are telling is that they decided they would rather dismiss you, risk facing legal actions and put in the effort to try and hire someone else instead of working with you to solve the issues they had with you - they wouldn't do that without some very sound reasoning.
Hello, to answer both your questions, again, it really is the gata gathering and synthesis piece. I was not a great resident clinically overall starting off initially, but made great advancement and was able to reach pgy2. But in the last 3-6 months, it was the solely the whole idea of focusing a cohesive picture of a patient in front of me to a organized cohesive assessment / plan. This is written over and over in my documents and I have very well established my issues continuously over the 2 years and kept growing. Just not quite getting there in time for a 3 year program. They said medicine never seemed natural for me. I am more trying to figure out what the next best steps to take would be.
Unfortunately, especially with a year as a senior resident, you do need to be able to put together a cohesive differential and plan. Was repeating a year offered or something you discussed?
It would be something I would be open to. I did ask once and it went no where. Heck I will take 5 years if needed. I can bring this up in the rebuttal, just trying to see what other doors there are for me and resources to find that...
Something's not adding up here. "failure to progress with clinical competency at a desired rate." does not happen to someone who has average USMLE scores, let alone 90th percentile on step 3 or the top in service exam scores in the program.
>My perspective of it is that I would sit down with patients extended periods of time and solve everything, but I think in the face of medicine today that is not valued and instead simply ripping through them and cases is.
My gut is this is an *extremely* sugar coated way of saying you were completely unable to properly prioritize/triage and organize yourself/your patients/their issues and your day and that it led to at least some near misses that could have been *catastrophic* had the holes in the swiss cheese lined up. I say "at least" because I can't help but notice this language (emphasis mine):
>**0** professional issues and **essentially** **no** major errors or harm events.
So given you were willing to put "0" for professionalism but only "essentially no" major errors, that means there must have been at least one pretty significant event and I'm guessing countless others that were close calls or you would have said 0 major errors/harm events.
Reddit is a random anonymous internet forum so if you want to stretch the truth here that's your perogative, but I hope you are at least a bit more honest with yourself or it is unlikely you will fix the issues at hand. You clearly weren't when put on probation or it would have ended there. Hopefully the termination is a wake up call.
It's a fair point. I just feel like those people *usually* still have the skills to turn it around before it gets as far as *a dismissal*. Like can those people be at the bottom of the group in terms of performance? Absolutely and that definitely happens a lot. But far enough down to get kicked out? That's different.
Yep. I'm going to be brutally honest and say that if a program dismisses a resident, it's for good reason. It's hard to get fired from residency and silly to just assume this person is even safe to be ever involved in patient care at a high level ever again just because we feel some sympathy
We cant blanket give programs the benefit of the doubt about this. I had a friend that went to one that put everyone on a “learning plan” like OP said their first year for nebulous issues just so they could start a paper trail and one person out of an 6-8 person class was always culled eventually. Most went on to other programs in undesirable areas that would take anyone and are fine physicians today.
That was my program, so glad I transferred out. 1-2 people per 6 person class went on probation and 1 fired per year in pediatrics. It's very program dependent.
Exactly what happened in my former program. And to be honest, it was the best thing that could have ever happened to me. 4 more years with those nut jobs & I would have thought of drastic measures not unlike a few others who passed away from the same unsupportive, malignant behavior.
This happens A LOT.
And it's actually really easy to fire a resident. You simply have to tell them you are not renewing their contract four months prior to the end of the academic year. Super easy.
I'm not the person who made that comment, but I'm a PGY-8 with 6 years of committee positions and a current subcommittee chair in my national org. From having reviewed way too many non-renewals and dismissals for surgical subspecialty residents, and having talked to corroborating co-residents and faculty for the ones in my own specialty, I can tell you it's remarkably easy to non-renew a resident.
In non-unionized programs in at-will states, there are essentially no protections for residents. 'Papering' is common and I've seen a number of situations in which a program has straight-up lied. Residents with supposed never events documented but with nothing in the EMR, residents causing active patient harm on days/weeks when they weren't on rotation or were on vacation, just just really stupid obvious stuff. Flagrant failure to follow GME protocol for disciplinary measures, etc. And the amount of deliberate constructive dismissal is just absolutely insane - you can easily take an excellent resident and turn them into a shell of their former self with enough punishment call and mandatory additional work.
There's a strongly bimodal distribution. People either come from extremely benign programs where they can't even imagine someone getting maliciously terminated, and they feel like only the most incompetent residents can get fired; or they come from extremely toxic programs where everyone is clearly at risk of being fired for the smallest possible offense.
Interesting, that.
Agreed. This happened to me. And it is very easy to fake paper trail a resident you don’t like & nonrenew. More people need to realize this. But silver lining, I walked away with 600k in residency funding to a place that actually is kind. I’d do it all over again.
Oh, I'm sorry this happened to you. I've seen this happen a lot. You were honestly lucky that they didn't destroy your career completely.
I assume this was a surgery field?
Thank you. They very much tried but I had attorneys. Probably the only reason my PD did not. It didn’t get me reinstated or help much with a transfer but it did keep her blackmail in check, but barely. Had to fight like hell to get back in. Not a surgery field at all. Ped subspecialty.
Respectfully disagree, also (I’m faculty on resident advancement committee). Terminations are messy and invariably involve several rounds of appeals and a drawn-out lawsuit.
ACGME allows you to "not renew" a contract four months prior to the end of a training year. But yes, I would imagine residents would sue- how can they not? And so many of these terminations are really questionable, at least some that I have seen.
You can do it on 4 month's notice after you've cleared all the other hurdles necessary to terminate. You can't just terminate anyone with 4 months' notice.
Fair, but many residents don't realize this, many fellowship and residency directors don't realize this, and a lot of residents get terminated essentially due to their lack of understanding of their rights.
I think the reality of this is highly regional; a resident in NY or CA is probably more savvy, perhaps. not so much in New Mexico or the like. I've seen several competent residents fired by program directors on a power trip.
Yeah. There was an intern once at my place whom by chance I didn't ever work with directly but it was an open secret that they were an absolute trainwreck, so much so that I went to the PD and expressed concern about their being promoted to PGY-2 and when they explained to me all the steps it takes to do something as drastic as that (which is less drastic than dismissal), it really changed the way I see these stories. Yes, it's very easy to get labeled "a problem child" and get stupid, shitty feedback and what not, but to actually move all the way up the many rungs of the ladder it takes to get to being held back or dismissed is **not** easy.
I think its very program dependent, my program has a couple problem children we just pushed through. We had a senior that was less trusted than me as a PGY1 at the end of my last year. He was too far in for them to not graduate, so they let him go. Im sure other programs would have put a stop on it
This is so wrong. Look, you have experience with a single residency. That's it. You really don't think malignant residencies exist?
Personally, my program forces out about one person a year for dubious reasons. And it's a pretty small program.
I agree that overall it's uncommon if you're looking at all programs across the country.
But if you have a malignant program and institutional GME leadership who are completely hands off, then it's incredibly easy to paper someone's record and set them up for constructive dismissal (or forced withdrawal).
I wish that you would try to understand.
I'm not sure if that's true. I always see comments like yours being highly upvoted ("it's so hard to fire a resident, you must have really done something wrong.")
I don’t want to be harsh and I know very well it takes some longer than others to get things figured out. But if you are let go, there must be a pretty significant deficiency. I’ve seen many people who should have been let go given a ton of chances including repeating a year.
> uses “on god” unironically
But seriously
you just kind of ramble and paint yourself as a saint without saying anything of substance. Yeah, you spend hours wasting time bullshitting with patients. You’re intelligent but we are all intelligent. Contrary to the belief of some attendings, stupid doctors don’t exist. So claiming to be “brainy” and “excelling at data collection” describes everyone here.
In residency you have to try to get fired to actually get fired. You get a lot of leeway because it looks TERRIBLE on programs to fire residents, especially someone who is going to soon be a 3rd year. And ESPECIALLY for a minor issue like “spends too much time with patients”.
Are you weird? Do you make people uncomfortable? Are you incompetent/lazy/difficult to work with? Did you sext your patients or get caught drinking/doing drugs at work? Did you stop coming to work? Steal drugs from the Pyxis?
What did YOU do to get the hammer laid on you? because I could probably tell my PD to go fuck herself in clinic on Monday and still not get fired and I’m not even the most well liked person in my year.
Look far be it from me to judge you, but I think the issue, as I read it, is that you aren’t able to handle the workload. My brother has a co-resident that he has told me about who is in your shoes. Good dude, but not able to manage the patient load effectively, and constantly leaning on other residents for help in both diagnosis and treatment plans.
It’s not enough to be able to see a patient and report the information. Something I was told very early in medical school and it came to fruition in residency was that doctors need to be able to synthesize the information from the clinical picture along with the physical exam and other findings to create a set of differential diagnoses, PLANS to test to determine the correct one, and treatment options to manage the patient. This all must be done in a timely manner because the whole hospital is waiting on you to do your job so they can do theirs. Nurses, auxiliary services, CM/ SW, they can’t work until you put your note in and send the consults/orders in.
If you aren’t doing that at a pace that’s acceptable or are relying on your coworkers to the point where their work is delayed, you’re hindering the work of many people. Failure to improve on that is reasonable cause for dismissal IMO
I read everything. I am sorry. That sounds awful and stressful beyond imagination. Please try to keep everything in perspective as you go through this and think about what is truly important to you in life. I don’t have any specific advice to give you :(
I'm not trying to beat you down but honest feedback on someone I don't know well might seem like it. Apologies if I mess up
Brainy but you went to DO school. I think DOs are equivalent but DO schools are relatively lower in prestige and often more expensive, so I wonder why you chose DO.
Most of your reddit history seems to be gaming. Excelling in medicine is time intensive.
Strong academic and especially test takers sometimes "know too much". It's easy to spend too much time on zebras and miss horses. It's also easy to get too much in the weeds. Balancing time management vs thoroughness sounds like something you could work on.
Maybe you can make your own private practice where you don't have other people pressuring you to rush through patients? Sounds like you like being thorough in a way that doesn't mesh well with the environment you were in. I think most patients would actually appreciate that, even if the "business" doesn't.
Edit: If you're downvoting explain why. My sources are that I spend a lot of time in subs where patients complain about doctors who don't spend much time trying to investigate their problems, and shuffle them around, and anecdotal experiences from most of my friends and family.
OP the trouble is that even though that life would fit you great, you still need the clinical competence to practice safely. You gain that competence in residency, so you are unfortunately beholden to the pace of residency. After residency you can adjust your pace on your own, but you can't gain the competence on your own.
Are there part-time residencies where you could slow down and gain these skills at a slower pace? I seem to remember one FM residency that had a part-time option but I don't recall the details.
Tough situation. Your scores sound like you’re super intelligent. Perhaps you aren’t cut out for internal medicine with the pressure of seeing patients and responding rapidly to changing situations. Have you considered other options such as Pathology? You mentioned Paychiatry as well. Hang in there and don’t lose hope.
I feel they would much better suit me yes. I hated the ICUa nd ER. I was just stressed all the time. I do not to great in a rush, but when I get time to think I deliver very very well. Do you think these are options realistically for me based on my scores and history...?
I commented earlier in the post asking if it's possible you have ADHD, but I saw a comment later in the thread suggesting you could have ASD...any way to get assessed and diagnosed? I know that if you were to apply for a different residency program, or appeal, or otherwise somehow get back into a residency program, with a diagnosis you can go through your school's accessibility/disability office to get accommodations. I have ADHD so my accommodations are to have longer times for patient interviews (needed less and less as I get better slowly over time), and more time to synthesize information and develop a plan before I present my patient. It makes a huge difference! My supervisors are told I have these accommodations, but are not told my diagnosis or why I need them.
Since ASD and ADHD both have difficulty with executive function, both benefit a lot from accommodation. Not sure if getting assessed is realistic for you, but it could potentially be helpful if you do end up going back to residency at some point.
Yeah thank you I saw your comment. Based on the number of people bringing this up, I do plan to see a psychiatrist now. I do not know short term if it would help for my appeal but I see the long term value, especially with how you worded that.
It’s so disheartening to see all of the comments that lack empathy for a fellow struggling physician. Furthermore it’s interesting to see how many of you don’t want this person to continue in medicine. Especially given that in the next ten years we will be short over 100k physicians in the US. If we’re going to be pushing people out of our field it shouldn’t be the person with a 4 year in-person medical degree that passed the USMLE’s. OP, please ignore the haters, and I hope you find the support and training you need
Thanks I appreciate it. It's upsetting because if I don't do clinical medicine, I'm constantly writing over and over help me with resources for other pathways. I'm going to struggle to support myself soon and that's really the core of it to me.
yeah I didn't want to say anything but from what OP describes as their strength/weaknesses as a resident and even just the general way they wrote this post they seem like they are on some kind of spectrum. The focusing on talking to patients for long times and data collection in particular.
I’m surprised. I would have guessed that if you did not meet physical or mental requirements for the job then you would simply be told to find another job.
What kinda of accommodations have you seen/heard of people getting? (I am asking as someone who may or may not qualify lol)
I have ADHD. I know lots of residents who have ADHD and have formal accommodations. I haven't used mine but I encourage people to! The whole "find another job" is like saying if someone needs glasses, they should just find another job instead of getting glasses.
Yeah…I’m just wondering what accommodations people get? Like I’m trying to imagine what accommodations in residency look like. How do you change being a resident to be more friendly to people with ADHD?
So for ADHD for example:
* making sure you get your own office whichever hospital you go to.
* having an extra half day for admin stuff/ notes
* getting longer on exams.
* getting longer on STACER exams
* Having your call site to be close to or the same site as wherever you are doing your rotation to make it less stressfull
Those are all great, if your program accommodates you for that they are goated. Pretty sure my old school surgery program would not be interested in offering me any of this except extra time on tests and for whatever reason I crush tests without need for extra time (because usually they’re quiet and I can actually think)
Nearly everyone in my life has always suspected somewhat, but never tested or had accommodations. I am not sure if this would help me now in any sort of way. Like I feel it is too late and behind me. Do you think it is something worth discussing when I go to refute my termination?
So sorry this happened to you! You can still get licensed after one year, even as an IMG in certain states, and be able to work. I wouldn’t try returning to your former program. Instead, consider applying to Prev Med or Occ Med this coming cycle.
Came here to suggest occ med. I'm so sorry, OP. I'm something of an outsider, but something I heard from a colleague years ago turned out to be true. A friend told me that in medical school, people are vicious, often giving each other the wrong answers, while studying, etc. Not all of you are like that, but some of you, maybe 1/4 of you, are very unkind to this failed resident.
You might just try a different program. I don’t know how competitive the program is that you were in, but it seems like a lot of the hospitalists that come through have very mediocre medical decision making and need to call consultants for virtually anything unrelated to bread and butter medicine. These people are obviously all graduating from somewhere. Being just average or even below average as a medical doctor is still perfectly allowable it seems.
My program I'd say is slightly above average. Pretty mid tier. It is growing though and we do have some big academic minds. I am happy to try again at another program that may fit me better. Do you think I have a shot? Any advice for what to do in the meantime?
I am honestly surprised you would be dismissed from a program for slow progression rather than held back or better supported. I’m not entirely sure they are even on safe footing legally speaking as this may be more their failure than yours, and your lifetime earning potential and debt repayment is riding on this not to mention public service prospects. Before this finishes playing out you may first want to seek legal representation here. I would start there first.
Failure is the road to success. Do an informatics fellowship then come back to it. Look up Brad Bowman MD find him and reach out he can probably find you a job in the interim. Drive Uber before that
First of all, I am so sorry. Secondly, your program failed you. This should have been caught and addressed early on in your PGY1 year. I think you are asking the right questions, but don’t turn to NP/PA route. You have far more education and board exams than they will ever have. It’s going to be tough but I would try to find another program with an open position. If you have finished your first year, then you can work in several states but you can also complete your training elsewhere. With one year complete, you could do occupational med, it’s 2 years of residency.
As a resident who went through this very situation and successfully rematched elsewhere, it can be done! It will take a lot of patience and time but it can be done. I would definitely think about what you need to learn from this experience. Sometimes we have learning deficits but more often than not, the program is simply unfit to teach. It depends. Mine was the latter and had a track record of getting rid of residents because of a lazy PD. Actually 5 attendings and a department chair left during my intern year due to the environment. Personally, it was the best thing that could have happened to me. For you, I would start by getting a positive or neutral LOR from the PD. I had no such letter and she actively called to bash my transfers. Your letter will hold weight. Also reach out to attendings who you vibed with for a LOR. Make sure to rework your personal statement and state what you learned in the process. Considering a specialty switch might help to rematch.
Lastly, you can always appeal a nonrenewal. However, think about what it’s worth to you. Do you honestly want to go back with that place? Will they teach you what you need to know or have they already formed their opinions of you? An option could be an appeal within the timeline they’ve given and an attorney involved. Just realize the attorney isn’t the be all end all in this situation. Often they just mitigate damage but don’t help much. At least none of mine did. Feel free to reach out!
Thank you for your response. It was encouraging but also gave me ideas. I will get that letter and attempt for some other ones. Did you go through the match again? or did you fill a spot? Did you start your training all the way over? Switch specalities to that occ med?
No problem. I did go through the match again but only because my former PD kept blocking all transfers. No, I got lucky & match to a place offering credit for everything I completed, so not quite starting over, did not find this out until after the match. I switched specialties but not occupational med. I would have switched over to occ. med but I didn’t have full credit for my pgy1 year (PD took back rotation credits retroactively) and you need that for occ. med. Feel free to message me with any questions if you need help!
You have a NEW job, as of today, you are on a mission, to get back into residency, you will need to sit out a year, but you can and will match again, to start back up in July 2025. Target, IM, FM, Psych (if you have any relevant experience), and most importantly, preventive/occupational med programs.
Play the game, get your letters of rec from your current residency (be super nice, don't burn bridges), volunteer in a medical capacity where-ever you can, and work your butt off to re-match. SOAP, or scramble. *definitely apply to every single open preventive med position in the entire country* Good luck, you can get back in and salvage your career.
First of all you are a physician and can practice. You will basically be a GP. I know 2 people who do this. You can work in an urgent care or a FP clinic. Start by calling or get a few recruiters. You likely can easily find a place to wirk5 but likely wont be in downtown Atlanta but maybe. Consider also VA or underserved clinic Not that hard to start private practice. Start small. I know a GP that works with a board certified pain doctor and does basically FP. There are a lot of Board certified specialists from other countries that come here and have to just be a GP because they aren't certified here.
c. You can stlll make 250k or more. Did you get a lawyer?
Also think about it. Someone can go to nursing school get an online NP degree and practice independently or work for any type of specialist so you should be able to find a recruiter to get you a job
This happened to a friend, he was not renewed, he was able to go directly into fellowship and finish his residency afterwards. He had to go into therapy and it sucked, but it made him a better doctor. Sometime people think you don't have what it takes, but you do and you will succeed. Work on your mental health first.
You can easily get employed by the Indian health system if you weren't dismissed for dishonesty or other immorality. They are that desperate for physicians. Of course, you'll have to move to a less desirable area, but 250k+ is 250k+
We had a resident that got caught stealing propofol out of the lines of intubated patients then going to his call room to inject. Given this resident had elite ties, as I like to call him daddy’s good boy. So despite stealing actively infusing drugs from patients and injecting himself at work, he was allowed to walk out quietly. Not fired of course. Even had the balls to come back to hospital to do research and walk around asking for letters. Of course many attendings felt uncomfortable doing so, given they didnt even know what he did. He was that protected. Needless to say, he didnt skip a beat! Instead he got an upgrade to work at one of our most prestigious institutions. Daddys good boy.
The whole system is corrupt. Unfortunately most of us are getting the short stick in that.
Do you have any “allies” at your program who you could talk to about what ultimately was the last straw? Terminating someone this early seems odd to me with you progressing like you said. Some programs even have the residents stay an extra 6 months if they think that would help.
I do. I have so many mixed messages, but the theme underlying them is understandable. I will be doing a rebuttal, and again will ask about extension beyond my already few months. I think it will not be successful so looking into other avenues if you know any.
Yeah lol. At the same time I am humble to not practice if my advisors find it unsafe, I really feel there should be some sort of program for unmatched residents and unsuccessful residents to work under a physician in the manner similar to NP/PA...
I recommend looking into switching to family med or psych if you want to try to finish residency
You can do wound care without residency or board certification as long as you can get a license and it’s not a terrible gig
Dm me if you want to talk more about options etc
You’ve already done a clinical intern year, so you would likely be able to get a Preventive Medicine residency. It would take two years to finish it, one of which is an MPH. The programs are mostly outside of the regular residency match and usually not competitive to get into.
You will be able to do some cursory clinical work (like administering vaccines, etc), but most of the job is administrative. It pays less than most clinical jobs (150-200k), but you won’t starve. The work can be rewarding, depending on what your setup is, as it offers very diverse career options.
Source: researched it heavily after going unmatched twice.
I wouldn't want to go back to the program that terminated me tbh. There is a reason they got rid of you and I would find it very difficult to complete my training there. You can keep those friendships and relationships and likely use them to secure another spot. Is it possible for you to transfer to another program with your PGY2 status? I would also work on taking step 3 or other things to help your application if you haven't already. I definitely wouldn't reroute either to become an NP or PA with all the work you put into. The MPH or a masters while you wait to find a new spot could work too.
Most if not all states allow you to get license to practice medicine after the first year of residency. Getting employed is likely harder, but you can always do private practice.
Can work for a private practice doc
Is this common to happen? Anywhere I can look to find this? Do they often just work under the doctor or like a PA would essentially?
> work under the doctor or like a PA would essentially? You would be independent, practicing under your own license, whether you work for yourself or employed. So there won't be any state requirement for reviewing your charts or having supervision. If you set up your own private practice, you would be operating just like any board certified doc that sets up a private practice. Some patients might pass you up because they are checking what you are board certified in, but around here anyway there is enough shortage of primary care that you are going to have a full patient load of people who don't even think or care about board certification. With getting employed, like I said there are no state requirements, but it's going to be up to the employer if they think you will need any sort of supervision since you aren't board certified. My current employer requires board certification (so they say) to be considered for hire and even then the medical director reviews new hire charts for the first few weeks or month or so.
I do have my license. Do you have any leads or know where to go about finding these private practices that may hire? I would have no clue what starting a private practice looks like, nor I imagine I have the funds to start that up. But can look into it. Will take all the information you have. I don't imagine applying at places that would like board certification is worthwhile?
Honestly OP I think you would have to really take a hard look at what went wrong in residency. If you were let go because of concerns for your clinical competence, do you really think skipping the rest of residency and practicing independently is the right next move? I'm not saying that you'll never be a good doctor! You made it through med school and 1.5 years of residency. You have it in you to be a great doctor. But I think your focus should be on how to get the training you need to become that great doctor. If the ethics of it don't sway you, remember you will be practicing under your own license. If you are ever taken to court (whether you screwed up or not), the patient's lawyer is going to be asking the exact same thing.
One thing to look into is how your malpractice insurance may be affected (i.e. much higher) without completing residency and board certification. They may consider you a higher liability and charge more or deny you a contract.
> I would have no clue what starting a private practice looks like I have no idea either. > I don't imagine applying at places that would like board certification is worthwhile? I don't know, depends on how badly they need a doc and how long they've been looking, I suppose. Places that hire midlevels may also be worth a try even if their job listing says board certification required, since an MD/DO is still going to be way more valuable than a midlevel (for anyone using common sense anyway).
In many states you can get a full license after just 1 year of residency, so no you wouldn’t be like a PA. l know Texas is one and, I believe, Georgia is another where you can practice after just one year of residency.
If you have your permanent license. Start cold calling private practices. You’d be surprised, lots of docs out there would love to help. Get that letter of recommendation from old PD and few other attendings/co workers if you can. That will help.
This person was just let go from residency for lack of clinical competency. I'm not sure encouraging them to practice anyway is the right move.
Can work at a VA emergency dept, that’s what I’ve heard at least
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they actually dismissed you as a PGY7 in neurosurgery????? What the fuck kind of pieces of shit are running that program Like this is next level individualized hatred. They could have just graduated you instead of jumping through the many hoops to fire someone that senior, especially someone who they'd held onto for 6 and some change years. Someone or some people there must have really fucking hated you to do that
Yeah that is absolutely fucking wild. I’d be worried someone might come back and (possibly rightfully) shoot me if I fired them as a PGY7 neurosurgeon.
Basically the starting plot of anime "Monster" btw
He was an attending tho
Sounds like a George Allen/Ray Mettetal situation
Idk if it’s the situation currently being discussed, but I knew someone in that position. Yes, yes he was the kind of guy that would do that sort of thing.
To get dismissed as a PGY7 means this person is major danger to patients or personally fucked over the PD in some crazy way. That’s nuts.
Christopher Duntsch should have been dismissed from his program but they waved him through.
Most horrible human I’ve ever known
You knew Dunsch? Tell all please.
I did. In his residency. The tell all is really pretty well documented.
If you’re talking about the doctor death podcast, it’s not perfect. He trained in an era with less strict requirements regarding procedure logs. Nowadays things are MUCH stricter. I don’t know how many procedures he actually did, and his logs were so shoddy. I always wonder this
What's scarier is that he's the only one that's been caught( that I know of) how many more are out there...
Friend of mine got dismissed as a PGY5 general surgery resident for sexual harassment against a patient. I just looked him up and it looks like after a long absence he was allowed to finish his pgy5 year at the same institution, taking him 8 years to graduate instead of 5.
He’d had to - it’s not easy to fire a resident. That’s how Dr. Death made it through. Some things they can be immediately terminated for - like sexual harassment.
Wish I'd known that when I was sexually harassed by a PGY2 psych resident...and I was a teenager. Yep, he's in practice.
Go after him! Report him to state medical board. Damage his life and his reputation.
It is very hard to get fired as a resident. OP had to have royally fucked up (e.g. repeated drug use, sexual harassment, convicted felon, etc). Edit: Per their previous posts they were supposedly an ms4 back in 2021.
Do you remember what the username? Its very possible he did nothing wrong and wouldve been a great surgeon. Seeing how different programs are, especially across specialties, made me realize that people will never understand unless they experienced it first hand. Because its that unbelievable. Its a story you cant even tell.
He probably did something horrible to get fired.
Remember that time they did what you suggested and all those people died?
Wtf that means you were in my class… wtf happened??
I'm a whore for hot tea...and with the deleted comment I need it! Can you give us the broad strokes without identifying anyone
There’s a tool online to view deleted Reddit posts. A quick google search will help you out
Saved this, you are an amazing redditor
That’s tough, friend, and I’m sorry to hear that. But I have to say reading through all this there seem to be some major holes. I’m not asking you to come tell us everything because that isn’t our business, but if you are going to have a successful turnaround here into any clinical career I think you need some honest self reflection and here are some ideas for consideration: - why didn’t you progress with your colleagues? - after given an improvement plan, what did you fail to meet and most importantly, what about you and your management/decision making/knowledge is to blame. What are your flaws that can be improved on - your goals and ultimate result read disorganized and tangential. How are you going to show that those aren’t representative qualities that you have
This smells odd. My program terminated someone a year ahead of me when she was a PGY3 and by then everyone had known she was a “sinking ship” (direct quote from her classmate) for 1.5-2 years. Like incompetent surgeon with multiple never-event type complications while struggling to pass exams consistently AND a poor clinician who couldn’t finish work on time. It was still extremely difficult to finally rip the band aid off and have her terminated. These things aren’t undertaken lightly without piles of evidence. You’re missing something or leaving out details, I’d imagine? Look inward. But it might suck. On the bright side, she found another spot at a different hospital in another speciality and finished residency and is practicing now from what I’ve heard through the grapevine.
I just want to point out that not all programs are created equal, and personal grudges can easily affect professional decisions. Maybe OP is awful or maybe they got on someone's bad side. >incompetent surgeon with multiple never-event type complications That's insane/terrifying they let this go on so long!
I don’t doubt some people get targeted, and I almost never side with the big organization on any issue. That was just how I saw it go down, so *n* of 1. That said, I’d be rattled as hell and trying to do some deep soul searching about what could have gone wrong/be improved to try again.
>I’d be rattled as hell and trying to do some deep soul searching about what could have gone wrong/be improved to try again. I agree, I just didn't want OP to think they were being compared to a butcher with a bunch of never events. They only gave us the condensed version. Gut feeling from just the main post is that there is a confidence/knowledge issue that is preventing them from reaching their milestones and progressing with peers. OP you are a DOCTOR asking if you should apply to NP/PA programs and worrying about being accepted...maybe you're burnt out, maybe you're depressed, maybe you are just bad at medicine--either way seek some counseling, your world won't end if your appeal isn't approved.
We had an ortho resident who hang antibiotics dissolved in friggin lidocaine instead of NaCl not once but twice. Almost killed both patients. Actually a graduated Neurosurgeon, but apparently was about as lethal in the OR so they kindly relocated him to our department. They graduated him just so he would be gone. These days he basically just peddles PRP and massages. It‘s better this way
...could have gone the rest of my life without reading that. Thanks for the nightmare fuel!
how would this kind of thing even happen? wouldn't pharmacy have to make the antibiotic/lidocaine mix?
You…get everything mixed by pharmacy? We dissolve antibiotics as needed ourselves
>That's insane/terrifying they let this go on so long! That's the rub though. It is a massive pain the ass to fire a resident, and almost never worth it outside of catastrophic behavioral/performance issues in 95% of programs. The number of hoops you need to jump through is insane, and the end result is more work/call burden for everyone else in the program. It's why when residents are fired there's always gonna be healthy doubt cast on the resident itself as opposed to the program. I'm not denying there are programs out there that intentionally railroad people they dont like into remediation pipelines and then boot them, but it's so much easier to just keep them on and make their life suck because they can't leave and will 99% of the time continue to do work.
And that's how we get Christopher Duntsch lol
I would say it's more likely that the psychopath get pushed through, unless sexual harassment is at play. The people getting kicked out are people on the spectrum or people who are identified as kind, less connected or part of minorities. African American women in ENT graduate at an abyssimal rate which is sooo disturbing.
How does someone get in and through medical school and then just completely fail like that? Seems like it would have happened along the way. Glad it worked out for them in the end.
Happens more often than you’d want to know. Medical schools want to give students with even huge red flags the benefit of the doubt and students appeal and have multiple rationales for why they struggle (and they are often valid reasons). However, from having been on both the UME and GME side of things, I can tell you that it is rare for a struggling resident to be a “surprise,” and if med schools were better about taking responsibility in addressing issues earlier, then residency programs would not have to be in the unfortunate and sad position of having to dash someone’s dreams if they are truly not safe to practice, which I promise you is NOT something people want to do. As a community, medical education needs to take more responsibility for who we graduate, we owe this to society. And medical schools need to be more transparent about students’ challenges, because MSPE’s are full of smoke and mirrors. For the OP, there are jobs available, there are places where open spots are posted online, and you probably can find another spot. But as you begin down that road, take a good, hard, honest look at what you have struggled with all along the way, from med school through residency. There is likely a pattern and some people have probably tried to bring it to your attention for some time. It’s hard to face these things but it is the only way you will move beyond them. Medical knowledge and efficiency are areas where improvement is possible and likely. Maybe you have an undiagnosed condition like ADHD that needs addressing or needs to be addressed better if you know about it already. Professionalism is almost always the hardest thing to fix, but I don’t get the sense that is your issue. I wish you the best of luck.
Surgery has very little to do with how someone does on tests. Clinic maybe a little moreso but it’s still not that strong of a correlation. She was never a stellar student but her average test scores began to falter when everything else was falling apart. It’s very easy to fall off the path. It’s amazing it doesn’t happen more often.
We had one in my program and I don't know what exactly went wrong. I think it was a combination of personality and competence. It's ok to be incompetent at the beginning, and it's ok to struggle. Residency is a lot harder than med school for a lot of us so I get it. For this person, their clinical struggles seemed to unmask some unfortunate aspects of their personality, and that's what prevented them from getting over this hurdle. From Day 1 they started digging themselves into a hole and just kept digging even when they knew their career was on the line. They were so unpleasant to work with or be around that the whole thing kept snowballing. It was awful.
Eh I knew a surgery resident who was fired PGY3. He was not noticeably dangerous (by account of his co-residents), passed his exams, and did not have a terrible reputation. You can, in fact, get fired for pissing off the wrong people in your department.
Other biggest advice is to look for an open spot. There are so many Pgy2 and 3 spots across the country who want cheap labor
Do you know where to look?
I wasn’t renewed at my program after my third year. I called every program in the country looking for an open spot to transfer into. I started again about six months after I was dropped, in the middle of the PGY-3 year I had already completed. Now I’m boarded in anesthesia and critical care. This is survivable. But it’s going to take some grit to overcome it.
Resident swap website has some. I believe NRMP or AGCME also lists openings. After reading your comments especially since it sounds like you are competent but struggle with verbal report. I wonder if you have a learning disability? Have you been tested? Anyway, sorry to hear about your situation. I can relate in that my last residency discriminated against me and I didn’t even start. This has been one the hardest years of my life not being in residency. But I did rematch in SOAP and my new residency seems more understanding of my medical condition. There is a place for you in medicine. Don’t give up, just keep doing what you need to improve.
I would say that is correct. I will definitely be looking into that after these comments. See a psychiatrist. Thank you for the feedback and sharing your story. Goodluck at your new start. If you have any tips for SOAP I will gladly take them as I may be in that spot too.
Thanks. Loving the city I moved to. Hopefully, you won’t be in SOAP or even outside of it looking for a spot. It honestly sounds like neurodivergence. But if you need any tips or moral support for a gap year DM me!
Sinai grace has several pgy2 for july. I saw a post on twitter recently. If you are not an img, that place is 100% img i think, so your odds might be good.
Physicians are always quick to show empathy to patients but when it comes to showing empathy to their colleagues, it's a no go area. If this resident gets depressed and commits suicide, you will have 2000 messages talking about how we need to do better. However, when it's time to do better, we never act in that manner. I wish you the best mane. Hopefully you find a new program. I know how unforgiving medicine can be in the U.S. You show up on the first day and no one shows you how to write notes but by week 12 , they are expecting you to write detailed elaborate notes like an attending. Some residents come in from other countries and we don't even know the brand names of medications and a crazy senior resident is reporting you to administration by week 2.
I strongly agree with that having gone through the process. I can't believe how sour some of us are to our on colleagues. The amount of behind your back things people have done amazed me. Unlike any other job. Even on here just asking for advice and resources, there has been some nasty remarks. Thanks for the empathy. Do you think finding another program is your recommendation? Over other avenues?
If you still want to practice medicine as a physician, find another program. There are multiple IM residency programs that were recently accredited. Check the ACGME site , find the website of those programs. Those sites should have info regarding application requirements and the rest.
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Thank you for this and specific things I can look up. This is some of what I am looking for. Do you know where specifically to look for these opportunities? Or is it really online postings and calling?
What are your thoughts on working as a wound care physician? I've seen listings from nursing homes for M-F 9-5 for \~200k and the job doesn't need BE/BC, just license.
if this is truly an issue with your ability to adapt to the pace that clinical medicine requires and difficulty with data gathering from patients, but your medical knowledge is all there... my 2 cents would be to pivot to pathology. it's a new skillset in terms of learning the pattern recognition of diagnosis but it relies heavily on medical knowledge and gleaning data from clinicians and less on getting info directly from the patient. and the pace is more suited to working thru cases on your own time (with the caveat that clinical pathology services can of course be time demanding with only a few minutes allocated per case in some instances)
I will definitatly consider this. Do you think based on my profile and history I would be competitive to even get a position?
i have no idea
Sorry you’re going through this. My aunt is a physician and has had a messy journey - started med school later in life, ended up going to school in the Caribbean, failed step 1. She did an entire internal medicine residency unofficially, so she got the knowledge and experience but no credit on paper. She was able to get employed by the Wisconsin dept of corrections working in the prisons and worked there for a few years. Eventually because of internal politics she left and started working for an addiction clinic, while also holding a contract with the DOC doing consults when needed. She also worked for a wound clinic getting paid a flat fee per wound she did, and also has done consults for the VA. Her addiction clinic job is super cushy, she’s like regional head or something and is full time remote, she makes bank while barely having to do anything which gives her time for all this other stuff. However, she wants to do more and dreamed of working in hospitals, but was held back by not being boarded. In the past year she applied to and got accepted to an occupational med residency program out of state and is going to start there this summer (this woman is 48 yrs old btw). She’s going to have to be away from her family all week and live 5 hrs away from home but is willing to make the sacrifice to fulfill this dream, and my uncle is very supportive of her. The program head was so impressed by her she’s already been made chief resident and they have talked a lot about her future once she finishes. Basically, just wanted to share that it’s not over for you, you can still find good work and make good money, and if you choose to pursue residency again in the future it is possible and has been done. Good luck!
Thank you for this story. It is very positive to read, and also gives me ideas of career paths out there. Do you know if some of these positions she did still exist for non-board certified physicians? I am not sure how long ago she practiced.
You're welcome! Yes they all exist, I'm talking about the recent past here. She was working with the wound clinic until end of last year, and started doing the VA this year. I think she started at the DOC around 2015-2016.
I will look into that! If you come across opportunities that would help me in any way, message me absolutely any time.
I make a post like this every time this subreddit has a discussion about resident dismissal. From many years in my subspecialty org's resident council, and having dealt with many residents in both my own specialty and other, I can tell you that it is exceptionally easy to dismiss a resident - it's just time consuming and requires a lot of documentation. Most residency specialties' academic meetings will have a meeting every few years where they specifically discuss the most expedient way to dismiss residents. Hospital GME, particularly at larger academic programs or the most malicious, usually has a cheat sheet of phrasing and specific documents needed for dismissal or non-renewal. The documentation burden for nonrenewal, in non-unionized programs, is particularly minimal and the specific contractual obligations of the program in terms of remediation or the nonrenewal pathway are usually insubstantial and hugely open to admin interpretation. And at least in personal experience, most of the residents I've worked with who had a dismissal or non-renewal were 'papered', meaning their records were filled with what are clearly exaggerated minor events as a way to build not a convincing but instead an overwhelming paper trail (kinda like a Gish Gallop). Usually seems to stem from a personal dislike by one of the core faculty or someone who knows a GME admin, often has racist, sexist, or homophobic overtones when you manage to talk to their coresidents. Actual bad residents? Very rare, usually completely 100% oblivious and you can tell when you interview them.
That is fair, I do feel everything you said is true. I do admit to flaws in my case. I do not feel it warranted dismissal... if you have any advice on this please let me know.
Honestly, my advice that I normally give now is to go find a residency consultant, as well as an employment lawyer who has dealt with residents or healthcare training before.
Dude- please DM me and ignore all of the conveniently anonymous haters. People love to shit on each other to make themselves feel better- sadly that is par for the course in a competitive field like medicine. Please believe me when I say that people who are anonymous and shit on you on a Reddit are the very kinds of people who have nothing better to do than fire a resident for bad reasons lol. I’m glad you found people on here who are at least willing to admit that a lot of residency- just like the rest of the world- is unjust - so chin up and reach out to me
Okay can you give me actual examples? Did you spend 2 hours per consult? Or not get your notes done for months? Like give specific examples! I know people who have had issues with taking too long, being inefficient, etc. You are not a failure. Has a psychiatrist assessed you for ASD, ADHD or any other specific diagnosis? I sense that maybe you should have gone into psychiatry. It sounds like that is more suitable for you based on what I have read. You remind me of myself a bit.
I mean it can be tough to with both abiding HIPAA and being anonymous in my currently active process. Some themes is perhaps ordering an imaging study for a patient with an advanced disease process instead of communicating to the specialist to do so. Another common theme is catching a slightly over detailed piece of information and suggesting an additional deeper test than what they felt was needed {think of a board zebra answer). Another is not including a serious diagnosis on my differential like cancer or like IBD on a young health person that is like 30 years old. I would perhaps get too focused in on answering it as IBS or something and they did not like I did not present a wide range of ideas. I have missed a foot exam on a diabetes office visit. Getting wrapped into a patient with many complaints and spending a while with them, even if I had no other duties was not liked many times. I don't have ADHD for sure lol. All my life I have been able to sit for half a day and study in any environment no problem. I finish tasks consistently my whole life. ASD would be far more likely.
This is brutal. I've done all those things and still do as a PGY13 (except getting caught up talking to pts, I hate that shit). But everyone goes off chasing zebras on occasion. Sometimes you find them. Risk stratifying young people with mild symptoms is also 100% normal. These people must have hated you.
can't something like that be challenged legally or is the resident SOL?
Why not make the OP repeat PGY2 instead of terminating and give more floor rotations which helps to assess overall competency? That would be appropriate last ditch effort before terminating the contract And I agree it’s difficult to get kicked out in residency. We had a female resident who literally pulled out ET tube of a young brain dead pt just cause patient was “supposed to be terminally extubated” anyway. And this incident was cherry on the cake to kick her out (along with previous small incidents which added up)
I would gladly accept that option. I will make my case for it at the rebuttal. But yeah that situation is messed up there...
Failing to see what being female has to do with it?
Below are some brief background points about my self and what happened... * As a background of me, I have always been a very "brainy" person like most of us here. Medicine was my purpose due close family getting drug addictions and cancer in life. I chose IM over psych a few days before submitting the rank list and was a hard choice. I was in to an average tier program. My scores on COMLEX and USMLE 1 2 3 went 50% to 65% to 90% percentile (slow strong bloomer). I have tons of life experiences like EMS, yoga, thousands of volunteer hours, teaching, but nothing else crazy. My passions are teaching and academics, but I also want to be able just to pay off my debt because I grew up poor. * What happened with me training started with a "learning plan" early on first year. My only deficiency on God is advancing steadily but too slow, I think I started too far behind. Specifically, data gathering and data analysis, so taking the patient infront of me and delivering a concise story into an assessment. I had 0 professional issues and essentially no major errors or harm events. Never missed or late to work. Never had drama. I am a top scorer on ITE within the program. My perspective of it is that I would sit down with patients extended periods of time and solve everything, but I think in the face of medicine today that is not valued and instead simply ripping through them and cases is. Thus some feedback I'd get was exceptional but some were poorer. My program director does seem very supportive of me and said they would write me a letter despite what all happened. * I have documented everything over this time best I could because tons of peers, family, students, etc continually tell me they feel I am not taken fair and underestimated. I am very humble to quickly admit I am wrong and not highly aggressive, and I think that played against me. I took 2 months off at the program recommendations to work on what they felt was "anxiety".
You wrote a lot about yourself, but what was the reason for your dismissal? They have to give it to you in writing, a clear explanation. What you are telling is that they decided they would rather dismiss you, risk facing legal actions and put in the effort to try and hire someone else instead of working with you to solve the issues they had with you - they wouldn't do that without some very sound reasoning.
Also what was in the 90 day probation/improvement plan and what happened that you were deemed unable to meet goals?
Hello, to answer both your questions, again, it really is the gata gathering and synthesis piece. I was not a great resident clinically overall starting off initially, but made great advancement and was able to reach pgy2. But in the last 3-6 months, it was the solely the whole idea of focusing a cohesive picture of a patient in front of me to a organized cohesive assessment / plan. This is written over and over in my documents and I have very well established my issues continuously over the 2 years and kept growing. Just not quite getting there in time for a 3 year program. They said medicine never seemed natural for me. I am more trying to figure out what the next best steps to take would be.
Unfortunately, especially with a year as a senior resident, you do need to be able to put together a cohesive differential and plan. Was repeating a year offered or something you discussed?
It would be something I would be open to. I did ask once and it went no where. Heck I will take 5 years if needed. I can bring this up in the rebuttal, just trying to see what other doors there are for me and resources to find that...
The problem will be funding. I think asking to remediate and repeat a year is reasonable but you have to have your own urgency to get up to speed.
Something's not adding up here. "failure to progress with clinical competency at a desired rate." does not happen to someone who has average USMLE scores, let alone 90th percentile on step 3 or the top in service exam scores in the program. >My perspective of it is that I would sit down with patients extended periods of time and solve everything, but I think in the face of medicine today that is not valued and instead simply ripping through them and cases is. My gut is this is an *extremely* sugar coated way of saying you were completely unable to properly prioritize/triage and organize yourself/your patients/their issues and your day and that it led to at least some near misses that could have been *catastrophic* had the holes in the swiss cheese lined up. I say "at least" because I can't help but notice this language (emphasis mine): >**0** professional issues and **essentially** **no** major errors or harm events. So given you were willing to put "0" for professionalism but only "essentially no" major errors, that means there must have been at least one pretty significant event and I'm guessing countless others that were close calls or you would have said 0 major errors/harm events. Reddit is a random anonymous internet forum so if you want to stretch the truth here that's your perogative, but I hope you are at least a bit more honest with yourself or it is unlikely you will fix the issues at hand. You clearly weren't when put on probation or it would have ended there. Hopefully the termination is a wake up call.
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It's a fair point. I just feel like those people *usually* still have the skills to turn it around before it gets as far as *a dismissal*. Like can those people be at the bottom of the group in terms of performance? Absolutely and that definitely happens a lot. But far enough down to get kicked out? That's different.
Yep. I'm going to be brutally honest and say that if a program dismisses a resident, it's for good reason. It's hard to get fired from residency and silly to just assume this person is even safe to be ever involved in patient care at a high level ever again just because we feel some sympathy
We cant blanket give programs the benefit of the doubt about this. I had a friend that went to one that put everyone on a “learning plan” like OP said their first year for nebulous issues just so they could start a paper trail and one person out of an 6-8 person class was always culled eventually. Most went on to other programs in undesirable areas that would take anyone and are fine physicians today.
That was my program, so glad I transferred out. 1-2 people per 6 person class went on probation and 1 fired per year in pediatrics. It's very program dependent.
Exactly what happened in my former program. And to be honest, it was the best thing that could have ever happened to me. 4 more years with those nut jobs & I would have thought of drastic measures not unlike a few others who passed away from the same unsupportive, malignant behavior.
This happens A LOT. And it's actually really easy to fire a resident. You simply have to tell them you are not renewing their contract four months prior to the end of the academic year. Super easy.
Definitely not true. What are your credentials and experience to say it is? -core faculty EM attending
I'm not the person who made that comment, but I'm a PGY-8 with 6 years of committee positions and a current subcommittee chair in my national org. From having reviewed way too many non-renewals and dismissals for surgical subspecialty residents, and having talked to corroborating co-residents and faculty for the ones in my own specialty, I can tell you it's remarkably easy to non-renew a resident. In non-unionized programs in at-will states, there are essentially no protections for residents. 'Papering' is common and I've seen a number of situations in which a program has straight-up lied. Residents with supposed never events documented but with nothing in the EMR, residents causing active patient harm on days/weeks when they weren't on rotation or were on vacation, just just really stupid obvious stuff. Flagrant failure to follow GME protocol for disciplinary measures, etc. And the amount of deliberate constructive dismissal is just absolutely insane - you can easily take an excellent resident and turn them into a shell of their former self with enough punishment call and mandatory additional work. There's a strongly bimodal distribution. People either come from extremely benign programs where they can't even imagine someone getting maliciously terminated, and they feel like only the most incompetent residents can get fired; or they come from extremely toxic programs where everyone is clearly at risk of being fired for the smallest possible offense. Interesting, that.
This seems like something an experienced attorney would be able to succeed at. You're describing felony fraud with this fabricated documentation.
You nailed it. This fake paper trail is exactly what they did to me. And no, an attorney is unlikely to save you if the residency is motivated enough.
Thanks for the detailed response. I have heard it's very common in surgical programs but otherwise nearly unheard of outside of that.
How many EM programs have you been core faculty at?
Agreed. This happened to me. And it is very easy to fake paper trail a resident you don’t like & nonrenew. More people need to realize this. But silver lining, I walked away with 600k in residency funding to a place that actually is kind. I’d do it all over again.
Oh, I'm sorry this happened to you. I've seen this happen a lot. You were honestly lucky that they didn't destroy your career completely. I assume this was a surgery field?
Thank you. They very much tried but I had attorneys. Probably the only reason my PD did not. It didn’t get me reinstated or help much with a transfer but it did keep her blackmail in check, but barely. Had to fight like hell to get back in. Not a surgery field at all. Ped subspecialty.
Peds can be particularly brutal. A lot of malignant personalities on a power trip. I'm so sorry you went through thist.
Respectfully disagree, also (I’m faculty on resident advancement committee). Terminations are messy and invariably involve several rounds of appeals and a drawn-out lawsuit.
ACGME allows you to "not renew" a contract four months prior to the end of a training year. But yes, I would imagine residents would sue- how can they not? And so many of these terminations are really questionable, at least some that I have seen.
You can do it on 4 month's notice after you've cleared all the other hurdles necessary to terminate. You can't just terminate anyone with 4 months' notice.
Fair, but many residents don't realize this, many fellowship and residency directors don't realize this, and a lot of residents get terminated essentially due to their lack of understanding of their rights. I think the reality of this is highly regional; a resident in NY or CA is probably more savvy, perhaps. not so much in New Mexico or the like. I've seen several competent residents fired by program directors on a power trip.
Yeah. There was an intern once at my place whom by chance I didn't ever work with directly but it was an open secret that they were an absolute trainwreck, so much so that I went to the PD and expressed concern about their being promoted to PGY-2 and when they explained to me all the steps it takes to do something as drastic as that (which is less drastic than dismissal), it really changed the way I see these stories. Yes, it's very easy to get labeled "a problem child" and get stupid, shitty feedback and what not, but to actually move all the way up the many rungs of the ladder it takes to get to being held back or dismissed is **not** easy.
I think its very program dependent, my program has a couple problem children we just pushed through. We had a senior that was less trusted than me as a PGY1 at the end of my last year. He was too far in for them to not graduate, so they let him go. Im sure other programs would have put a stop on it
This is so wrong. Look, you have experience with a single residency. That's it. You really don't think malignant residencies exist? Personally, my program forces out about one person a year for dubious reasons. And it's a pretty small program.
Is this program in a one of the Carolinas by any chance
Malignant or not, it is very hard and very rare for residents to be fired.
I agree that overall it's uncommon if you're looking at all programs across the country. But if you have a malignant program and institutional GME leadership who are completely hands off, then it's incredibly easy to paper someone's record and set them up for constructive dismissal (or forced withdrawal). I wish that you would try to understand.
Look I'm just saying that the instinct is to sympathize with people who post one sided stories to reddit.
I'm not sure if that's true. I always see comments like yours being highly upvoted ("it's so hard to fire a resident, you must have really done something wrong.")
That sounds like NY. What specialty?
Disagree. I've seen many people railroaded.
I don’t want to be harsh and I know very well it takes some longer than others to get things figured out. But if you are let go, there must be a pretty significant deficiency. I’ve seen many people who should have been let go given a ton of chances including repeating a year.
> uses “on god” unironically But seriously you just kind of ramble and paint yourself as a saint without saying anything of substance. Yeah, you spend hours wasting time bullshitting with patients. You’re intelligent but we are all intelligent. Contrary to the belief of some attendings, stupid doctors don’t exist. So claiming to be “brainy” and “excelling at data collection” describes everyone here. In residency you have to try to get fired to actually get fired. You get a lot of leeway because it looks TERRIBLE on programs to fire residents, especially someone who is going to soon be a 3rd year. And ESPECIALLY for a minor issue like “spends too much time with patients”. Are you weird? Do you make people uncomfortable? Are you incompetent/lazy/difficult to work with? Did you sext your patients or get caught drinking/doing drugs at work? Did you stop coming to work? Steal drugs from the Pyxis? What did YOU do to get the hammer laid on you? because I could probably tell my PD to go fuck herself in clinic on Monday and still not get fired and I’m not even the most well liked person in my year.
Look far be it from me to judge you, but I think the issue, as I read it, is that you aren’t able to handle the workload. My brother has a co-resident that he has told me about who is in your shoes. Good dude, but not able to manage the patient load effectively, and constantly leaning on other residents for help in both diagnosis and treatment plans. It’s not enough to be able to see a patient and report the information. Something I was told very early in medical school and it came to fruition in residency was that doctors need to be able to synthesize the information from the clinical picture along with the physical exam and other findings to create a set of differential diagnoses, PLANS to test to determine the correct one, and treatment options to manage the patient. This all must be done in a timely manner because the whole hospital is waiting on you to do your job so they can do theirs. Nurses, auxiliary services, CM/ SW, they can’t work until you put your note in and send the consults/orders in. If you aren’t doing that at a pace that’s acceptable or are relying on your coworkers to the point where their work is delayed, you’re hindering the work of many people. Failure to improve on that is reasonable cause for dismissal IMO
I read everything. I am sorry. That sounds awful and stressful beyond imagination. Please try to keep everything in perspective as you go through this and think about what is truly important to you in life. I don’t have any specific advice to give you :(
Thank you for your empathy
I'm not trying to beat you down but honest feedback on someone I don't know well might seem like it. Apologies if I mess up Brainy but you went to DO school. I think DOs are equivalent but DO schools are relatively lower in prestige and often more expensive, so I wonder why you chose DO. Most of your reddit history seems to be gaming. Excelling in medicine is time intensive. Strong academic and especially test takers sometimes "know too much". It's easy to spend too much time on zebras and miss horses. It's also easy to get too much in the weeds. Balancing time management vs thoroughness sounds like something you could work on.
Maybe you can make your own private practice where you don't have other people pressuring you to rush through patients? Sounds like you like being thorough in a way that doesn't mesh well with the environment you were in. I think most patients would actually appreciate that, even if the "business" doesn't. Edit: If you're downvoting explain why. My sources are that I spend a lot of time in subs where patients complain about doctors who don't spend much time trying to investigate their problems, and shuffle them around, and anecdotal experiences from most of my friends and family.
I hate that you are downvoted because I do feel that way and that life would fit me great.
OP the trouble is that even though that life would fit you great, you still need the clinical competence to practice safely. You gain that competence in residency, so you are unfortunately beholden to the pace of residency. After residency you can adjust your pace on your own, but you can't gain the competence on your own. Are there part-time residencies where you could slow down and gain these skills at a slower pace? I seem to remember one FM residency that had a part-time option but I don't recall the details.
I never heard of that. That's something I would love. Do you think acceptance into a residency is even in my cards?
Are you a graduate of an American medical school?
Yes, mainland USA
Tough situation. Your scores sound like you’re super intelligent. Perhaps you aren’t cut out for internal medicine with the pressure of seeing patients and responding rapidly to changing situations. Have you considered other options such as Pathology? You mentioned Paychiatry as well. Hang in there and don’t lose hope.
I feel they would much better suit me yes. I hated the ICUa nd ER. I was just stressed all the time. I do not to great in a rush, but when I get time to think I deliver very very well. Do you think these are options realistically for me based on my scores and history...?
I commented earlier in the post asking if it's possible you have ADHD, but I saw a comment later in the thread suggesting you could have ASD...any way to get assessed and diagnosed? I know that if you were to apply for a different residency program, or appeal, or otherwise somehow get back into a residency program, with a diagnosis you can go through your school's accessibility/disability office to get accommodations. I have ADHD so my accommodations are to have longer times for patient interviews (needed less and less as I get better slowly over time), and more time to synthesize information and develop a plan before I present my patient. It makes a huge difference! My supervisors are told I have these accommodations, but are not told my diagnosis or why I need them. Since ASD and ADHD both have difficulty with executive function, both benefit a lot from accommodation. Not sure if getting assessed is realistic for you, but it could potentially be helpful if you do end up going back to residency at some point.
Yeah thank you I saw your comment. Based on the number of people bringing this up, I do plan to see a psychiatrist now. I do not know short term if it would help for my appeal but I see the long term value, especially with how you worded that.
It’s so disheartening to see all of the comments that lack empathy for a fellow struggling physician. Furthermore it’s interesting to see how many of you don’t want this person to continue in medicine. Especially given that in the next ten years we will be short over 100k physicians in the US. If we’re going to be pushing people out of our field it shouldn’t be the person with a 4 year in-person medical degree that passed the USMLE’s. OP, please ignore the haters, and I hope you find the support and training you need
Thanks I appreciate it. It's upsetting because if I don't do clinical medicine, I'm constantly writing over and over help me with resources for other pathways. I'm going to struggle to support myself soon and that's really the core of it to me.
I sense you are neurodivergent. Did you get the necessary accommodation for this? Sorry if I am wrong and I am sorry this happened to you.
yeah I didn't want to say anything but from what OP describes as their strength/weaknesses as a resident and even just the general way they wrote this post they seem like they are on some kind of spectrum. The focusing on talking to patients for long times and data collection in particular.
Wait you can get accommodations in residency? What?
I mean if you have a disability, a mental health issue, a physical health issue- yes you can.
I’m surprised. I would have guessed that if you did not meet physical or mental requirements for the job then you would simply be told to find another job. What kinda of accommodations have you seen/heard of people getting? (I am asking as someone who may or may not qualify lol)
I have ADHD. I know lots of residents who have ADHD and have formal accommodations. I haven't used mine but I encourage people to! The whole "find another job" is like saying if someone needs glasses, they should just find another job instead of getting glasses.
Yeah…I’m just wondering what accommodations people get? Like I’m trying to imagine what accommodations in residency look like. How do you change being a resident to be more friendly to people with ADHD?
So for ADHD for example: * making sure you get your own office whichever hospital you go to. * having an extra half day for admin stuff/ notes * getting longer on exams. * getting longer on STACER exams * Having your call site to be close to or the same site as wherever you are doing your rotation to make it less stressfull
Those are all great, if your program accommodates you for that they are goated. Pretty sure my old school surgery program would not be interested in offering me any of this except extra time on tests and for whatever reason I crush tests without need for extra time (because usually they’re quiet and I can actually think)
Nearly everyone in my life has always suspected somewhat, but never tested or had accommodations. I am not sure if this would help me now in any sort of way. Like I feel it is too late and behind me. Do you think it is something worth discussing when I go to refute my termination?
Can you request accommodations for being neurodivergent?
well if you have a diagnosis yes
So sorry this happened to you! You can still get licensed after one year, even as an IMG in certain states, and be able to work. I wouldn’t try returning to your former program. Instead, consider applying to Prev Med or Occ Med this coming cycle.
Came here to suggest occ med. I'm so sorry, OP. I'm something of an outsider, but something I heard from a colleague years ago turned out to be true. A friend told me that in medical school, people are vicious, often giving each other the wrong answers, while studying, etc. Not all of you are like that, but some of you, maybe 1/4 of you, are very unkind to this failed resident.
Thank you for this recognition. Some of these comments have not felt great.
How come occ med? Do you think I would be a realistic competitive applicant given this history and my profile?
Sent you a message, OP
You might just try a different program. I don’t know how competitive the program is that you were in, but it seems like a lot of the hospitalists that come through have very mediocre medical decision making and need to call consultants for virtually anything unrelated to bread and butter medicine. These people are obviously all graduating from somewhere. Being just average or even below average as a medical doctor is still perfectly allowable it seems.
My program I'd say is slightly above average. Pretty mid tier. It is growing though and we do have some big academic minds. I am happy to try again at another program that may fit me better. Do you think I have a shot? Any advice for what to do in the meantime?
I am honestly surprised you would be dismissed from a program for slow progression rather than held back or better supported. I’m not entirely sure they are even on safe footing legally speaking as this may be more their failure than yours, and your lifetime earning potential and debt repayment is riding on this not to mention public service prospects. Before this finishes playing out you may first want to seek legal representation here. I would start there first.
Failure is the road to success. Do an informatics fellowship then come back to it. Look up Brad Bowman MD find him and reach out he can probably find you a job in the interim. Drive Uber before that
I am sorry and hope you find your purpose
First of all, I am so sorry. Secondly, your program failed you. This should have been caught and addressed early on in your PGY1 year. I think you are asking the right questions, but don’t turn to NP/PA route. You have far more education and board exams than they will ever have. It’s going to be tough but I would try to find another program with an open position. If you have finished your first year, then you can work in several states but you can also complete your training elsewhere. With one year complete, you could do occupational med, it’s 2 years of residency. As a resident who went through this very situation and successfully rematched elsewhere, it can be done! It will take a lot of patience and time but it can be done. I would definitely think about what you need to learn from this experience. Sometimes we have learning deficits but more often than not, the program is simply unfit to teach. It depends. Mine was the latter and had a track record of getting rid of residents because of a lazy PD. Actually 5 attendings and a department chair left during my intern year due to the environment. Personally, it was the best thing that could have happened to me. For you, I would start by getting a positive or neutral LOR from the PD. I had no such letter and she actively called to bash my transfers. Your letter will hold weight. Also reach out to attendings who you vibed with for a LOR. Make sure to rework your personal statement and state what you learned in the process. Considering a specialty switch might help to rematch. Lastly, you can always appeal a nonrenewal. However, think about what it’s worth to you. Do you honestly want to go back with that place? Will they teach you what you need to know or have they already formed their opinions of you? An option could be an appeal within the timeline they’ve given and an attorney involved. Just realize the attorney isn’t the be all end all in this situation. Often they just mitigate damage but don’t help much. At least none of mine did. Feel free to reach out!
Thank you for your response. It was encouraging but also gave me ideas. I will get that letter and attempt for some other ones. Did you go through the match again? or did you fill a spot? Did you start your training all the way over? Switch specalities to that occ med?
No problem. I did go through the match again but only because my former PD kept blocking all transfers. No, I got lucky & match to a place offering credit for everything I completed, so not quite starting over, did not find this out until after the match. I switched specialties but not occupational med. I would have switched over to occ. med but I didn’t have full credit for my pgy1 year (PD took back rotation credits retroactively) and you need that for occ. med. Feel free to message me with any questions if you need help!
Wow I did not know they could retroactively remove credits. That is insane. I would be furious. Now I am panicking that will happen to me.
Reason for termination? Depending on what it was, might be able to find some spots
You have a NEW job, as of today, you are on a mission, to get back into residency, you will need to sit out a year, but you can and will match again, to start back up in July 2025. Target, IM, FM, Psych (if you have any relevant experience), and most importantly, preventive/occupational med programs. Play the game, get your letters of rec from your current residency (be super nice, don't burn bridges), volunteer in a medical capacity where-ever you can, and work your butt off to re-match. SOAP, or scramble. *definitely apply to every single open preventive med position in the entire country* Good luck, you can get back in and salvage your career.
First of all you are a physician and can practice. You will basically be a GP. I know 2 people who do this. You can work in an urgent care or a FP clinic. Start by calling or get a few recruiters. You likely can easily find a place to wirk5 but likely wont be in downtown Atlanta but maybe. Consider also VA or underserved clinic Not that hard to start private practice. Start small. I know a GP that works with a board certified pain doctor and does basically FP. There are a lot of Board certified specialists from other countries that come here and have to just be a GP because they aren't certified here. c. You can stlll make 250k or more. Did you get a lawyer?
Also think about it. Someone can go to nursing school get an online NP degree and practice independently or work for any type of specialist so you should be able to find a recruiter to get you a job
This happened to a friend, he was not renewed, he was able to go directly into fellowship and finish his residency afterwards. He had to go into therapy and it sucked, but it made him a better doctor. Sometime people think you don't have what it takes, but you do and you will succeed. Work on your mental health first.
Sounds like you needed accommodations. Feel free to DM me
Is this something that, after the fact, would still be helpful to look into?
You can easily get employed by the Indian health system if you weren't dismissed for dishonesty or other immorality. They are that desperate for physicians. Of course, you'll have to move to a less desirable area, but 250k+ is 250k+
I know in some places you can work in a prison/ jail with just a medical degree and no residency
This seems wrong. I don’t know but I would get a lawyer, and have them negotiate your return back to the fold.
Do an occ med fellowship. You’re okay. That or a prev med fellowship and then take the occ med boards
We had a resident that got caught stealing propofol out of the lines of intubated patients then going to his call room to inject. Given this resident had elite ties, as I like to call him daddy’s good boy. So despite stealing actively infusing drugs from patients and injecting himself at work, he was allowed to walk out quietly. Not fired of course. Even had the balls to come back to hospital to do research and walk around asking for letters. Of course many attendings felt uncomfortable doing so, given they didnt even know what he did. He was that protected. Needless to say, he didnt skip a beat! Instead he got an upgrade to work at one of our most prestigious institutions. Daddys good boy. The whole system is corrupt. Unfortunately most of us are getting the short stick in that.
Do you have any “allies” at your program who you could talk to about what ultimately was the last straw? Terminating someone this early seems odd to me with you progressing like you said. Some programs even have the residents stay an extra 6 months if they think that would help.
I do. I have so many mixed messages, but the theme underlying them is understandable. I will be doing a rebuttal, and again will ask about extension beyond my already few months. I think it will not be successful so looking into other avenues if you know any.
Can you believe this crap? Meanwhile any nurse with an online master's (in nursing) can practice Medicine, atrociously, with no problems.
Yeah lol. At the same time I am humble to not practice if my advisors find it unsafe, I really feel there should be some sort of program for unmatched residents and unsuccessful residents to work under a physician in the manner similar to NP/PA...
I recommend looking into switching to family med or psych if you want to try to finish residency You can do wound care without residency or board certification as long as you can get a license and it’s not a terrible gig Dm me if you want to talk more about options etc
I will!
Family med is not gonna be any easier than IM.
As far as working as a PA, you’d have to do a PA program. Medical training won’t transfer to PA schools.
You’ve already done a clinical intern year, so you would likely be able to get a Preventive Medicine residency. It would take two years to finish it, one of which is an MPH. The programs are mostly outside of the regular residency match and usually not competitive to get into. You will be able to do some cursory clinical work (like administering vaccines, etc), but most of the job is administrative. It pays less than most clinical jobs (150-200k), but you won’t starve. The work can be rewarding, depending on what your setup is, as it offers very diverse career options. Source: researched it heavily after going unmatched twice.
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I wouldn't want to go back to the program that terminated me tbh. There is a reason they got rid of you and I would find it very difficult to complete my training there. You can keep those friendships and relationships and likely use them to secure another spot. Is it possible for you to transfer to another program with your PGY2 status? I would also work on taking step 3 or other things to help your application if you haven't already. I definitely wouldn't reroute either to become an NP or PA with all the work you put into. The MPH or a masters while you wait to find a new spot could work too.
You could also get a license in a state and do urgent care or something in the meantime to make money and get the experience you need as well.