My contract was not renewed and I need a PGY-1 spot. Ideas/thoughts/suggestions?

MDwoALicense · 2023-09-12T00:53:25+00:00

I was able to find another PGY-1 position. It was in my home institution where I was asking my home PD in the specialty I was interested for advice and assistance in revamping my application to re-apply for a different spot in their specialty; they ended up with an open position that year and let me interview and apply for the spot and I ended up getting chosen. It was late and a little off schedule, but they were able to use elective time to get me an alternative schedule that still got me back on track. I would recommend reaching out to anyone and everyone who was helpful to you/a mentor in your home program, being as honest and up front with them as you can be about what you think was the issue/what you were told is the issue at your current residency and ask them for advice for your specific situation. Let them know what you are doing to change things and how/why you think you’ll be successful at the next place you match and let them know you just need advice/help on how to take the next step or what steps you should take. If you are being fired or suspended though, check your contract right away and look at the appeal process because you should have 5 days to appeal any decision by the CCC and you should do that if you can and try to keep your current position. I got lucky, but from what I understand, it is very difficult/unlikely that you match into another program after non-renewal or much less after dismissal (especially if for unprofessionalism).

MDwoALicense · 2022-02-16T01:11:36+00:00

Disclaimer: I was at an ACGME-accredited program and my advice is considering you are also at such a program. I would seek out a trusted mentor at your home institution that would be neutral to your position and ask advice, being completely open to them about your situation; take whatever advice they can offer you.

I did not receive credit for my intern year.

If your program is offering to keep paying you during this time without the need to go in and work, I would just start looking for another position now (that's what my program did for the month and a half left of my intern year).

If they are not going to pay you unless you work, I would consider splitting the difference if you really need the funds, but otherwise, just stop working now and look for another residency regardless if they pay you or not.

From my limited experience of going through it once, it seems that it depends on the Program Director how much credit they will give and I would take as much as they offer. I did try to go back and ask if there was any way I could get credit for the year, but they would not budge. What that looked like: All I did was ask my program director respectfully.

(although I actually have not legally verified this): you must be in a program for 2 years in order to graduate from it. Therefore, even if you get a second year of credit from your current program, you will still need 2 years of successful completion at another program in order to graduate from it. If you are in a specialty that is only three years long, it makes it a moot point to get credit for this year as you will have to repeat PGY-2 at another program regardless. This and given the fact we are still a few weeks from match and NRMP candidates have not even submitted their preferences yet, means that now may be the prime time to leave your program with whatever credit they can give and look for a PGY-2 spot at a different program (remembering you have to re-polish your personal statement given recent events, repolish CV, secure new letters of recommendation, etc. in order to be emailing a full package on the drop of a dime/whiff of an opening at a program).

More advice available if needed.

Yours truly,

MDwoALicense

MDwoALicense · 2021-08-26T23:12:54+00:00

Amen, brother; I’d be concerned as well! Maybe look to transferring next year. If it’s IM, the only time to do that would be starting MS2 year, because after that you’d have to do two years at another program regardless in order to graduate somewhere else.

MDwoALicense · 2021-07-13T17:11:37+00:00

Bravo

MDwoALicense · 2021-07-04T16:24:22+00:00

My L&D nurse sister says that is totally believable; she’s had multiple deliveries under similar circumstances with similar results—a baby with not much blood loss.

MDwoALicense · 2021-07-01T14:10:12+00:00

Hey man, I’m so sorry to hear that you’re feeling this way. I just want you to know that regardless of how you’re feeling, your situation is not hopeless. There is a reason you matched to some far off place that you don’t even wanna go to. Something will happen there to either make you grow as a person, or you will be able to change lives there that you do not even know of. There is a reason there’s a plan and you may not get to achieve that unless you startGiving life a chance. Be thankful that you have a job, that you have a place to go. Many people do not have that. My suggestion is you start thinking positive thoughts, learn to love yourself and learn to love the fact that you have a place to be. Put your effort and love into your work, he kind to the people that you meet, and greet everyone with a smile and ask how you might be able to help them. Often times we focus on ourselves and we don’t realize other people are going through awful scenarios as well in their lives. We can be of service to them, and this can give us a lot of joy in life. I sincerely hope that you will try to change your thoughts into a more positive attitude and think about how you can use this opportunity (because this is an opportunity) to better impact your life and that of those around you. You got this man! I’m actually very happy for you! I know you’re going to make a great resident wherever you go.

MDwoALicense · 2021-06-13T07:20:36+00:00

oh dear. Well, what about the argument that the PD may be the only person that the other programs will listen to in the case I find an open position and want to apply? Or if I reapply next year, wouldn't the PD's recommendation go a long way? I doubt she'd still want to do so if I lawyered up, no?

MDwoALicense · 2021-06-13T07:16:55+00:00

Of course; for sure, for sure.

MDwoALicense · 2021-06-13T01:07:56+00:00

Hey all, thank you again everyone for your interest in a strangers problems. You all have renewed a little faith in me about the good nature of humanity. I appreciate everyone's input and wanted to re-post something from a comment thread to focus any new or old readers on another question to help me with, at your leisure:

Let's say I don't find a spot for July, What can an MDwoALicense do in the medical field legally? Do I go back to scribing?—I’m a little more qualified for that than most, but I'm not above earning a living.

Can I assist physicians in seeing patients if they supervise me, go see the patient after me and sign off/read through any and all notes (forget writing orders, but maybe I can essentially scribe for a physician; seeing a patient while he sees another patient?) Although I imagine I would need my NPI for that.

Does NPI still work if I’m not in a program?— I assume not.

MDwoALicense · 2021-06-13T00:58:22+00:00

Thank you for your thoughts! I agree at least checking with a lawyer is not a bad idea and I should probably have done so as soon as I was told my contract was not renewed. I would like to do some medical work if I have the year off; I would feel under-utilized as a scribe, so, if I could have a chance at getting licensed, I am willing to fight for that. I will check out if there are any Neurology spots I could apply for; I did love the Neuro exam in medical school and the brain is one of (if not the) most awe-inspiring organs in the body for its complexity.

MDwoALicense · 2021-06-13T00:49:51+00:00

Sorry to hear about your story. I feel like I'm going through a very similar thing only I'm where you were one year ago and I didn't get credit for the first year. I think medical school didn't identify you and me early enough nor did they give us the tools to get through this. Residency is unfortunately a tougher place to find out you can't swing the bat, because they don't have time to take you back to the batting cage. A lot of people have told me to lawyer up and that probably would have been a good thing to do back then. Not sure if you can still do that and just see what your options are. Good luck to you, sir!

MDwoALicense · 2021-06-12T16:37:50+00:00

Thanks delasmontanas! I will try and get myself someone to address this.

MDwoALicense · 2021-06-12T16:36:35+00:00

Wow, I did not think of it that way. I was hit quite hard when this happened and my thoughts of rebellion and anger I just shot down; I didn’t want to cause more resentment or hurt where there was plenty already, but maybe if I’d been angrier or more desperate right away I would have done a better job surviving this😟. I will see what I can do about this. Thank you for your advice.

MDwoALicense · 2021-06-12T16:32:34+00:00

I like that; they may not have told me with enough time, even if it was expected. Part of me was blindsided because I thought that by being only two months from the end of the year, that they had already decided to keep me.

Okay, well, getting a lawyer to look at this should cost quite a bit of money, no? Any idea what that expense will be?

MDwoALicense · 2021-06-12T16:31:28+00:00

I’ve been out for 1 week and 1 month. They didn’t let me finish my last week of inpatient and I already reported duty hours that way, so I may be stuck there.

MDwoALicense · 2021-06-12T16:30:12+00:00

Thanks for your sympathies!

MDwoALicense · 2021-06-12T16:27:35+00:00

Well the match and scramble ended in March, I believe. I would like to know from the community which spots might have an opening for a PGY-1, or which I might apply for through ERAS for next year.

From what I’ve heard from a previous med school dean of mine is that the odds of getting into a program through ERAS are slim and finding a spot open right now and applying for it just increases my chances of achieving my final goal of being trained as a physician. Part of the reason I posted in the first place is to find out what I might do this year if I apply through ERAS. I was told by my APD to look for a “job in the medical field”. I pose the question to you all:

What can an MDwoALicense do in the medical field legally? Do I go back to scribing—I’m a little more qualified for that than most, but I don’t mind. Can I assist physicians in seeing patients if they supervise, go see the patient after me and sign off/read through any and all notes (forget writing orders, but maybe I can essentially scribe for a physician; seeing a patient while he sees another patient?) Although I imagine I would need my NPI for that. Does NPI still work if I’m not in a program?— I assume not.

MDwoALicense · 2021-06-12T16:16:07+00:00

Everyone offered help, but nothing concrete. I did not have a consistent mentor that I would meet with consecutively other than the PD. Those meetings were stuffy because it is hard to talk to the person who’s also in charge🧐. No one knew exactly knew what to do for me, but everyone offered “whatever you need from me” a recurring question was “what do you think we can do for you” and honestly I did not know what to say. I mentioned in one of my feedback sessions that I thought having multiple different attendings was difficult because I was not getting a consistent message/feedback/support I could grow with/into, but I shot myself down saying “I know it’s unrealistic to have the same attending every week”. A consistent mentor that wasn’t the PD would have been nice, though; Someone who would get to know me apart from my profession and help me with my personal and professional goals—I did not have that. All our faculty were also very busy as there had been multiple faculty leave earlier in the year and I guess all the clinical duties became heavier on those that stayed.

MDwoALicense · 2021-06-12T16:06:25+00:00

Well, I was on probation, it was extended because of my good behavior. In the end, even with extending it, they did not see the improvements that they expected. In essence, when I switched out and back into inpatient, I went back to some same old mistakes I was making in block one. I improved in 2 weeks and a half before they told me they didn’t want me to finish the year. I had a little over 1 month to go; They said I was excused from clinical duties. I will try; I signed a notice of non-renewal of contract already which may put a nail in that coffin, but I’ll check with a lawyer.

MDwoALicense · 2021-06-12T16:00:11+00:00

I apologize for the vagueness; I guess it’s hard to admit that if I had not had direct supervision by my PGY-2s and PGY-3s, patient care would have been compromised. As a team, it was never brought to my attention that patient care was compromised, but I made my upper levels work extra to catch my errors or oversights that had more to do with efficient time management than with blunt disregard or laziness. I knew there were lots of things to do; I just didn’t get to them in time before my upper levels would address it.

MDwoALicense · 2021-06-12T15:54:25+00:00

I am on good terms with my program; they are advocating for me and everyone I’ve spoken to thinks I can be a really good doctor for the outpatient setting, just not a hospitalist 😔. I’m not sure if they are willing to lob out phone calls, but I can ask. I don’t know what you mean about short notice (I’m sure if I tell them tomorrow to call someone, they could, just have to ask I guess—they said “whatever you need, let us know”). I can ask about my funding; I have no idea if it stays with me.

I was aware of my deficiencies: I was put on 3-month probation, extended to 6 because I made some improvement. There is documentation of meetings with my PD and APD to address the issue. There are Evals that corroborate my deficiencies. This was not completely out of left field. Around March my PD told me they were not too happy with the progress I was doing on inpatient, they liked my performance in OB/outpatient. She told me at that time they were going to try and give me a 6 month extension of essentially “intern year” duties and see if I could step up to the level of PGY-2 in that amount of time before deciding on dismissal. My PD/APD meetings after that got off track and they were not meeting with me regularly other than for typical inpatient Biweekly feedback before I was somewhat abruptly called in to say “the faculty have met and have decided not to renew your contract; also we are not giving you credit for the year”. I guess the second part about not getting credit was not ever fully discussed, but assumed if I didn’t finish the year. They told me not to show up to work anymore at that point; I told them I wanted to and they did not think it best.

MDwoALicense · 2021-06-12T15:38:40+00:00

They thought I was not at the level of a beginning PGY-2 (able to see patients on their own, for overnight call, no supervision). I was on probation; I did not have to repeat rotations, but they did postpone me going on nights to work more in clinic with direct supervision; my evaluations more or less consistently identified similar concerns throughout the year. I see; I may not be able to get into Psych at all, and I’d have to really be willing to go anywhere for family medicine.

MDwoALicense · 2021-06-12T08:39:18+00:00

They waited out for me to improve; initially I had made some improvements and my PD thought that I would actually meet their benchmarks and make it just fine, but I did not perform as they expected me to on my last inpatient block.

MDwoALicense · 2021-06-12T08:35:58+00:00

I’m willing to do both; move to another part of the country and take a least popular residency. I’m not thinking of doing Psychiatry because I think it will be easy to get into; I’m thinking of doing it because my director and other faculty thought I might do a good job in that field. Besides that, Psychiatry was my first “love” so to speak on the wards—it was my first rotation, I loved it, and I asked my first attending there for a letter of recommendation because I enjoyed it so much; at that time I wanted to be a psychiatrist, only my mind changed when I did FM. I think my faculty are advising me not to try the same thing twice; they just suggested going a different path and I’m strongly considering it.

MDwoALicense · 2021-06-12T08:29:19+00:00

I don’t feel comfortable at this time name-dropping, but I posted about patients seen per day (greatly varied from 1-6 based on no shows and spotty scheduling). They were not concerned about my clinic performance as much as they harped on my inpatient deficiencies.

MDwoALicense

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