Need Surgery PD help

[AlQassim]

Dear all,
I’ve tried posting this to the confidential consult thread to no avail.
I quite desperately need advice and information from a gen surg PD about how different years of PGY “credit” is achieved / counted.

In short, I completed a PGY3 year and have an LOR from the PD recommending me for PGY4, as well as a summative evaluation showing no operative, clinical or professional deficiency signed by him at the end of the year, and a >50%ile ABSITE that year. I left the program on less than great terms after a lot of railroading (probably my biggest mistake was speaking up about issues that faced us in the program and my second biggest mistake was trying to stay in the program and finish with them rather than resigning, I realize that now and could not regret this anymore, I’m losing my career to these two mistakes. I hired an attorney but never pursued anything legally because they specifically told me they’d ruin my career if I did. Of course, when I took no action, they ruined it anyway).

I fought hard for more than a year, made contacts, worked, got more glowing LORs, re-took the ABSITE at the PGY3 level and scored well again and got an offer for a PGY4 spot. I then learned that despite giving me the paperwork showing I finished PGY3, the PD removed my name from the ABS resident roster and it shows that I did not complete PGY3.

I’m in a very desperate position. Is there any surgery PD out there who can shed some light on this? Please help.

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[Apollyon]

Lawyer is what you need. If you have documentation of completing PGY-3, but the PD says you didn't, that's a black letter place to grab on to and go. I am not a surgeon, and am not a PD, so, I don't know the minutiae.

I see your thread on the Confidential Consult forum; I'm sorry you did not get a response.

 

[AlQassim]

Lawyer is what you need. If you have documentation of completing PGY-3, but the PD says you didn't, that's a black letter place to grab on to and go. I am not a surgeon, and am not a PD, so, I don't know the minutiae.

I see your thread on the Confidential Consult forum; I'm sorry you did not get a response.

Thank you Apollyon.
If you had asked me a few years ago I would say terrible treatment to this extent is exceedingly rare and I honestly would have assumed the resident was probably the issue. And I held that belief for most of my training until I experienced first-hand the type of vicious and sadistic methods that the program used. In a million years I would never have stood up for myself or others if I knew the extent to which “paperwork” abs “evidence” can be fabricated. (nor will ever advise anyone stand up to their program). That being said I have a lot of documentation too because I saw it coming and was warned by my chiefs and recent graduates.

My fears are two-fold: first will they black-ball and retaliate worse, and second will any PD consider an applicant who’s in that situation, since any legal issue may take years.

 

[Apollyon]

Although your fears are well-founded, in my opinion, I, unfortunately, cannot give you more. I do wish you well. I also hope that our surgical colleagues do chime in soon.

The only thing of which I can think is not a direct parallel. Over ten years ago, there was an EM resident at Johns Hopkins who said something negative on an ACGME survey. The ACGME cleanly outlined that it was him, and, although I do not recall specifics, he left JHU (that is, I don't know if quit or fired). But, Ohio State stepped up, and gave him a spot, and he finished residency. There were a lot of moving parts in between, but, I don't know them.

 

[NotAProgDirector]

I'm not in surgery, but I expect the only person that can give you PGY-3 credit is the PD of your old program. I see several paths forward:

The best choice is to contact your potential new PD, and ask them to contact your old PD to help sort it out. Hopefully a different PD can talk some sense into your old PD. Your new program needs a PGY-4, so this issue is now hurting them -- hopefully that will help leverage your old PD.

You could probably force your old PD to fix things via a lawsuit. Even if so, this is a long, slow, expensive, and painful way to proceed. Even if successful, it's unclear if you'd be able to get a PGY-4 at that point due to the delay. You could theoretically sue them for credit and all lost income because of this -- again, this is a last resort.

You could ask your new PD if they would be willing to bring you on as a PGY-3. That would suck, but less than not being a surgeon at all.

 

[AlQassim]

I'm not in surgery, but I expect the only person that can give you PGY-3 credit is the PD of your old program. I see several paths forward:

The best choice is to contact your potential new PD, and ask them to contact your old PD to help sort it out. Hopefully a different PD can talk some sense into your old PD. Your new program needs a PGY-4, so this issue is now hurting them -- hopefully that will help leverage your old PD.

You could probably force your old PD to fix things via a lawsuit. Even if so, this is a long, slow, expensive, and painful way to proceed. Even if successful, it's unclear if you'd be able to get a PGY-4 at that point due to the delay. You could theoretically sue them for credit and all lost income because of this -- again, this is a last resort.

You could ask your new PD if they would be willing to bring you on as a PGY-3. That would suck, but less than not being a surgeon at all.

Hi NotAProgDirector,
Thank you so much for your response!
New PD called him and prominent academic surgeon called him. Initially he said I could reach out to the legal department and “see if there’s anything they’d want signed,” and if they give the OK, he’d email ABS. I called and emailed and got a generic response from legal saying they have nothing to do with this. When the attending reached back out to him he said “it would make the program look bad,” so he was advised not to do it.

Sadly their PGY3 complement is filled.

 

[deleted50541]

Awful situation to be in. I'm glad to hear you've got documentation to back your claims because that's your best ammunition for recourse.

Sounds like you need a lawyer to force the issue. The other PDs are clearly looking out for their own interests and you need an advocate on your side. Other than getting into a PGY-3 spot elsewhere, I don't see what choice you have if the old PD is playing hardball and you want to stay in surgery/be board eligible.

 

[AlQassim]

Awful situation to be in. I'm glad to hear you've got documentation to back your claims because that's your best ammunition for recourse.

Sounds like you need a lawyer to force the issue. The other PDs are clearly looking out for their own interests and you need an advocate on your side. Other than getting into a PGY-3 spot elsewhere, I don't see what choice you have if the old PD is playing hardball and you want to stay in surgery/be board eligible.

Thank you so much for your response.
PGY3 seems to be more difficult than PGY4. I’ve interviewed at at least five programs for PGY4 but have gotten no PGY3 interviews (granted I only recently started applying to them because the old PD had initially said he’d support me for PGY4 and I only recently learned of the ABS resident roster situation). I’m losing hope of being able to continue in my career.

I guess if any surgery PD chimes in, (publicly or privately) my question surrounds the ABS resident roster. Theoretically, BC is a voluntary process and there are fellowships and options to continue training and be BC in other specialties after GS training - what prevents a PD from taking on a resident who has completed all rotations and has the summative evaluation to show for it and has done well on the inservice and has good LORs? Eg allow them to finish training while sorting out the resident roster situation separately?

When I spoke to ABS, from whatever little info they could provide, they made it clear - they do not get involved in which residents are hired and based on what qualifications and that that “is the sole purview of the program and the director.”
So what’s the PD side? What would prevent you from taking on a resident with this type of issue given all the documentation he/she has?

 

[Smurfette]

Thank you so much for your response.
PGY3 seems to be more difficult than PGY4. I’ve interviewed at at least five programs for PGY4 but have gotten no PGY3 interviews (granted I only recently started applying to them because the old PD had initially said he’d support me for PGY4 and I only recently learned of the ABS resident roster situation). I’m losing hope of being able to continue in my career.

I guess if any surgery PD chimes in, (publicly or privately) my question surrounds the ABS resident roster. Theoretically, BC is a voluntary process and there are fellowships and options to continue training and be BC in other specialties after GS training - what prevents a PD from taking on a resident who has completed all rotations and has the summative evaluation to show for it and has done well on the inservice and has good LORs? Eg allow them to finish training while sorting out the resident roster situation separately?

When I spoke to ABS, from whatever little info they could provide, they made it clear - they do not get involved in which residents are hired and based on what qualifications and that that “is the sole purview of the program and the director.”
So what’s the PD side? What would prevent you from taking on a resident with this type of issue given all the documentation he/she has?

How long has it been since you have been a resident? It sounds like you are currently not in a training program and haven't been for a at least a year, correct?

The ABS needs documentation you completed all requirements. If you aren't getting any credit for a year of your 1st program, the 2nd program can't magically give you credit for time before you were their own resident. If you get partial credit, the 2nd PD can pick how many months of that partial year of credit will count toward what standing you have in that program to start with (i.e. whether you have to repeat some or all of the PGY3 rotations). If you are asking if places will take you knowing you can't be board eligible, the answer is probably yes. But buyer beware on that, as those are going to be sketchier programs that may be looking for a body to do work/dump on and not for someone to teach. Plus, you are shooting yourself in the foot if you aren't going to be board eligible at the end of all this. Most places in the real world are not going to hire a new surgeon who is not board eligible. It's often a requirement for hospital privileges as well.

Your best bet if you are really not going to get credit for completing PGY 3 is to find a PGY 3 or even a PGY 2 slot. It comes down to how badly you want to be a surgeon. While that sucks, you 1. want to be competent, and if you are behind your peers at the program you transferred to (like you came in as a PGY4 but are behind their PGY4s), you may be let go and then your chance of finding a 3rd program to take you in is virtually zero, 2. if you change fields, you are looking at 3-4 years for residency plus time for fellowships anyhow, and 3. the longer you are not working and doing surgery, the harder it will be to find a new program each year to take you....plus it will still end up extending the time it takes to be done.

 

[AlQassim]

Awful situation to be in. I'm glad to hear you've got documentation to back your claims because that's your best ammunition for recourse.

Sounds like you need a lawyer to force the issue. The other PDs are clearly looking out for their own interests and you need an advocate on your side. Other than getting into a PGY-3 spot elsewhere, I don't see what choice you have if the old PD is playing hardball and you want to stay in surgery/be board eligible.

Thank you so much for your response.
PGY3 seems to be more difficult than PGY4. I’ve interviewed at at least five programs for PGY4 but have gotten no PGY3 interviews (granted I only recently started applying to them because the old PD had initially said he’d support me for PGY4 and I only recently learned of the ABS resident roster situation). I’m losing hope of being able to continue in my career.

I guess if any surgery PD chimes in, (publicly or privately) my question surrounds the ABS resident roster. Theoretically, BC is a voluntary process and there are fellowships and options to continue training and be BC in other specialties after GS training - what prevents a PD from taking on a resident who has completed all rotations and has the summative evaluation to show for it and has done well on the inservice and has good LORs? Eg allow them to finish training while sorting out the resident roster situation separately?

When I spoke to ABS, from whatever little info they could provide, they made it clear - they do not get involved in which residents are hired and based on what qualifications and that that “is the sole purview of the program and the director.”
So what’s the PD side? What would prevent you from taking on a resident with this type of issue given all the documentation he/she has?

How long has it been since you have been a resident? It sounds like you are currently not in a training program and haven't been for a at least a year, correct?

The ABS needs documentation you completed all requirements. If you aren't getting any credit for a year of your 1st program, the 2nd program can't magically give you credit for time before you were their own resident. If you get partial credit, the 2nd PD can pick how many months of that partial year of credit will count toward what standing you have in that program to start with (i.e. whether you have to repeat some or all of the PGY3 rotations). If you are asking if places will take you knowing you can't be board eligible, the answer is probably yes. But buyer beware on that, as those are going to be sketchier programs that may be looking for a body to do work/dump on and not for someone to teach. Plus, you are shooting yourself in the foot if you aren't going to be board eligible at the end of all this. Most places in the real world are not going to hire a new surgeon who is not board eligible. It's often a requirement for hospital privileges as well.

Your best bet if you are really not going to get credit for completing PGY 3 is to find a PGY 3 or even a PGY 2 slot. It comes down to how badly you want to be a surgeon. While that sucks, you 1. want to be competent, and if you are behind your peers at the program you transferred to (like you came in as a PGY4 but are behind their PGY4s), you may be let go and then your chance of finding a 3rd program to take you in is virtually zero, 2. if you change fields, you are looking at 3-4 years for residency plus time for fellowships anyhow, and 3. the longer you are not working and doing surgery, the harder it will be to find a new program each year to take you....plus it will still end up extending the time it takes to be done.

Hi Smurfette,
Thank you for your response! I’m in a fellowship, I operate daily and function as a senior resident, running the surgical service. I am the most senior “surgeon” on any given night I’m on call at the hospital. The attendings I work with as well as the PD of the new program are all confident in my abilities. I don’t say that to defend, I’ve reached points so low emotionally in the last year that I’d at times wish they weren’t so confident, or I didn’t have the inservice score or something anything tangible that I could say to myself, ok clearly I’m not cut out for this and tap out. I don’t doubt that I’ll learn more and gain more skills by repeating more clinical years, and I’m willing to if I’m ever given the chance, but from the people who were and are evaluating me (including the old PD himself who wrote me a letter during my first PGY3, recommending me for PGY4 verbatim), being behind peers doesn’t seem to be an issue.

What I’m asking specifically, if you could spare the few extra minutes, is what would prevent a PD from taking on a resident in this situation? I think from your answer, if some (albeit seemingly sketchy) programs can do it, then technically all can? So why wouldn’t they, in your opinion?

Since I’m not getting interviews for any spots below PGY4, to me it seems like my only hope is to at least finish the five years of training and try to sort out the BE issue afterwards. There are a few avenues to contribute to surgery and give back to underserved populations, (even if Im not ever able to get the ABS thing sorted from the old program and become BE) not the least of which is practicing rurally or doing wound care.

 

[Smurfette]

Hi Smurfette,
Thank you for your response! I’m in a fellowship, I operate daily and function as a senior resident, running the surgical service. I am the most senior “surgeon” on any given night I’m on call at the hospital. The attendings I work with as well as the PD of the new program are all confident in my abilities. I don’t say that to defend, I’ve reached points so low emotionally in the last year that I’d at times wish they weren’t so confident, or I didn’t have the inservice score or something anything tangible that I could say to myself, ok clearly I’m not cut out for this and tap out. I don’t doubt that I’ll learn more and gain more skills by repeating more clinical years, and I’m willing to if I’m ever given the chance, but from the people who were and are evaluating me (including the old PD himself who wrote me a letter during my first PGY3, recommending me for PGY4 verbatim), being behind peers doesn’t seem to be an issue.

What I’m asking specifically, if you could spare the few extra minutes, is what would prevent a PD from taking on a resident in this situation? I think from your answer, if some (albeit seemingly sketchy) programs can do it, then technically all can? So why wouldn’t they, in your opinion?

Since I’m not getting interviews for any spots below PGY4, to me it seems like my only hope is to at least finish the five years of training and try to sort out the BE issue afterwards. There are a few avenues to contribute to surgery and give back to underserved populations, (even if Im not ever able to get the ABS thing sorted from the old program and become BE) not the least of which is practicing rurally or doing wound care.

Here are the RRC requirements for surgery programs. A program is required to verify your prior residency status before they take you, so it doesn't look like "accept now, sort it out later" is an option. I'm a little surprised you find more PGY4 spots open, as usually there are fewer slots available for later years. Although it could be that there were more PGY3 spots open earlier and they got filled by some of the current prelim PGY2s out there.

 

[AlQassim]

Here are the RRC requirements for surgery programs. A program is required to verify your prior residency status before they take you, so it doesn't look like "accept now, sort it out later" is an option. I'm a little surprised you find more PGY4 spots open, as usually there are fewer slots available for later years. Although it could be that there were more PGY3 spots open earlier and they got filled by some of the current prelim PGY2s out there.

Thank you so much for the link.
I have read through these pages of RCC requirements many times (sadly for me).

What I’m trying to explain is that I have the documents that this RCC PDF asks for, and those documents say I finished PGY3 without deficiency. The ABS resident roster is not mentioned in these RCC requirements, and as per ABS, the ABS resident roster does not get used to determine resident status in terms of eligibility to transfer to a program. It is only used for board eligibility once I apply to sit for the QE.

If you look under item III.C Resident Transfers on page 20:

“III.C. Resident Transfers
The program must obtain verification of previous educational experiences and a summative competency-based performance evaluation prior to acceptance of a transferring resident, and Milestones evaluations upon matriculation. (Core)”

I have this summative competency-based performance evaluation. He filled this for me and signed it at the end of PGY3 year. He then told my current fellowship director that he’d support me for PGY4. After taking the fellowship, re-taking the ABSITE, applying and being offered a position, it became apparent that he wrote to ABS and took my name off the resident roster.

The “figure it out later” avenue is only for board eligibility. I’m only considering the figuring it out later avenue because I’ve gotten no other interviews. Still, technically speaking, it is an avenue. I just wanted someone to help me understand why most PDs seem to be unwilling to allow a resident to “figure it out later.” I’m not a PD so I don’t know what pressures they’re under. That’s why I’m asking. Also, if I underhand their perspective I can work on the issue or (probably) I’ll find it persuasive. Either way the goal is to try to understand it.

I’m still applying, maybe new PGY3s will open up. Prelims deserve spots, so if that’s the case, I’m happy they’re getting em. Hard work pays off!

 

[Lem0nz]

I do not believe that there are any surgical residency program directors on SDN or on Reddit. There are maybe ~5 program directors who actively post to one or the other but I'm pretty sure none of them are surgical and will not be able to answer your specific questions. I at least have not seen one in the last year.

For what it is worth, you are correct that there are some avenues to practice minor medicine like wound care. One of our PGY4s got let go mid-way through PGY4 year and that is what she does now. I don't know the specifics on how to get from A to C on that though, and I (and I suspect the other more senior posters and surgical attendings) are unlikely to know the intricacies of board eligibility in such a nuanced situation as yours other than to simply say it is exceedingly unlikely unless you can get accepted to and complete a surgical residency like normal. Its possible that's a technically incorrect statement but at this point you probably know more about than us.

 

[ACSurgeon]

-Regarding why a program won’t take you if there’s no clear path to board eligibility: it looks like a program deficiency to have “graduates” not become board certified. Regardless of the reason.

- if the program really wanted you as a PGY-4 sometimes they can add a PGY-3 spot to have enough residents for the next two years. The problem is having too many chiefs or seniors in 2 years. If the program has people going in and out of the lab, sometimes that can work

- regarding non-traditional paths to board eligibility: I met a surgeon at ATLS instructor course. He was a foreign grad with surgery training in his country. He did 2-3 years of non-ACGME fellowships (I think transplant and MIS). He found a job as a non-board eligible attending at rural hospital that had a small Surgery residency program. After a few years, he joined that residency as a senior resident to finish 2-3 years of training to be eligible to sit for boards. Rare situation.

 

[AlQassim]

I do not believe that there are any surgical residency program directors on SDN or on Reddit. There are maybe ~5 program directors who actively post to one or the other but I'm pretty sure none of them are surgical and will not be able to answer your specific questions. I at least have not seen one in the last year.

For what it is worth, you are correct that there are some avenues to practice minor medicine like wound care. One of our PGY4s got let go mid-way through PGY4 year and that is what she does now. I don't know the specifics on how to get from A to C on that though, and I (and I suspect the other more senior posters and surgical attendings) are unlikely to know the intricacies of board eligibility in such a nuanced situation as yours other than to simply say it is exceedingly unlikely unless you can get accepted to and complete a surgical residency like normal. Its possible that's a technically incorrect statement but at this point you probably know more about than us.

Hi Lem0nz,
Thank you for your response and input!

 

[AlQassim]

-Regarding why a program won’t take you if there’s no clear path to board eligibility: it looks like a program deficiency to have “graduates” not become board certified. Regardless of the reason.

- if the program really wanted you as a PGY-4 sometimes they can add a PGY-3 spot to have enough residents for the next two years. The problem is having too many chiefs or seniors in 2 years. If the program has people going in and out of the lab, sometimes that can work

- regarding non-traditional paths to board eligibility: I met a surgeon at ATLS instructor course. He was a foreign grad with surgery training in his country. He did 2-3 years of non-ACGME fellowships (I think transplant and MIS). He found a job as a non-board eligible attending at rural hospital that had a small Surgery residency program. After a few years, he joined that residency as a senior resident to finish 2-3 years of training to be eligible to sit for boards. Rare situation.

Hi ACSurgeon,
Thank you for your response and input! I see what you mean about having a graduate not be board eligible, I guess I’m holding out hope that I can still be if I get them to write to ABS eventually. But at least in the mean be continuing training.
Thank you for sharing the rare anecdote as well 🙏🏼

 

[Dave1980]

Dear all,
I’ve tried posting this to the confidential consult thread to no avail.
I quite desperately need advice and information from a gen surg PD about how different years of PGY “credit” is achieved / counted.

In short, I completed a PGY3 year and have an LOR from the PD recommending me for PGY4, as well as a summative evaluation showing no operative, clinical or professional deficiency signed by him at the end of the year, and a >50%ile ABSITE that year. I left the program on less than great terms after a lot of railroading (probably my biggest mistake was speaking up about issues that faced us in the program and my second biggest mistake was trying to stay in the program and finish with them rather than resigning, I realize that now and could not regret this anymore, I’m losing my career to these two mistakes. I hired an attorney but never pursued anything legally because they specifically told me they’d ruin my career if I did. Of course, when I took no action, they ruined it anyway).

I fought hard for more than a year, made contacts, worked, got more glowing LORs, re-took the ABSITE at the PGY3 level and scored well again and got an offer for a PGY4 spot. I then learned that despite giving me the paperwork showing I finished PGY3, the PD removed my name from the ABS resident roster and it shows that I did not complete PGY3.

I’m in a very desperate position. Is there any surgery PD out there who can shed some light on this? Please help.

get a new position as a PGY-3 and redo the year. Easier than fighting against a system that holds all the leverage.

Genuine question: if you went to a new hospital system could you function at a PGY-4 level immediately? did your training suffer during the last 2 or 3 years because of the railroading? maybe redoing the year with the lower expectations of a PGY-3 vs PGY-4 isn't the worst thing in the world?