February 28 2023 (Update)
Roughly one year and a few weeks ago, something very exciting happened. The U.S. Army announced that they would be opening a new Orthopedic Surgery Residency program at Fort Bragg, North Carolina. I realized what an opportunity this could be. There would be two positions each year, but the plan was to start with 2 interns each year until the program reached full strength (10 residents).
I contacted the head of US Army Graduate Medical Education, as well as the head of U.S. Army Orthopedic Surgery and the Colonel who was identified as the program director for the new program. I asked them if I could become the first R2 at the new program, starting at the same time as the new interns. All three men agreed that this was a good idea, but that I would have to apply through that same old channel in September for it to become official.
This was pretty amazing, and once again, I summoned all of my motivation to prepare for a rotation where I could prove my abilities to a new group of staff members.
I even started a YouTube channel, which I promise I will continue one day in the future... I'll post it at the bottom.
Welp.. you can probably guess that something didn't go quite right.
As I approached August, I started making preparations to rotate with the Fort Bragg Orthopedic Surgery Department things started to come apart. First, the new program director called me to tell me that the civilian program with whom they were joined, stated that they did not want anything other than interns to start the program. No PGY-2s,3s, whatever. Big problem.
Weeks earlier, I had discovered something that had been buried in the GME policies for years, possibly decades. I even went back through years of emails to see that it has been the policy since I've been searching for a new residency spot. It turns out that if you are applying for an army residency as a graduate of a previous residency (like me) and there are more applicants than positions, you cannot get accepted above a medical student coming out of med school.
So in other words.. there are 19 orthopedic surgery spots and roughly 30 applicants. As a person who has graduated from Occupational Medicine residency, I cannot bump one of the army medical students from any of those 19 positions. The best that I can do is be designated as an alternate, number 20. Which is what happened in 2021. In many ways this makes sense.. the army has spent hundreds of thousands educating them, they don't want them moved out of an opportunity for an older doctor who already has a residency completed.
The only issue with this is that I was unjustly removed from my residency a decade ago, so there should be some kind of consideration for this fact. But in a big, bloated bureaucracy such as the DOD, there will be no such considerations. The rules also state that you can actually bump a graduating medical student, in other words, get ranked somewhere in the top 19 despite the number of applicants, if you have been out of residency for 5 years.
in 2021, I had only been out of residency for 1 year. But I would have been out for 2 by the time the school year started.
So, once again, I came within striking distance.. only to have ortho slip away.
As soon as the rotations were shut down, I momentarily strategized on how I could take USMLE step 2 again, get a competitive score and apply to civilian programs. Sounded good, except for the fact that I am running out of time. I'm 45 years old. And I have private school, vacations, travel soccer teams, and all sorts of other things to pay for.
There is life to live, and I have the means to make a decent living as an occupational medicine doctor. And so, with that realization, I officially shut it all down. It is over. I will not resume the chase as I believe that I am out of time to achieve a meaningful career in that field.
I will simply make do with the living that I have and make the most of the opportunities that are available to me with the board certification in occupational medicine.
Sad.. yes, but not absolutely tragic.
As I said before, I hope to return to the videos one day, but I have so many side projects going at the moment, that I do not feel as if I can put in the time needed to make a quality product. But I feel strongly that it is something worth doing.
The U.S. Army informed me that they want to re-assign me to Tacoma, Washington 5 months from now. I busted out my UNO reverse card and submitted my retirement paperwork the following week. My retirement date, if accepted, will be April 30, 2024. I interviewed for a civilian job closer than my current Army job and got a job offer the next week.
Part 3 What We (In the Military) Should Do About this problem
(Update) 23 August 2022
About two months ago, I gave a presentation to a group of military surgeons on the topic of Black Physicians in Residency Training. I had been in contact with several physicians in the US Army who have been pushing to improve the treatment of Black Docs, and she believed that my experience and insights would be beneficial.
I recorded the presentation and broke it into three parts for Youtube.
My Residency Experience
Written June 2012
I attended the U.S. Military Academy at West Point after graduation from high school and served 4 years on active duty as an Infantry Officer before entering medical school in my home state. After med school graduation, it was back to the military for a 5 year residency in Orthopedic Surgery. Halfway through my PGY-3 year is when the real trouble started. I was on a rotation at an outside civilian institution (Texas Scottish Rite) when I started to notice that people were not treating me fairly. I grew suspicious and started recording conversations here and there. The most valuable recording was captured after I asked the head attending how I performed during my month on his service. He gave a very thorough assessment of my month with him, and told me that I did well and that I should keep up the good work. I shared his opinion of my performance, but I had recorded him because I suspected that I would be betrayed in the very near future. If you have ever been an under-represented minority in an all white, elite professional environment in the deep south (Dallas, TX) then you understand my paranoia. Two weeks after leaving his service, I was sent back to my home hospital early with a failing grade. Upon my return, I was shown the evaluation from the attending that I recorded. He said that I was one of the worst residents he had ever worked with. Many would think that should be the end of the story. After all, I recorded him telling me that everything was fine, yet he wrote an evaluation describing me as a miserable failure. My program director brushed it aside, forced me to get a mental health evaluation and an IQ test. I submitted the test results to MENSA and was accepted, according to this information, my result placed me in the top 10% of physician IQs. After the psych eval and IQ test, I was placed on probation. During the probation they evaluated the way that I did everything. Every surgery, every morning report presentation, and every academic presentation was evaluated on a scale of 1 to 4. At the end of the 90 days, I had scored an average of 3 out of 4 across the board. The staff attendings voted, and unanimously determined that the probation was a failure. They recommended immediate termination.
I knew there was virtually no way out once the termination was on the table. A black physician had taken me aside and gave me hours of his time comforting me and advising me during that time period. One thing that he said stood out above all else. If the surgeons in your department submit their unanimous, professional opinion that you should not be a surgeon, there is no court, no GMEC, no commander who will override them. After some digging around, I realized that the psychiatrist who had evaluated me documented that there were some significant problems going on (I was addicted to amphetamine and had experienced personality changes) and yet, he never told me this, and did nothing to treat me for these issues. To this day, I suspect that he did this intentionally. When I realized what happened, I looked through the regulations and discovered that a major mismanagement had occurred. I raised this issue in my hearing, and it was enough to override the termination attempt despite the unanimous, professional opinion of the surgeons in my department. I went on a medical leave of absence for 4 months before returning to residency. Three Years later, I went back to this psychiatrist and confronted him on his biased approach to evaluating me. He 100% accepted the residency director's allegation that my accusations were baseless and that I was psychiatrically unstable. It was at this time that he admitted, that his original plan was to diagnose me with bipolar disorder so that I would be medically disqualified from military service, and then be forcibly removed from residency. He was doing this at the request of the residency director and the hospital's GME director. He abandoned this plan only after hearing that I had met with the hospital's commander, filed an equal opportunity complaint, and an inspector general complaint all in the same day because of the forced psychiatric evaluation. I asked him what he expected me to do after being dealt a blow like that, and he didn't really seem that concerned or consider his actions unethical (even though he changed his mind when the situation became high visibility).
I was placed on a re-integration plan that was supposed to span three months. But three weeks after my return, the program director decided that I just wasn’t performing well enough and told me that I should resign before I was terminated. I refused and took my case to a second hearing. I presented every piece of evidence that I had, but I lost. I appealed to the Hospital’s Commanding General and lost again. In the process of my appeal, I submitted an equal opportunity complaint and initiated a congressional inquiry alleging racial discrimination. This was due to the difference in the way white residents with mental health issues in the same program were treated, compared to my own treatment as the only African-American in the department for almost 15 years. The EO investigator found no evidence of racism (of course). In the modern era, it will be rare that racial discrimination is proven based on the burden of proof for these accusations and the subversive manner in which it occurs. The military does not seem to adopt the model established by Green v. McDonnell Douglass. Regardless, the investigator determined that I was still treated unfairly, and recommended that I be re-instated as a PGY-3 resident at a different hospital.
The investigator’s recommendations constituted a major victory, but I am still fighting. Even with the investigator’s recommendation, there are many officers in the system who are trying to oppose my return to training. In the meantime, I’m working as a General Medical Officer and awaiting my next assignment.
My experiences with the Military GME system have shown it to be horribly unfair and biased. Residents find themselves at the bottom of a military and a medical rank structure, and rank, above all else, seems to dictate who is right most of the time. I have also found that most residents have very little understanding of what it takes to mount a competent defense when they’re being bullied and cornered by the attending physicians. I have informally advised a number other residents in my hospital on how to navigate the issues within the GME system. I’ve found that experience quite fulfilling and cathartic, and I hope that I can help more in the future.
UPDATE (26 June 2013): The website has been up for almost a year and the word is starting to get around. About 1-2 residents per month contact me in search of advice or assistance. Some times, all that I can offer is a kind word in the face of extreme adversity. I'm more than happy to lend whatever assistance I can provide, so leave me your information on the comment page if you would like to speak.
My own battle continues... the equal opportunity complaint has been elevated to high levels within the Medical Command and it has finally received the attention that it deserves. A determination of some sort should come down within the next month.
UPDATE (12 Dec 2013): Details rolled in slowly over the past several months so I delayed my update until I had more information. My residency program was investigated for other racially insensitive behavior more than a year after I departed. My former residency classmates made a video which featured a man in a Klu Klux Klan outfit throwing a dart at a picture of my face. The video was played in front of a wide audience at the Chairman's promotion to Colonel party and it offended several African-Americans who were present. One of them was bothered enough to file a complaint with the hospital. This complaint was serious enough to generate a new investigation which was immediately elevated to the three star general level. It resulted in my former residency program director and the chairman (also a former program director) being forced to step down from his leadership position, letters of reprimand for several doctors in the department, and the military has agreed to pay me a military salary while I complete my residency training in the civilian sector. The battle is still not complete, but things have finally turned in my favor.
UPDATE (26 May 2014): As military doctors, we are given annual officer evaluations in addition to the residency evaluations. Most of the time, this is treated as a simple formality, and the events that transpire in the course of someone's residency rarely influence these evaluation reports. I have seen several doctors get terminated or resign and still move forward in their officer career, get promoted, get new residencies as if nothing were amiss. Not in my case. There were two residency directors in the course of my 4 years, and they both gave me poor officer evaluation reports (OERs) in two consecutive years, the years that all of these events transpired. The result of those referred (poor) OERs was that they triggered an automatic military separation board for me. That's right, despite being a West Point Graduate, an Army Ranger, serving 4 years in the infantry, and another 2 good evaluations inside that same department, I was up for separation from the Army. It sounded preposterous, and given the amount of trouble that both individuals had recently faced for misconduct within their department, I was sure that reasonable people would allow me to stay in the army. But I took no chances. I hired an attorney for $20,000, flew him in from D.C. and won the case to stay in. This automatically means that the army is obligated to allow me to join any civilian orthopedic surgery residency that I gain acceptance to, and they must pay me my current salary while I am training. The only remaining issue is the fact that I was supposed to get promoted two years ago. The poor officer evaluations resulted in me getting pulled from the promotion list and passed over for promotion in every year since. The attorney and I are still working on the best approach to correct this issue.
So, now a new phase begins. The mission to find a residency program. I completed my PGY-2 year in good standing, but I think it is in my best interest to do it again. My current strategy is to utilize the limited connections that I do have to attempt a meeting or conversation with a program director. The funding from the Army means that they can hire me at no cost to their program. I will ask if they are willing to expand their program by one position for a single year group, then I will ask if I can apply for that position. If I get nowhere with that plan in the next 3-4 months, then I'm going to apply for the Match and attempt to enter a PGY-1 position. I'd rather not, but I'm going back one way or the other. Wish me luck.
UPDATE (1 November 2014): Zero luck on the search for an open PGY-2 or PGY-3 position. I entered the match and applied to 112 programs in my specialty. I have been watching rejection letters roll in for the past few weeks. I am having to face the reality that I may never make it back into my specialty. I have been thinking of alternate routes to the objective, and sadly, other specialties that I may have to consider. One strategy involves 'sanitizing' my record by doing a preliminary intern year in General Surgery, by doing this, I will no longer have to refer people back to the program I was terminated from. It may also allow me to make new contacts in the local Ortho programs and possibly get some research and letters of recommendation. I have considered Emergency Medicine as a specialty. Even thought about plastic surgery a few times. On a happier note, I was promoted to Major one month ago. I am trying to see what can be done to get the rank back dated 2 years to the time that I was supposed to be promoted originally.
UPDATE (11 March 2015): Well, the residency match was a complete shut out. Not a single interview. I am damaged goods, and given that I did well in the match the first time around, I have to assume that the events surrounding my termination are responsible for the absence of interest in me as a candidate. Further complicating the matter is the fact that every potential residency director would call my old residency first, at which point they would tell them that they should avoid me at all costs, I like to beat puppies, and drop kick babies, etc. etc. Believe it or not, I'm not ready to give up yet. I am refocusing on the true problem. An Army residency program terminated me unjustly. The solution is to re-instate me in a different army residency, not to tell me to apply to a civilian residency. I am back on 'the attack' and looking for new angles that can force the Army to place me back in a military residency, in accordance with the initial investigation findings. I am strongly considering applying to ER residency while I am doing this. That way, if this takes another 3 years, I can at least complete a residency and board certification while I wait.
UPDATE (22 May 2015): I decided to take an overseas assignment just to mix things up. I asked the Army to send me to Vicenza, Italy and they obliged. I move out of here in 2 weeks, and fly to Italy in early August. I have no intentions of giving up the fight to return to my residency of choice. Three years of good evaluations in Italy will set me up to re-apply to the military match the year before I return to the United States. I shouldn't have to re-apply given everything that has happened, but I may not have a choice. I am scheduled to speak with the 2-star general who is second in command to the Army Surgeon general in about a month. I'm going to tell him about my situation and ask if there is anything that he can help me with. I've learned to keep my expectations low, and I have my eyes set on enjoying Europe and doing an excellent job in my next assignment.
UPDATE (23 July 2015): I met with the 2 star General in D.C. about a month ago. He spent an hour listening to me and suggesting solutions to my problem. Ultimately, he told me that he would not force the army to place me into an Ortho Surgery residency position. I will have to re-apply. This is a very influential and experienced officer-physician, I know that if he has made the decision, then no one in the Army will go against that. So, in my opinion, the matter is closed. I will re-apply two years from now, while in Italy. Until then, I'll be a father, husband, infantry battalion surgeon, and will partake in the Vita Dulce as they say.
UPDATE (11 Feb 2016) It has now been 4 years since I was terminated from my residency. I have to admit that work life is very comfortable right now. The Army has me working as a primary care provider for an infantry unit in Italy. I work 8-4pm almost every day. I jump out of a plane (with a parachute) once every 3 months, which is the minimum in an airborne unit. Every few months I have to visit a different country in Europe and just hang out, providing medical care as needed. I was in Ukraine a few months back, Slovenia next month, and Germany the month after. During this time, I generally have very few requirements, and I can make time for exercise, studying, and artwork (pencil and computer based cartoons mostly). Life is good, but I haven't lost sight of the goal. This fall I will visit Army residency programs back in the U.S. as I apply for first year positions. If not accepted, I will do the same the next year. If rejected two years in a row, I'll probably just accept that it's not going to happen, and I'll jump into a primary care or emergency medicine residency.
UPDATE (28 Aug 2016) I return to the United States in just a few days. I will be visiting the U.S. Army residency that I think I have the best chance of matching into. I'll be there for a month, and I hope to show them the kind of resident I really am. Wish me luck. After all of these years, I'm starting to relax a bit, so I feel that other aspects of my endeavors can overlap with this website. You visitors are one of the ideal audiences for my podcast. I speak on just about anything, but hopefully you find it to be an enjoyable disruption of the monotony of the drive into work, exercise, or whatever it is that you do for an hour at a time that requires minimal concentration.
UPDATE (23 October 2016) I just updated the appearance of the site today. The web hosting company switched software and I had no choice but to manually transfer over the contents of my entire page. Anyway, I returned from the U.S. a less than a month ago. The rotation went well, and the residency director and chairman said that they would like me to come to their Orthopedic Surgery residency. Now, I just have to wait for the military match to go down. Results posted 8 December. If I succeeded in matching, it will mean the end of this 5 year nightmare. It won't be the end of residency, of course, so I have to come in sharp, and stay ahead of all of my peers, exceed expectations, and kiss some ass for good measure. Hey! A man's gotta finish residency, don't judge me.
UPDATE (11 December 2016) The night of December 7th into the 8th I could hardly sleep. It all came down to the morning of December 8th. Five years of legal battles and moving around clinics and specialties, a year of strategic planning and execution of a clinical rotation in the United States funded with my own money (had to fly in from Italy). Since I am in Poland at the moment, I had to wait until midnight on the East Coast of the United States. I popped the MODs website open and looked at the results... utter horror. It said "Orthopedics Non-select" as in "sorry, ya didn't make it." This is supposed to be just about impossible. I matched 9 years ago with my grades and board scores, boosted by my prior military service. This year, I have a field assignment as a doctor under my belt, and I come into the application (for an intern position) having already finished the R2 year and half of the R3 year in this very same specialty. It is pretty much indisputable that I am the most qualified person for the job of ortho intern. But, here I am, empty handed again. There are still other possibilities for re-entry, some discussed with the folks that I rotated with, but it's nothing easy or worth talking about right now. Psychologically, this was a total gut punch. I had waited around for 3 years, hoping the Army would do right by me. When they didn't, I seized control of the situation, got sent to Italy to give my service record some shine. I spent a year setting up a clinical rotation, did well at said rotation, got letters of recommendation as well as verbal reassurance that I was good to go before I returned to Italy. I feel that my path is being deliberately blocked by agents of my former program. There is solid evidence to support this. But what can do about it.. I don't know. This is the challenge that we must all overcome in order to return. I will drive on. I will apply again next year. Deflated indeed, but not defeated.
UPDATE (8 August 2017) The last 8 months have been a waiting game. I went on an email writing campaign to the Surgeon General herself and several people beneath her right after the bad news in December. I was attempting to communicate that there was no way possible that I was not the most qualified applicant for Orthopedic Surgery given my experience level. I wrote and corresponded with her attorneys and the U.S. Army MEDCOM level awaiting a response. My greatest fear was that she would gloss over my statements and evidence and do what everyone has done. Respond with a basic claim that "There's nothing wrong here." Never bothering to go into the details of the case, or defending against some of the very strong points that I made. The problem that I have found is, the US Army does not take action against injustice unless inaction has the potential to harm its image or humiliate the Army, it's officers, and policies. Unfortunately, the army and its command has no fear that this specific injustice will harm its overall image. Army legal and army leadership does not seek out justice, they simply seek out courses of actions which are defendable. And they can very easily defend what was done to me. So.. after all of these years, that's probably the end of it. I am re-applying to Orthopedic Surgery through the military one last time. I'm not optimistic, but I might as well do it. If and when I do not match, the army will automatically place me into one of the residencies that never fill: Family Medicine, Opthalmology, Flight Medicine, Preventive Medicine. At this point, I just need to make it to retirement so the military would not have been a total waste of the last 20 years of my life (13 years active duty). So I will finish a residency in something, I will serve my time and I will retire. It is VERY likely that I will not do this as a surgeon of any variety. And for the most part I can accept that, even if I don't like it, and I know deep down how wrong it is that any of this happened.
UPDATE (30 October 2017) Almost two months ago, I re-established email and telephone communication with my only mentor and possible confidant within the U.S. Military Orthopedic Surgery community. While visiting the residency program in the U.S. last fall, I met an attending physician who is currently a Colonel, and serves as the Chairman of the Orthopedics Department at that program. He is also an African- American. The first time that we had the opportunity to speak behind closed doors, he told me just how certain he was that problems came my way because of my racial identity . He told of his own difficulties with the same issues while he was a resident, and assured me that white residents guilty of far worse issues than my own had benefited from mercy and grace of the powers that be. One of them was actually at the residency program at that time. This resident had been forced to resign from the very same residency 5 years earlier, and managed to be brought back in without going through the official military match program. They just made it happen for him. When 'The Colonel' spoke with me on the phone, we both agreed that it would be best to find out if the residency program director had any intentions of actually considering me for a residency slot. He went and spoke with the residency director and inquired about whether or not he and the other staff would consider bringing me on the team given my performance last year. He called me back after he spoke with them and told me that his honest opinion was that I pretty much had zero chance of matching given their cold response to his inquiry. He came across as very genuine and regretful that my hopes of returning were pretty much ending then and there with this new information. He said that he wished it was different, and that once again, he was sure that had I been a different color, I would have been shown grace and mercy, and I would have been welcomed back into the fold. He wished me well, and said goodbye. And a moment later, I said goodbye to any future as a surgeon. It was shortly after this that I realized that by carrying on the fight for more than 5 years I had held onto hope, and found motivation despite disappointment. But, inadvertently, I had also prolonged the grieving process. I found myself struggling with anger, sorrow, and even denial over the following 2 weeks. Finally, I decided that it was time to move forward and to get on with my career. Instead of applying for Ortho and allowing fate to decide where I would go once I was rejected, I decided to plot a deliberate course to the place that I was most likely to end up. After a week of mulling it over, I decided that I would go for Family Medicine (it never fills in the U.S. Army), and I would aim for the program that was closest to my hometown. If I can't do exactly what I want, I might as well go where I want. I called the residency program and set up an interview. They asked that I do so in person, so I dropped $800 and flew from Italy back to the States for a few days so that I could interview. They were a really nice group of people and I would like to be a part of the program that I visited. Once again, I won't know the final decision until around mid December.
23 January 2018
Last month, the US Army released the results of the Joint Services Graduate Medical Education Selection Board (JSGMESB) in mid-December, the day of my birthday. The Military could call it 'The Match' or 'The Military Match' but they had to roll out these long ass acronyms so they can sound fancy and shit. Anyway, the irony of the situation at hand was that the very same day, my 30th birthday, 10 years earlier, I was informed that I had matched in the most competitive specialty in all of U.S. Military Medicine, Orthopedic Surgery, and that I was headed to Hawaii for residency. In 2017, I was nervously waiting to find out if I would be accepted into the least competitive specialty, salvaging my career and officially starting the process of moving on more than 5 years after being kicked out of my Orthopedic Surgery Residency program. Turning 40 years old is bittersweet all by itself. Turning 40 on the morning that you find out that you've been REJECTED by ARMY FAMILY MEDICINE residency program's across the country despite them having open positions was absolutely bitter. My only thoughts were "WHAT THE FUCK???!!!" How is this still happening? How can I still be rejected by these folks when I am a competent, friendly, licensed and actively practicing physician? It didn't make sense.
I experienced a wide range of emotions. My wife cried quietly alone in our kitchen after I hung up the phone from giving her the news. My three year old daughter walked up behind her and started rubbing her back, telling her it was going to be okay. To this day, I have not shed a single tear for my lost residency or my professional woes. I refuse to give over that power to my oppressors even if they would never know. I prefer to be angry, that's an emotion that I am comfortable with.
What I wanted to know more than anything was why was I rejected? I had interviewed in person with four physicians at the Fort Belvoir Family Medicine program in person, the day after I stepped off an international flight out of Venice. They were very friendly and reassuring. Why was I rejected? It didn't make any sense to me. Was everyone still holding my backstory and residency termination against me?
I had no time for sadness, it was my damn birthday and I had just bought an Xbox One after eye balling that machine for years. I was planning to play Titanfall 2 that night regardless of whatever the clowns in Washington had shit out onto my plate. But more important than my video games, I needed to speak with the program director in Virginia and figure out what happened. And even more important than speaking with him, I needed to make contact with the people who were in a position to still put me in a residency spot before the summer of 2018. It is imperative that I start a residency in the summer of 2018 because the army has already told me that they are moving me back to the United States. Somewhere in the U.S. If they move me back to the and I do not enter residency at that time, I cannot enter residency any sooner than 2020 due to a regulation that states that you need to sit tight for two years before you move again. That doesn't sound like a big deal I'm sure, but there is a problem.. my promotion board to Lieutenant Colonel meets in March of 2019. If I have not completed a residency by 2019, I won't be promoted. If I am in a residency program and on my way to graduation, I can be promoted and probably will be. If I have not graduated, and am not even in a residency I will definitely not be promoted in 2019. The army would then meet again in 2020 and see that I am still not in residency. At that point, the army would issue an order than I be released from service. I would be put out on the street, no residency, no job, no pension.
So, you can see, getting back into residency was the most important thing for my future and that of my family. I spoke with the program director in Virginia days after getting the news that I didn't match. He didn't provide much other than saying that some of his colleagues around the nation were put off by the fact that I didn't interview with any of the other programs. In the military system, all of the program directors together convene to decide who should be accepted to the specialty overall. Then they determine who goes to each location. When they saw that I didn't interview anywhere else, it sent a message that I wasn't that serious about Family Medicine. They didn't know what to do, so they didn't match me despite having empty seats. I spoke with a fellow doctor who was thrown out of a different residency in the same hospital 5 years ago. We met in the office purgatory that the hospital had set aside for former residents wallowing in the misery of their failure. He told me that he was rejected as well. There is a document that is placed on top of your application each time you enter the military match. It's called the Residency Program Director Recommendation Form. It allows them to write a long essay about how bad you suck, and they can check one of three boxes at the bottom. The first is 'highly recommend for further GME training', the second is 'recommend for additional GME training', the third is 'do not recommend for further GME training.'
Ideally, this is to distinguish among qualified candidates who enter the same system in attempts to match into fellowship. But in our case, it had been used to stop us from getting another chance at a much needed residency. We seethed in anger as we discussed the injustice of it all. For days I called attorneys in Maryland, Hawaii and everywhere in between to pursue the lawsuit that I hoped I would never need to file. It was apparent that there was no other way. I found it frustrating how attorneys never got back to me or provided adequate response to my inquiries.
In the meantime, the army emailed me and told me that there were unfilled positions in Occupational Medicine, Family Medicine, Preventive Medicine, Urology, Aerospace Medicine, Anesthesiology, and Internal Medicine. I immediately zeroed in on Occupational Medicine as my best bet. It was only available to folks who had already completed an intern year, and it was only 2 years in length. You earn a Master's of Public Health and do some rotations in various workplaces around the nation's capital. It would be easier than Family Medicine! And Shorter! Family medicine wanted me to do a full 3 years. I set up an interview for the next day. The interview went well, and I was satisfied that I was good to go. But then something interesting happened.
A different Residency Program director from another Family Medicine site contacted me and asked me to interview with him. It's strange, because if I was interested in the position (I had put my name in the ring for insurance, I was supposed to ask them for an interview). Before the interview, I sent him two documents which I now realize are the most powerful documents in my possession. I call them the golden tickets, and they will probably look different for each person in a situation similar to my own. But they are indeed tickets, and they are certainly golden.
Part 2 My Personal Residency Experience
As many of you know, you cannot re-enter Orthopedic surgery Training without a very strong endorsement from a former program director. So the staff from Tripler Army Medical Center fully supported a confessed abuser of prescription medications who used his license to obtain narcotics fraudulently, but this same group of men wanted me not only removed from Orthopedic Surgery, and not only removed from the practice of medicine, but they also wanted to see me separated from the U.S. Military and thrown out into the street with absolutely nothing. And that is because I stood up for myself, and not because I actually violated any rules or regulations. There was also no malpractice issue in my case. Some will say that racism has nothing to do with it, but all of the facts of his offenses are right here it's public information from the Nebraska Board of Physicians. And in case you don't feel like going through all of that, the pertinent passage is right below the link to the original document. The source document is 8 pages, and can be found right next to the pic of his online profile if you are interested. I have no interest in drawing negative attention to the surgeon who has benefited from such obvious bias, however, I want to make it clear that I am not making any of this up. This is why I have put the public document here, and why I posted his profile from his current job while editing parts of his name and obscuring his facial features. For some people, racism and racial bias will always be a leprechaun, the easter bunny, or the boogeyman that doesn't actually exist. And for those types, this probably won't be enough to show you just how biased the system is. But if you are even partially open to the possibility, I hope that this will help you understand what minority physicians (especially African Americans) are dealing with.
(Update) 18 June 2020
Well, today I graduated from the MPH program, tomorrow I graduate from the Occupational Medicine Residency itself. And with that, I have officially recovered from the devastating effects of being terminated from my Orthopedic Surgery Residency 8 years ago. Throughout the Corona virus response, it became even more clear (if it wasn't already) that this job has basically no impact on people's lives. It is the least important thing that you can possibly do with an M.D. (maybe prescribing medical marijuana is less important). During this entire crisis, the main task of occupational medicine doctors (as much as I have seen) is clearing people to return to work. So.. what that means is that after an internist, infectious disease doctor, or pulmonologist has treated the patient, brought about their recovery, and told them that they can return to work.. that person then comes to an occupational medicine clinic so that we can sign a piece of paper confirming that they can indeed return to work. So the biggest health crisis in recent history, and this is what we are doing.
So.. if you couldn't tell, I am absolutely determined to return to my original specialty. I am in the midst of establishing a relationship with a local program director in hopes that I can arrange for him and his team to evaluate me as a candidate. My hope is that I can re-enter residency in 2022. In other good news.. I have been told that I will be promoted to Lieutenant Colonel in October. This means that I will get to stay in the military for my full 20 years, and I will get to retire as a Lieutenant Colonel! This is great for my family and my financial security.
As you may be aware, there are massive protests throughout the United States over the death of George Floyd. This event along with several other racially motivated killings and public displays of disregard for the humanity of Black People seems to have inspired White People to verbally commit to doing something about racism. Now, if there is anything that my experience has taught me, it is that the vast majority of White people need to be re-educated as to what racism really is to the average, modern day black person. Many of us are afraid that his historic moment will come and go and people will basically go back to the way that things have been for the past 30 years.
Yesterday, Forbes magazine published an article that addressed the difficulties faced by black doctors. This is the largest publication that I am aware of that has specifically discussed the nuanced racism experienced by us in the hospitals. The fact that the issue has given this kind of attention makes me hopeful that some change will come of all of this. I promised myself many years ago that I would not leave the U.S. Army until I had ensured that no young doctor will live through the experience that I had in Hawaii. This Article, Black Doctors Need More Than Demonstrations, They Need Change, will help me state my case before congressman and higher level officers in the coming months as I attempt to force some policy changes.
The website has been up for 8 years now and I can say that I feel as if I have definitely made a difference for a lot of people. It has been a very fulfilling experience even if it deals with something as shitty as getting your soul torn out of your chest (residency termination). And what is awesome is that many of the people contacting me have shared information or ideas that have helped me help others more effectively. Generally, I get requests for help from about 2-3 residents a month. April must be the most popular month to tell people that their contract is not being renewed. I get almost twice as many requests during that time. Usually things stay quiet in June, July, and August. If you would like to speak, I try to make myself as available as possible. So send me an email: firstname.lastname@example.org and I'll get back to you as soon as I can.
(Update) 27 January 2021
Well, the past few months have been more good news. In October, I was promoted to Lieutenant Colonel, which secures my ability to retire from the military with a decent pension in 3.5 years! As a physician, I always considered that something of a minimum standard or even a 'who cares?' kind of thing given the salary that I expected to make as a civilian. But, after this long and unexpected journey, I have learned to be grateful for everything.
My first assignment in the U.S. Army as an Occupational Medicine Doctor ended up being a whole bunch of nothing. Literally, I signed into my new unit and there was nothing for me to do. Nobody had any work for me to do. So I watched my kids go to virtual school and I put in some serious work with Signify Health. Because of the COVID-19 crisis, I was able to do insurance 'physicals' virtually over zoom and FaceTime. This made it possible for me to 'Work for the Army,' Watch my kids, and earn $800-$1000 a day from my basement. A few times, the company paid for me to travel, stay in a hotel, and see patients about 2-3 hours from my house for a week at a time. I did this for several months, and was able to save a lot of money for the family.
At the end of October, after studying for only a month during which I was doing some of this telework, I took the Occupational Medicine Board exam. And 5 days ago, I found out I passed! Yay! So now I am an economically viable physician capable of working outside of the military in a wide variety of roles when the time comes.
Months ago, I made contact with a civilian Orthopedic Surgery Residency Program director. He interviewed me, reviewed my CV and has me interviewing with other staff members this week sometime. I rarely talk about things like this (because I could still be left in the cold once more), but it is worth mentioning just for the fact that it is progress that I have worked so hard for. I don't know what will come of this, but I am optimistic.
Lastly, I have circled back to fulfill a promise that I made to myself 11 years ago while I was rotating at that hospital in Dallas. I swore that I would make sure that the world knows what is done to Black Doctors in residency. I have used the Freedom of Information Act to request 30 years of termination statistics from the U.S. Army Graduate Medical Education Office. I plan to use that data to clearly define the problem and appeal to the Secretary of the Army and demand that systems are enacted to prevent the powerful bias that I experienced from harming others in the future. Part of this plan involves establishing an organization of Black Military Physicians. If you can believe it, no such organization actually exists as far as I know. But we will need it if we are going to handle this thing. So I have linked up with some strong Black Doctors from my past and we are going to get this thing off the ground.
(Update) November 23, 2021
It's been an exciting year to say the least. Using my contacts from over the years, I loosely assembled a group of current and former Black Military Physicians and came up with a plan. Turns out there was an email sent between two senior leaders at Tripler Army Medical Center in 2020. In this email, they discussed statistics that demonstrated that Black Residents at Tripler Army Medical Center have been terminated at a rate that is almost 8-10 times that of white residents over the past 20 years.
I requested this email through the Freedom of Information Act. You may not know this, but every email sent from or to a government email account is government property and subject to becoming public. They actually handed the email over, but redacted the portions that proved how much inequality is occurring. So that means, they showed me the email, but whited out the portions with the most damning statistics in it.
Why would they do that? Could it be they are ashamed? Embarrassed? Concerned?
So, I put together a letter signed by Lieutenant Colonels, Colonels, and Retired Colonels which requests that they hand over the unredacted letter. This letter, because it is an appeal, is automatically elevated to the Secretary of the Army for Review. The letter was sent in May 2021, and it is November 2021 with nothing but silence. Either they are working hard to fix it, or they have buried it.
I didn't mention this here, but those who are in sporadic contact with me know that I deployed to Kuwait March of this past year. Made some excursions to Saudi Arabia and Qatar while I was there. My job title was 'Theater Preventive Medicine Physician.' This job was essentially a waste of time. I judge that based on the fact that if I was not there, literally nothing that happened over there would have occurred differently. It was a reminder of just how little Preventive Medicine and Occupational Medicine contribute to the military as a whole. Not saying that to be demeaning or to belittle anyone's profession, it's just reality when you consider that I once saw 40-50 patients in a day who were experiencing anything from a fractured femur to a hand laceration. When that was your introduction to medicine, sitting in a cubicle inside a tent for 8 hours a day seems kind of pathetic. I used the deployment to pad my resume, and to regain some of the health that has slipped away over the years. Healthy eating (only fresh fruit, vegetables, grains, nuts, and small portions of meat) as well as walking/running 10-14 miles a day finally burned off the final 10 pounds of weight that I have been unable to lose for almost a decade.
While I was there, I made contact with the Orthopedic Surgeon who was assigned to the base. He just happened to be assigned to Walter Reed Army Medical Center, where I wanted to rotate in September of this year. I reached out to a classmate of mine, who introduced us, and I saw patients in his clinic a few times in addition to my other duties. I then made arrangements to rotate with Walter Reed and Eisenhower Army Medical Center Ortho in Sept and October of this year.
The rotations went very well, I had great experiences and even ended up doing some trauma surgeries on the Marines wounded in the Kabul Blast that occurred as the last Americans were departing Afghanistan. I was just about given verbal assurance that I will return this time. As much as people feel comfortable doing such things. It seems like the only fair outcome.. I'm 18 years in at this point, I have prior infantry experience, significant research experience, my ortho knowledge base exceeds that of the current interns and R2s (I am applying for an intern spot). I got great evaluations in Kuwait and Letters of Rec from high ranking ortho surgeons in Washington D.C.
So.. what could go wrong?
I should have a great answer for that in mid-December. I have actually found peace for either outcome. Should I match.. I was given a preview of what is waiting for my ass. 6 years of hard work. Make no mistake, whether I have prior experience or not, Ortho residency will be no cake walk. It will be difficult, and I will have to work exceptionally hard to stay ahead of the game and to ensure that my ethic and performance is beyond question.
Should I fail to match, I will be spared this hardship, but will have to accept the 'hardship' of knowing that I am paid very well, to do very little to make the world a better place or help individual patients. For me, that really matters, and I hate knowing that this is my life. But I realize, that this is flawed thinking.. instead.. I should be grateful that I walked through the flames of residency termination and on the other side I have a peaceful life, a very good income, a good family life and more hobbies than I can actually do.
I have so much to be grateful for with either outcome. I believe that the beauty of this particular year is that should I fail to match, that is the final word on the matter. I have had help from some very powerful allies this year. Very high ranked classmates from West Point and my Med student year group mates who have influence and are sympathetic to my plight. Should I fail to match this year with their support, I can be certain that I will do no better in future attempts. The only reasonable course of action will be to step away, and say goodbye to orthopedic surgery. I don't like it, but after 10 years and two solid, well planned and executed attempts at return, I must accept this reality.
So.. I'll let you know how it goes.
(Update) January 10, 2022
Well, perhaps the prolonged period of time since the last post, the few of you who follow my updates closely have probably concluded that I was not successful in my final bid to return to Orthopedic Surgery Residency.
The news came on December 8th. A number of friends in the Army who knew that I had applied sent me text messages asking the results. For whatever reason, I was off by an entire week. I was expecting the results to come around the 15th. In the back of my mind, I knew that if had been successful, my phone would have been inundated by congratulations from folks in the know.
I logged into my military email expecting to confirm my suspicions.
I received a message directly from the head of U.S. Army Orthopedics informing me that I had not been selected, followed by the typical, generic points about how it was so competitive. I knew that it was a generic form letter as it ended with a request that I contact him if I had questions about the outcome and how to be a better candidate.
This guy is a fellow West Pointer, and a Colonel, and we had something of an understanding that I am an unusual applicant. I told him about my patents, and my long journey during the interview a few months back. I decided to send him a reply message stating that I did indeed want to speak about the outcome.
No response. I sent a follow up message a few days later.
Also no response.
This was not the outcome that I expected, but I always knew that it was possible. My immediate response was just numbness and mild disappointment. Over the next week, this would transition to profound sadness with a bit of anger. That would give way to almost a sense of existential dread.. “this is it?? I’m going to be an administrative, paper pushing, doctor weenie for the rest of my life?”
As I said before, this past application cycle I had the assistance and support of very powerful people inside the system. To include two Army Program directors who I had known personally as peers in the past. In the military, the program directors of all of the programs in the system come together to decided who is selected. I had also worked directly with the Walter Reed Program director while deployed in Kuwait. We were friendly, and I felt like he understood and was sympathetic to my cause.
My most powerful ally, was the former Chairman of Walter Reed Orthopedics and the Army’s number one Spine Surgeon. He was promoted to the Director of Surgery at Walter Reed last summer while I was deployed. He is my West Point classmate, we had chemistry classes together as cadets in our teens and early twenties, and I had kept in loose contact with him over the years.
5 years ago, I emailed him while transferring a patient from Italy to Walter Reed. At the end of our correspondence, he asked how I was doing, and I decided to actually tell him that I was struggling with my predicament as a General Medical Officer, and that I wanted to return to Ortho training. I sent him the documents that I have posted here which summarize what happened to me. I didn’t expect much, but he said “I will help you in whatever way that I can.” Most of me was under the assumption that he was being kind and polite.
2 years later, I started seeing him around the hospital when I was there for my occupational medicine residency. He would always ask me if I wanted to return and would say to reach out if I needed help getting there. Again, I figured he was being polite.
Then in 2020, when Racism in America became a headline again, I emailed him the article that I mention above from forbes.com which talks about black physicians and workplace hostility. He thanked me, and then utterly blew my socks off with his response.
A week earlier, he had compiled a series of articles and statistics on how Orthopedics was white male dominated, was aware of this fact, but as an organization had made very little progress on the matter. He called it ‘an embarrassment’ and convened a journal club on the topic. He actually seemed rather passionate about the topic. This was a surprise to me, as he is a white male and never gave me any reason to believe that his experiences, understanding, and general concern for racism in the workplace was going to be much different than what I had come to expect as ‘baseline for white males.’
I say that not to disparage White males, but more because the phenomenon of preferential treatment of white males by the majority white male power structure seems to be mostly invisible to the beneficiaries of such treatment, while glaringly obvious to everyone else.
While in Kuwait, I reached out to him back in the U.S. to introduce me to the Walter Reed program director who happened to be deployed to work at the clinic located one mile from my office. I thought it would be useful to work along side him during my time off. He made the introduction enthusiastically and quickly. Before I returned, he also agreed to write a letter of recommendation for my application.
After I returned from Kuwait, I went on a brief vacation, and then began rotating with the Walter Reed Ortho department as a medical student equivalent. At times, it was a bit awkward because I am a Lieutenant Colonel and a full fledged physician. But I made it a point to emphasize that I was there to learn and that I should be treated the same as the Second Lieutenants against whom I was competing for a position.
During my time with the department in September 2021, my classmate lead the Walter Reed Orthopedic Surgeons through the fallout from the cluster of injuries and wounds that occurred as a result of the United States’ messy departure from Afghanistan. He was so measured and effective, very calming, and extremely competent.
During a journal club convened during that time, I noticed that even now, more than a year after the George Floyd protests have come and gone, he dedicates 2 journal articles per meeting to the discussion of inequality in America. Then he leads the discussion in summarizing their significance and how it applies to these surgeons in training.
Lastly, during my final week with the department, he sent all of his residents to see a Faith Ringgold exhibit at a local museum. She is an African American artist who creates very vivid, striking, and a bit unsettling art that depicts racial injustice in America. I encourage you to google her for more detail. He acquired 20 tickets, had the attending physicians handle clinic, and then sent all of the residents and med students to take in the exhibits.
I was basically in awe of this man at this point.
Knowing that he is there, that someone at the top understands what has happened in America, and how that fits into my own story really provided me with some healing that I had been unable to find after all of these years.
I never use names here, but for him I will.
His name is COL Melvin Helgeson, MD and he is a great Spine Surgeon, but more importantly, he is a great man who understands where we all stand in history, and how he has the power to positively impact the world. I will always hold him in high regard.
Now, back to my own plight.
It is customary to give a presentation during your final days on the service as a med student/applicant. I gave a presentation that combined my current profession (occupational Medicine) with my passion, Orthopedics. I presented a series of articles on Radiation and Orthopedic Surgeons. I also integrated occupational medicine articles and textbook data to present the information in a way that showed several gaps in the current understanding and management of Ortho Surgeons’ risk mitigation. I also identified a new device, personal radiation exposure electronic monitors, that could be used to start a new prospective study that measures exposure among residents of each year in training.
The program director told me directly after my presentation that he would like to perform that study. I gave the same presentation again in Georgia, while rotating with Eisenhower Army Medical Center a few weeks later. The entire department followed my presentation with a 15 minute discussion and again, the head of the department said that he wants to perform that study.
During my time at both programs, I was functioning much like a R4 or R3 resident. I was seeing patients, doing injections, writing notes, doing additional paperwork that the med students could not do. I was presenting the attending with assessments and plans that were 100% on point, no adjustments needed.
And I did all of this as I applied for an intern position. My medical knowledge easily matched the current R2 residents and easily exceeded the current interns and med students against who I was competing.
Lastly, during my time in Kuwait, I studied using question banks from orthobullets.com and created a video series for publication on YouTube. The goal in making the video was to prepare myself academically through the act of creating it, with the hope that it would be used by me and other residents/med students in the future to review and study anatomy.
It took me about 4 months, and at least 15-20 hours to put my first 45 min video together. I assume that I can get that down for future videos. I used a QR code to attach the video to my personal statement so that anyone reading my personal statement during the application period would be able to easily watch the video by aiming their phone camera at the QR code, which would then open the video in YouTube. See for yourself.
Part 1 The Current Situation Facing Black Physicians in Residency Training
The first is a memorandum written by a one star General which explained what happened back in Hawaii in 2012. You can read a redacted version meant to protect sensitive information by clicking on the button near the right margin. The other was a letter of recommendation written by my mentor in the Orthopedic Surgery department at my residency. When the residency program director and chairman responsible for my termination were themselves relieved of duty, he rose to the position of department chairman. I called him one day back in 2014 and asked if he would be willing to help me, and he said he would indeed. You can read that letter here, also redacted to protect sensitive information. When the Residency Director read both documents (he received them during our 1 hour conversation) he was speechless. He was extremely empathetic, and stated his sympathies that I had lived through such an ordeal. He then said that I needed to show these documents to everyone in the system who had even the slightest bit of influence. I had done so the year prior when applying to Orthopedics, and no one seemed to care. I also showed them to the Surgeon General herself and she also did not care. When the other family medicine program directors saw the documents, their responses were very similar. The top representative from Occupational Medicine read the documents and spoke with me about them for almost 20 minutes. He seemed very concerned that I should be permitted to practice my first love, Orthopedics and did not understand why this was not the case. I appreciated all of the support, and was pleased to see that there are breathing, thinking, and fair minded humans in the US Army after all. Leading up to the day that the results were to be released, I told the central army GME office that I wanted to do occupational medicine and that if given a choice between that and family med, I'd rather do occupational med.
The morning of January 17th, 2018 I read an email that the Occupational Medicine Residency had accepted me and I'm moving home to Washington D.C. It was two days after MLK Day, so I was all like "Free at last... Free at last... Thank G..." Fuck that. I'm not really free, but I will continue to get paid, I'll probably get promoted, and I get to retire from the Military as long as I don't do anything crazy over the next 6 years.
UPDATE (19 December 2018): It has been a year since the last Military Match, and almost a year since I got the news that I would be moving to my hometown to start a 2 year residency in Occupational Medicine. Moving back from Europe to the United States was hectic, but the experience of moving forward with my career has been pretty good. The Occupational Medicine residency in the Military Begins with 9 months of classroom work earning a Master's of Public Health, followed by another year and a half of clinical rotations, agency rotations, and an opportunity to go overseas to South America, Africa, or Asia as part of a public health project. Honestly, given all that I've been through, I find it oddly ironic that such a good opportunity was given to me because nobody else was really seeking it out. It's actually a really good deal! The classes for my Master's of Public Health are SIGNIFICANTLY easier than the classes I took as an undergraduate. I spend most of the class time drawing, inking, and coloring images for an online comic strip that I recently started (click here to view it). Despite my lack of attention to the task at hand, I have straight A's and one B in a class that I literally put zero effort into. Of course, getting straight A's in an MPH program as a Physician is sort of like winning the 50+ age group in a local 5K race. Nobody gives a shit. You pretty much just need to avoid C's. Anyway, things are good, and I'm on track to make Lieutenant Colonel in about a year or two. This will allow me to retire in 5 1/2 years. Despite having a clear direction for my medical and military careers, I cannot fight the feeling that I was massively violated and cheated by not being allowed to complete my Orthopedic Surgery residency. Part of me wants to get back to Ortho Surgery training any way possible. The other part of me realizes that after 7 years and significant damage to my reputation, there is still no clear cut or easy way to go about doing this. Additionally, undergoing training will involve a pay cut, sleepless nights, volumes of studying, and the politics and personalities that come with being a part of an elite specialty training program. At the moment I have started a business, and have investors backing me along with prototypes being developed by two different companies as I type. If my business were to succeed, going back to surgical residency would not make much sense. But as I see things now, financial independence would actually make me MORE interested in returning to my former profession, not less interested. If my business does not succeed, then I will be reliant on a physician income to support my family, pay for private school (I know, I know), fund my children's college tuition, pay for weddings, and help out with whatever else the kids need as they start out early adulthood. These sorts of expenses actually make me more wary of taking a pay cut to re-enter residency training in surgery. Time will tell what is to come. Until then, I'll finish up this Occupational Medicine Residency, continue to develop my business, and keep drawing cartoons as often as possible.
Update (3 September 2019)
Well, I've been in residency now for over a year. Occupational Medicine is not a bad specialty at all, I believe that it could be the perfect 'rebound' specialty for anyone who has experienced an unwelcome interruption in their graduate medical training. One month rotations at various clinical sites about the Washington D.C. area started back in April of this year, and none of them has been even a little difficult. Finishing by 4pm or 4:30 is the norm. No overnight call ever is the standard. Patient loads are very, very light with 4 -8 patients per clinic day being the most I've ever experienced. If I wanted to sit back and collect money for the next 20-30 years, I would be very pleased. But that's not something that leaves me fulfilled, and quite honestly, I'm not very proud of what I'm doing right now. I have made arrangements once more to rotate with people in the Military Ortho Surgery system who can assist me in another attempted return. I have to serve at least 2 years as an occupational medicine physician, so I cannot apply until the fall of 2021 for an attempted return in the summer of 2022. This is the new objective. If successful, I will return to residency 14 years after the date that I initially began my orthopedic surgery residency. I have thought it over, considered the options, started several business projects (which includes 2 medical device patents) and started drawing and publishing cartoons online regularly. But none of this makes me want the original objective any less, and so I will keep pushing. I will keep studying, and I will try my hardest once more to return through the military GME system. I will
keep you updated
(Update) 21 October 2019
As my story is told again and again, people are generally supportive. One issue however, that bothered me way back then and that continues to bother me today is the fact that these residencies injustices are dealt to minorities so much more often than white males. It's not like I want to watch white males suffer or anything like that, I just wish that as a group they would recognize this tendency to group together and unleash hell on earth on 'others' and outsiders in environments like residency. What makes it worse, is that if you tell the average white doctor that there is a racism problem in medicine and in residency training specifically, they are unlikely to believe you or care. I haven't mentioned it until now (on this site), but way back in 2011 as the staff in my residency program were closing in for the kill, another resident in my Orthopedic Surgery Program at Tripler Army Medical Center found himself in quite a bit of trouble. It turns out, he was using his medical license to get access to opioids which he then turned around and abused all around the clock. Yes, this resident was coming to work altered, operating on people AND committing felony offenses in the methods through which he obtained the medications. The interesting thing about his situation, is that the staff, the program director, and the chairman all rallied behind this guy. They wanted to see him graduate from the residency (he was caught months before his graduation and everything was put on hold). The whole drama took an entire year to wrap up (that's the US Army for you). In the end, this guy was separated from the military on an other than honorable discharge, he was released without his graduation diploma from residency. He was put out on the street with a drug offense, no residency, and faced the possibility of losing his medical license. Sounds pretty bad huh? Well, some people in America will always get a second chance. Turns out he's doing a lot better than I am.
Incidentally, I was able to check the video statistics as I waited during the months between submitting my application, and waiting for the news. I made a brand new QR code and video just for the surgeons who would review my file.
I was able to see, that not a single person viewed the video. Not one. Which led me to believe that most likely, nobody even bothered to read my personal statement.
I reached out to the two program directors who I had the strongest relationship with after I got the news. They said we could speak, but then stopped responding to my messages. There is a rule that stipulates that they cannot say anything specific about the selection process or the results. So I guess they decided not to speak.
I reached out to Mel Helgeson and he wrote back. Said that he was deeply sorry that it did not work out and that he did his very best.
So.. where does this leave me?
Basically, right back in the same place I was almost a year ago. But now I know that there is no way back. This is as far as I go. And as I said a few months ago, I should be happy for that. Residency terminations and mishaps like my own can absolutely ruin people. Suicides and murders have emerged from despair created by these situations.
But I have righted the ship. I’m ok, my family is ok, I get to retire, I get to work in the civilian world as a board certified physician. So why do I still have this bitter taste in my mouth??
Orthopedics is basically the only big failure I have experienced. And it appears that there is no way to try again, no way to make it right. That’s hard to swallow. So then, I’ve had to again ask myself.. was this most recent application cycle more about not failing, than actually practicing orthopedics?
If I am honest with myself, it is hard to separate the two in my mind. Am I really disappointed that I am going to miss out on 5-6 years of sleep deprivation, exhaustion, endless studying, working under men with gigantic egos, and always trying to measure up month after month, year after year?
If I am honest, NO. I am not going to miss those things.
Am I sad that I cannot be proud of what I do on a daily basis? Absolutely. I am not proud of what I do, and it is an embarrassment to say that I am a doctor given the follow up question of ‘what is your speciality?’ Is that embarrassment worth the price that I was willing to pay? Surgical Residency Training at 44 years old?
I’m really not sure.
I’ve read about this idea that there are stories that we tell ourself about ourself. And in many ways, I can see that. The story that I wanted to tell is that I was unjustly persecuted, stripped down, cheated, almost kicked out of the army.
Then I got to work, fought year after year, healed myself, got promoted, advanced, proved myself again and again before finally emerging victorious - exposing my oppressors for what they were. That would have been an awesome story, but it’s clearly not going to happen that way.
I still have a lot of business ideas, innovations, and even art that I would like to pursue. So in many ways, I have been freed from the matrix. I am free of the binding restrictions of surgical training and surgical practice that would limit my ability to seek out these things.
Time will tell if they will simply be hobbies, or more valuable than a career in ortho could have ever been.
(Update) 27 January 2022
Okay, so I am posting the above entry as well as this one at the same time because something very unexpected occurred hours after I finished typing the entry from 10 January. I hadn't posted it yet because I wanted to proofread it the next day. But that evening, I got a call from US Army Medicine Headquarters. It was the head of Graduate Medical Education at the US Army.
He called to inform me that there had been a change, and that I was selected as an alternate. My number was being called and I was promoted into the ‘civilian match position.’ What this means is that of all the applicants, I was number 21. 19 of the selected individuals go to army residency positions, the 20th position is released to the civilian world and allowed to match at civilian organizations around the nation. So I was being told that now, I am free to attend a civilian program if selected.
I had the opportunity last year for just such a thing, and even interviewed for a position. But this year.. I didn’t apply to any civilian programs. So, I would have to find a program with a missing resident who also wishes to take a chance on me.
Not a likely outcome.. but it does change a few things for me mentally.
One.. I was very close to matching.
Two… the reason that nobody would speak to me is because they didn’t want to reveal any of that information while there was still a possibility that I would match as an alternate.
So, what do I do now?
It would have been easy, if things were as they were on 10 January. Game over, total shut out, move on.
Now.. I am still kind of in a place where it could be possible. I have reached out to about 20 programs in New York, Maryland, Pennsylvania, New Jersey, and Washington D.C. Predictably, they have either not responded or they have stated that they do not have any available slots.
The big question is, do I apply again next year given that I was just one place away from matching and that I was given a chance to match in a civilian spot?
In the beginning of the application cycle last summer, I told myself that if I did not match, that I should not try again. It's been 10 years of me working towards one goal, get back to where I was at age 30 - Reclaim what was unjustly taken from me. But now, I am financially set, stable, I have a very relaxed lifestyle, and a relatively young family. I live 10 miles from my childhood home, and I'm surrounded by loved ones in a great community where my children are thriving. Over the years, I have developed a 'never back down' and a 'never quit' mindset. But I know that this mentality can go past the point of being beneficial. I feel that continuing on with the pursuit of Orthopedics in the face of everything that I have going for me would lean towards almost obsessive behavior.
I have not made my final decision, but I am leaning towards shutting it down and moving on. I cannot continue to hold my breath, to search for that next thing, to put my joy on hold in hopes that I will regain that opportunity lost. I need to enjoy life and put this to rest. To be continued...
(Update) 5 July 2022
I have made the decision to proceed once more with an application to military Orthopedic Surgery Residency. The application cycle has begun and I will rotate with the military's brand new Ortho Surgery program (starts in 2023) in September with the results expected in December. There is a lot to this new attempt, but it's best that I say little until after it is all said and done.
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