My Residency Experience
Written June 2012
I attended one of the U.S. Service Academies after graduation from high school and served 4 years on active duty before entering medical school in my home state. After med school graduation, it was back to the military for a 5 year residency in a competitive surgical field. Halfway through my PGY-3 year is when the real trouble started. I was on a rotation at an outside civilian institution 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. 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 (the test results put me in MENSA and put me in the top 10% of physician IQs) and then 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. But, 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. 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 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. 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. One accusation 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 having 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. 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 here ---> 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 do get to be promoted and retire, so good enough Cot Dammit.
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