Tag: struggling

Posted on by

I Am Caught In An Early Vicious Cycle: Help!

vicious cycle

Question:

Hello Dr. Julius,

I found your article about the struggling radiology resident and looked at your previous answer to a similar question. I am an R1. At the end of October, the program informed me that I was struggling and having problems with synthesizing information and communication issues. Since then, they told me I haven’t improved and am still behind my peers.

I know that you mentioned getting out of the vicious cycle will be difficult, but I feel that every time I’ve spoken with my PD or assoc PD, they think my problem is inherent and I can’t be a radiologist. I’ve seen a psychologist for help, and I accidentally got the GME involved in seeking information. I’ve been studying harder, but I have a shaken confidence. And I keep missing things and not improving. I am concerned that they will fire me. Where do I go from here? Do I start looking for another specialty or stick it out until they’ve had enough and will not renew my contract?

Name

Scared R1

————————

Answer:

Dear Scared R1,

Before anything else, you need to ask yourself if you have been putting in many hours of studying each day and have immersed yourself in radiology. If you are honest with yourself and have genuinely been putting everything you have into learning radiology, you shouldn’t be so hard on yourself. I am going to assume in your case that this is true.

So, what bothers me most about your situation is how you explain it. You said you just recently started as an R1. That would mean that you just began the second half of your first year. And yet, it seems that you assume that your PD and associate PD think that, inherently, you will not make it through your program.

It would be highly unusual for a PD to know that you can’t make it through your residency so early on. In my experience, I have had several residents who had a questionable first year, only to discover that they became more than proficient when they started on call. Typically, they can know only by seeing how you do on call. (assuming you passed a precall assessment) So, it seems they haven’t even given you a chance. From what you are saying, you may be in the midst of an early vicious cycle.

Remediation of the Vicious Cycle

Second, the ACGME requires the program director to allow you to remediate your situation. They can’t just indiscriminately fire a resident without due process. And, since you have barely started radiology, there is no way you could have had an adequate opportunity to remediate the situation. Again, this assumes that you have not done anything to endanger your patients or fellow staff that would require them to prevent you from working.

So, where does this leave you? Well, improvement is an incremental process with occasional setbacks along the way. You may feel like you are not improving, but you are. The key is to learn from your mistakes and not repeat them repeatedly so that the vicious cycle continues. It’s ok to have missed at this point. You certainly can’t expect a first-year not to make any mistakes.

All this being said, occasionally, some residents can’t cut it. But these residents are rare, and I certainly would not be ready to pack it in just yet.

At this point, you should view each mistake as a learning opportunity, not as something to get discouraged about. You need to stick it out with some grit and determination to get through this difficult time. Radiology residency can be very tough for first-year residents. Staff can be unforgiving.

Improvement is a gradual, almost imperceptible process in any small time frame. You may notice the changes from reading and studying in a more extended period. Continue to soldier on, and let me know how things go!

Sincerely,

Barry Julius, MD

 

——————–

Question About Improving The Vicious Cycle:

Hello Dr. Julius,

Thank you for the encouraging reply. In your experience, what is the usual time frame for struggling residents to see improvement? I’ve finished four weeks on a must-cover, and my faculty state that I am not improving. I have another four weeks to go, but I am concerned that if I haven’t improved much in the first four weeks, what are my chances of improving in another?

Sincerely,

Scared R1

———————-

Answer:

Scared R1,

Four weeks is a concise amount of time to assess for global changes/improvement. If we are talking about more specific goals you have set, that would be more appropriate. Based on what you are saying, it is hard to determine what improvements they are trying to assess. Global assessments don’t work too well. I am writing an article talking about that.

On the other hand, programs and residents can assess and create incremental specific goals. Hopefully, they are creating these for you, and you have made some for yourself. You can undoubtedly reach specific smaller goals within a 4-week block if these goals are appropriate.

Barry Julius, MD

Posted on by

Should I Take A Leave of Absence During Residency?

leave

 

Sometimes events beyond our control interfere with radiology residency. It may be a personal situation, a new business opportunity, mental illness, or severe burnout. I outlined some of these issues in my previous article called The Struggling Resident. And perhaps, one or many of these reasons have you thinking about taking a leave of absence.

But, what does this option entail? Many residents don’t know the details about taking a leave of absence. So, we will talk about the potential consequences of what can happen after a leave of absence and why you need to take the option only as a last resort. Then, we will discuss what situations merit taking a leave of absence, a circumstance where you might want to think about taking a break (but very carefully!), and finally, situations where it is seldom appropriate to take a leave.

Truth or Consequences

What is so serious about deciding to take a leave of absence from residency for some time? Maybe it’s six months, a year, or more. There are so many reasons why it can become a significant issue.

1. It will potentially take you off schedule for getting into a fellowship. Many fellowships will not consider residents who begin in the middle of the year.

2. You will likely have to start paying your health insurance and benefits. Believe it or not, it can cost tens of thousands of dollars for health insurance for a family. You may pay a few hundred dollars out of pocket per month when you are employed, but it can run over a thousand dollars per month when you are not. Can you cover those expenses?

3. You create a reason for future employers not to hire you. Many employers become very concerned when they see a gap in your employment history without an excellent cause.

4. It can cause irreparable harm to your residency program and classmates. You can no longer take call. Additionally, the rest of the class needs to shoulder the responsibilities. It does not set you in the light of a team player.

5. And finally (and perhaps most importantly!), you may be legally required to start paying off your massive debt load. That can be a real bear!

I Can’t Do My Job

So, when should you unconditionally take that leave of absence? It comes down to one situation: you cannot perform your job duties safely. If you can complete your residency duties, radiology residency is a temporary affair (albeit four years). And, believe it or not, many physicians would love to be in your shoes. So, if you are able and healthy, you should put all your efforts into completing your residency.

That said, if you have a mental illness, severe disability, or significant trauma, by all means, take that leave of absence. You took the Hippocratic oath and may not be able to abide by it in these circumstances. So, these conditions necessitate a departure. My advice: If it is some reason that does not involve breaking the oath, do what you can to pursue other endeavors until after your residency. You will have a great field to fall back on.

A Once In A Lifetime Opportunity

A confluence of events occurs from time to time, leading a resident to consider a job opportunity in another field. Perhaps, you just got that call to anchor a TV show. Maybe you created an invention, and a large company wants to buy out your patent for 5 million dollars; that will take a long time/lots of work to seal the deal. Or, you’ve been dancing for years, and a director in Broadway wants you on his show.

As I began brainstorming about what issues may eventually allow a resident to take a leave without regrets, some of these reasons could potentially cause a resident legitimately to rethink a radiology residency. I get it. Just remember, for those of you with significant debt, if you don’t pay your debts, the IRS can garnish your wages for the rest of your life. And these unique situations are not always a means of securing a lifestyle for years to come. (although occasionally it can be) So, those residents in this unusual situation need to think long and hard about taking a leave of absence.

Situations That Do Not Merit A Leave

If you are thinking of starting a business, quitting medicine, or needing some time off to relax and travel the world, this is not the time. You’ve already been through 4 years of college, four years of medical school, and a year of internship. What is four more years or less in the scheme of things to complete a radiology residency?

So what are some other situations that you should not use to take a leave of absence during residency? These would include taking a break to pursue another subspecialty (why can’t you just wait it out to apply, so you don’t have a gap in employment?) Or, maybe you have mild burnout (better off talking to a coach, colleague, or physician.) Perhaps, you want to start a new business (can you wait until after residency?). Attempting to train for the next Ironman triathlon is not a bad idea (you want to jeopardize your future?), and so on.

Final Thoughts

Taking a leave of absence is a huge deal. Many residents may dream of taking a break at one time or another to go for something they never had a chance to do before. However, think twice, my friends. Often, it sounds good in principle, but the practicalities behind it don’t make much sense!

What do you think? If you have any opinions, please leave a comment below!