Residency transfer and Limited Permit

[Concerns]

Dear Anatolyk,

I appreciate your input regarding a situation. Currently, I am preparing documentation for limited permit and I am having some concerns regarding an aberrant situation from my previous residency program.

I am having an outstanding background, attending in my speciality in Europe, extensive clinical research experience in the same field with famous professors from a prestigious institution, outstanding achievements in my internship year in the same one and complications in my previous program, the same speciality and categorical program.

Unfortunately, a chaotic and unlucky circumstances made the program insecure regarding ACGME compliances. The ex-director and also ex-chairman entitled on tenure on both positions was displaced by a a new chair, extremely undidactic and limited compromising the program and careers for his ambition. Also, the program is serving a small comunity full of exotics.

I had a complication there right at the beginning of PGY 2 due to a bad behavior of senior, pakistani who was running for the title of chief residents and displacing rivals. I have been straightforward with him highlighting the fact the he has to cover as a senior. Unusual for a program, the seniors in the program did not perform their activities, no pre-rounds, no sign outs as the ex-director was manipulated by taken them in the program directly from Pakistan for different favors. He was fighting on my back and I have got a letter from the ex-director after two months of my PGY 2 that the new chair is going to place me on probation for unfounded grounds. I proceed to appeal that was held in December. I have been sustained and guided by the co-director open minded due to abnormalities of the program as his niece and my PGY 2 colleague had the same problem with pakistani and was forced to take leave of absence for one month and then vacation without any problems afterall. The new chair did not recognize his mistake and did not show up to my appeal. The ex-director said that it is incorrect but he can offer me counseling. I put the cards on the table and I reiterate the fact that I am going back to my prestigious institution to perform my education in peace and to preserve my outstanding background. I resigned after consulting an attorney that I am entitled to leave after one year according to the contract and to perform the rest of two in a different setting. By mid of February, due do my pressure at the faculty meeting, the chair changed his decision from probation to academic insuficiency (imagine with notes of 4,5,6,7,8,9) dated back with the date when the probation was issued adn said non- renewal of the contract after my resignation. Just a justification in front of the ACGME to explain my reason for leaving. I have been taken the in- service exam and got my credit for the year. By the end of the program in June, another complication occured due to lack of sign outs and a case report was issued in our floor virtual team and the chair send a case report to the GME, credential office and OP with my name on it. The program credential has been extended til April- May 2007 while ACGME is coming to the site visit to see if the new chair is compliant with the residency education.

I missed a contract for PGY 3 in a good program due to the fact that my previous program undermined me out though the ex-director was impressed that he helped me out.

Currently, I am back in my previous academic prestigious institution performing a research fellowship with two years of residency and applying for limited permit.

I am having some questions regarding this application:
1. shall I mention the "probation" as was changed in academic insuficiency with the same date dated back after my appeal?
2. what about my resignation? voluntary resignation? avoid any disciplinary action?
3. regarding the case report?any professional misconduct?

What are my chances of getting a PGY 3 next year while presently I am sustained and the director is good will.

I really appreciate your help to avoid future mistakes.
I am looking forward hearing from you.

Thank you.

[anatolyk]

First of all, I admit that I am not sure I got the story 100%. It is going to be very important to have your story presented in a shorter way, so that your new potential PD gets the digest of it.

It is not clear whether you are in Europe or in US fellowship.
Are you applying for in-training permit for a fellowship in the US?

If I were you I would try to read the story a few times and rephrase the sentences that are confusing to the reader. Another advise - when applying for PGY-3, do not talk bad about your old program. Stay positive. This is very important. You can mention incompatibilities with the PD, but nothing negative.


1. In your application you should mention whatever the official version is. However I am not sure if "academic insuficiency" is a disciplinary action.
2. If it was a voluntary resignation - than yes.
3. I am not sure what the case report involves as it is not clear from the description.

[Concerns]

Dear Anatolyk,
Currently, I am doing a research fellowship applying for limited permit in the US with two years of residency, one internship and looking in the long run for either PGY 3 spot or even PGY2.

The case report was about an elder patient with bad outlook and multiple complications and DNR afterall, an order about tube feeding was mistaken placed due to lack of supervision by the night team of a film and mistaken induced by the day shift nurse, patient was fed in the lung for 1 h and then all the staff invloved in the patient care recuperred the mistake induced by random, case intubated and recovered 10 days after though died 2-3 months of hospitalization.

So, voluntary resignation as I guessed.

[anatolyk]

What "limited permit" are you applying for? First I thought you are referring to "in-training" permit. But this does not seem to be the case.

[Concerns]

Dear Anatolyk,

Limited permit might be the in-training permit that are you referring to. There are two options, A while applying simultanoeusly for a license in the state or B while not applying on the same time. You can work with this unde supervision of a licensed physician.

[anatolyk]

I am sorry, but I still do not understand what are you referring to.
Whatever it is, when applying for any kind of license to the state medical board you must disclose all the disciplinary actions taken against you. The board will also require a letter from the PD at your old program to describe the reason for these actions.

[Concerns]

Dear Anatolyk,

Thank you for valuable input. Shall I consider the oficial version (academic deficiency) which might not be the case for disciplinary action and satisfactory completed the year. What about voluntary resignation vs. non- renewal. As you know I was entitled to live according to the contract but blemished by the chair.On the 360 degree he mentioned that I am going to pursue the residency in the same speciality in a city.

[Concerns]

Dear Anatolyk,

I am still reserved how to approach the problem to the state board. The initial probation was revoked after appeal and swiched to academic deficiency with the date back when the intial one was issued. Do I have to report the final version or not?

I appreciate your input.

[anatolyk]

Ot makes more sense now. You have to report academic deficiency then.

[Concerns]

Thank you Anatolyk.

[Concerns]

Dear Anatolyk,

I received the certificate from my previous program and also, a letter that I requested from my ex- PD which states that I was placed in academic deficiency not on probation (according to the final version after the appeal)but I corrected the deficiency and I have received credit for my year. Tough, I had a personal discussion with him and he said that it was inadequate and incorrect from the chair this action.

Regarding the patient, I have been called by the OP as they were investigating the case reported by the chair, a terminal DNR case. They are closing the case and they had a discussion with my ex- PD and he stated that there were many factors contributing to this accident and it was inadequate from the chair to place me on suspension (elective) for 1 1/2 week right before my leaving. OP said that this not going to be a disciplinary action or profesional misconduct. They will send me a confidential letter.

Question: shall I request a letter from the OP about this discusion or from the ex- PD about the inadequate actions of the chair?

[Concerns]

Dear Anatolyk,

I am having a residency interview in the same speciality. How to present the past problems and the reason for leaving. I guess that "incompatibilities" with the new chair is not enough.

Thanks.

[anatolyk]

This is more than enough. Just make sure to stay positive about your old program and do not blaim anybody. Be straightforward and just tell the way things are.

[Concerns]

Thank you Anatolyk.