Big updates to cover in this post, so lets get started

First and Foremost, I am no longer a resident physician. The committee who originally placed me in my current straits once again met, reviewed my performance and evaluations of the last 6 months of my remediation and decided I had sufficiently overcome any deficiencies (at least as defined by them) and could be allowed to graduate early, not being required to finish out the full year of remediation.

So for those of you who have followed me since I was just Josh, all the way from a young pre-med, to an idealistic medical student, through the slightly cynical almost Dr J through alternating optimistic and burned out resident Dr J, thanks for being along for the ride and I step into my future role as a staff/attending physician. 

The last six months I have worked my ass off, trying to demonstrate to people I cant stand and have little to no respect for that I am as good or better than the arbitrary standards they have set for me…and i have DONE it. No one was going to shorten my punishment out of the goodness of their hearts, I have forced them to acknowledge me in the only way I can.

A few excerpts from the last several months:

“Dr. D demonstrates clinical skills expected at his level of training. I found his knowledge base to be at or above his level of training as well; most questions I posed to the interns on the team which they could not answer, he was able to do so. Managing his team of interns, he was prepared for attending rounds, aware of the plan for each patient, and provided requested data when interns were unable. When asked to identify deficiencies in the interns for me to address, his specificity regarding this assured me of his adequate oversight over them. His efforts to communicate with patients and their families provided them confidence in our service’s abilities. As an attending physician on R-service I will often receive 1 or 2 afterhours calls from patients’ families inquiring about a patient’s condition, which was never the case with Dr. D as the resident. He demonstrated commitment to teaching as well, focusing on various topics during rounds to review with the interns and, without prompting, volunteered to present an article. On one occasion, a patient of ours became unstable. Dr. D directed the stablization of the patient calmly and with focused attention until her transfer to the ICU. In the time I worked with Dr. D it was evident to me he had overcome the deficiencies prompting his remediation”

“Dr D once again performed in a stellar fashion on this rotation. His management of each patient was appropriate and measured. He was well aware of the developments in each patient’s case, and handled them according to standard of care. He triaged patients well and was able to prioritize work. His documentation was concise, but showed the appropriate level of detail.  Teaching residents and medical students is a priority to Dr D: he puts time aside to do teaching sessions. He actively listens to all team members and tries to take into account the feedback of junior residents and students. I personally elicited the impressions of other team members of Dr D: they felt that he provided excellent oversight, taught well, and respected each and every one of them. Several of those team membetrs highlighted the fact that in this rotation, they received a higher level of quality teaching at the resident level, than on most of their other rotations. 

At the beginning of the rotation and throughout the rotation, I had offered Dr D several minor suggestions. Almost immediately, he attended to each of these suggestions and implemented them well, even better than can be expected. He was very receptive to any advice give, and did not any time, show resistance to being re-directed. Dr D readily admitted fault when necessary; he never shrunk away from responsibility.As on his last rotation with me, he functioned at a level much superior to many that graduated from residency last June. He showed a capacity to function masterfully at an attending level. I strongly believe that Dr D has demonstrated mastery of all core competencies. I am fully aware of the deficits in the past that necessitated remedial work; in my opinion, Dr D has done signifcant and sufficient work to remedy these problems. Hence, I confidently recommend him for graduation as of December, 2012. Furthermore, I endorse his candidacy for gastroenterology fellowship.”

Now they can all just suck it. That said, while my candidacy for gastroenterology fellowship was endorsed, it was not granted. I had hoped, but held realistic expectations. Although I had matched once into this program, the unfortunate reality is that GI is one of the most competitive fields to enter, and I had been amazingly fortunate to obtain a position the first time around. This time, I had no additional research, minimal updates to letters of rec as I could not exit my home facility to do electives, and a black mark against my name from being on probation that anywhere I applied would see. Almost, it is like checking off being an ex-convict on a job application-companies will look, but nobody really wants that risk around their office.

And so, I have achieved half my resolutions-I forced them to allow me to go in time to prepare for a GI fellowship I shant be getting. At least this year. I will take time to think if I wish to reapply yet again with all the baggage attached to my name now, or If i rather will enter the workforce, and begin my practice as a outpatient doc or hospitalist, start repaying my loans and living the life the universe has deemed fit for me.

While the whole situation has been terribly frustrating, I at least have the knowledge that I did make it once…ergo, I’m good enough, I’m smart enough, and gosh darn it, people like me! 

My official date of graduation is Dec 31st although my clinical duties the remainder of the month are mostly restricted to a couple clinic days and administrative educational activites. On Jan 1st, I begin the new year as a new doc, a new person, and who knows, perhaps we will cross paths one day. That said, the adventure will continue as I learn my way through the recruitment process and the first fumbling steps of a new attending, and I hope you will all still come back for regular visits with this virtual doc

-The Real Dr J