Mental health leave of absence

[mew]

Hi everyone, 

I had a tough time adjusting to medical school this year. I developed an eating disorder and was in an all around bad state mentally and physically. After 10 months on waitlists I was offered a spot in a treatment program last night, but accepting that spot would mean deferring my second year of med school and returning in August 2020 with the class below mine. I'm most concerned about the impact this will have on matching and, if I do match, on my ability to secure a license. I know that in a perfect world my health would come first, but with CaRMS as competitive as it is, I'm extremely wary to red-flag myself and sacrifice everything I've worked for. Plus I've heard some horror stories about the CPSO review process. Does anybody have any wisdom/experience in this matter?

Thanks!

[frenchpress]

9 hours ago, mew said:

Hi everyone, 

I had a tough time adjusting to medical school this year. I developed an eating disorder and was in an all around bad state mentally and physically. After 10 months on waitlists I was offered a spot in a treatment program last night, but accepting that spot would mean deferring my second year of med school and returning in August 2020 with the class below mine. I'm most concerned about the impact this will have on matching and, if I do match, on my ability to secure a license. I know that in a perfect world my health would come first, but with CaRMS as competitive as it is, I'm extremely wary to red-flag myself and sacrifice everything I've worked for. Plus I've heard some horror stories about the CPSO review process. Does anybody have any wisdom/experience in this matter?

Thanks!

I know a couple people in my year who deferred because of personal issues, or were held back. I don’t have personal experience with it, so my insight is somewhat limited. But my impression from their experiences is that you’re much better off all if you have taken a leave proactively as opposed to having to retake a year because you struggled and couldn’t keep up. 

My two cents - If you feel like you’re in a position now where you need help, and you have the ability to actually access some of the support and treatment that you need, then that seems like a priority. Even if you did manage to struggle through with the issues you’re currently facing this year - things will only get tougher, and it will become more difficult to take time away without impacting your match or licensing the deeper you get into your training.

But others may have more insight into the specific implications for the match and any issues you might have once you’re finished if you take a leave now.

Edited August 7, 2019 by frenchpress

[NLengr]

My advice: Talk to a lawyer about how much you have to disclose if you take a years leave of absence. Don't lie, but don't offer any more information than is absolutely legally required. The school, residency program or the college may act like they want to help you, but I have only seen people get screwed over in those situations.

Get the care you need but always protect yourself, because nobody else will do it. As bad as it sounds: trust nobody in administration.

 

[freewheeler]

1 hour ago, NLengr said:

My advice: Talk to a lawyer about how much you have to disclose if you take a years leave of absence. Don't lie, but don't offer any more information than is absolutely legally required. The school, residency program or the college may act like they want to help you, but I have only seen people get screwed over in those situations.

Get the care you need but always protect yourself, because nobody else will do it. As bad as it sounds: trust nobody in administration.

 

This ^^^. Always disclose the minimum possible. Exercise caution around any admin. Don't talk about it with your preceptors.

[ChemPetE]

My two cents being a recent grad in a small, middle of the road specialty (and no further mental health rotations since med school mandatory ones)

Take the time off to be well. Those treatment programs are hard to access, and have the best chance at helping you recover and maintain resiliency long term. Eating disorders carry a non-significant mortality and morbidity, and sub optimally treated combined with the rigours and inhumane stresses of medical school you may find yourself in a rough or worse spot. 

Long term, what will be most important to you is your health, not on how fast you completed medical school. It’s more common than you think to have to take time off for both physical and mental illnesses, and this is one of the ones that will transcend both. 

If you decline the program now but find your symptoms worsen while in clinicals or in residency, that just makes it that much harder to get a successful match/career. Imo M2 is far enough from Carms that I don’t see it impacting things. I’m not saying this lightly, but people would take time off for cancer treatment, and I would put this in the same category. Focus on your wellbeing and maximizing that, which in turn will maximize your success ongoing. I’ve reviewed enough CaRMS applications and been on the other side of the process to see that what matters most is research/recommendations/personal statements and not a year off for non-professional reasons. My program has taken multiple applicants who have needed an extra year for whatever reason, be it academics/health/whatever. And like NLengr said, keeping details brief but professional can help, and no one can bat an eye. Some discretion can help, such as documentable physical illness and then no one should bat an eye. I can’t comment on the licensing aspect, but as much as a pain it is to answer that yes here have been issues in the past, the colleges just want to know you’re well. For the people I know PERSONALLY that have taken time off for mental health issues at some point or another during training, it’s not been an issue for them to practice or get jobs/licenses after residency.

I can’t speak for hypercompetitive specialties, but I can’t imagine that this would exclude you from those. What I can imagine is things getting worse and your performance suffers and then doors start closing. 

So take the time and treatment, start a year later, and when you come out on top, even if it’s a bit early, you can use the time to shadow/research/etc and *those* things *will* have a material impact on your carms apps in the future. So while there is a monetary opportunity cost here, I think the personal risk could can be quite high in eating disorders without treatment, and would take the offer presented.

Just one opinion. I hope things go well for you and treatment helps. Also like NLengr, look after yourself, but also don’t forget to love yourself too.

[Birdy]

I think you reached out to me on another platform so I won’t repeat here what I said there. Tread cautiously but get the care you need.  I wish you well. 

[blah1234]

I have seen too many colleagues get burned for disclosure. Never reveal more than you have to. The profession does not treat mental health kindly and can heap on additional stress that you don't need. 

[LittleDaisy]

On 8/7/2019 at 5:33 AM, mew said:

Hi everyone, 

I had a tough time adjusting to medical school this year. I developed an eating disorder and was in an all around bad state mentally and physically. After 10 months on waitlists I was offered a spot in a treatment program last night, but accepting that spot would mean deferring my second year of med school and returning in August 2020 with the class below mine. I'm most concerned about the impact this will have on matching and, if I do match, on my ability to secure a license. I know that in a perfect world my health would come first, but with CaRMS as competitive as it is, I'm extremely wary to red-flag myself and sacrifice everything I've worked for. Plus I've heard some horror stories about the CPSO review process. Does anybody have any wisdom/experience in this matter?

Thanks!

I would advise that you take a year off for the treatment program. You will have to speak to the undergraduate wellness director, who should have some sense of your medical condition, as you will require to provide letters and documentation of why you need 1 year medical leave.

As far as clerkship is concerned, depending on how your treatment goes, you might need accommodations with less call duties. I knew a few medical students who received accommodations and who matched well to moderately competitive specialties.

I think that it's better that you proactively take your time off rather than passing out during exams and during clerkship rotations, where the UG Dean will get involved sooner or later and put you on a mandatory leave. 

For CPSO, I know that Nlengr asked you to consult a lawyer. Unfortunately, they ask during Postgraduate CPSO license renewal: have you ever taken a medical leave during medical school, or something along the line have you taken a leave during medical school-> if yes--> please justify? You will have to click yes, they will usually require you to disclose your medical information to the college (unless you take a short leave for something like appendicitis or fracture). They might get PHP involved for monitoring, but PHP is usually on the physician's side unless you don't show up for appointments, not compliant with treatments etc. 

But that's too far down the road to worry about CPSO for now. I would say focus on your wellness and get the treatments that you needed. Struggling with eating disorders can be extremely hard during medical school & residency, I have a few friends who were put on mandatory leave because they passed out in rotations. I don't want you end up being that person because you don't want to seem "weak" or take "medical leave". 

Bottom line with CPSO, for every resident out there who has a medical condition and who has taken a medical leave,  you will have to disclose to CPSO, and it will go to the registration committee who will ask you to be involved with PHP. The best advice is to apply early, and call PHP proactively to get monitoring set up. The Registration committee have delayed a few residents' license with medical conditions because they want the PHP monitoring to be set up before you can return to residency training. But you will get your license, and if you act proactively, it should be issued on time. It will be a lot of bureaucratic process to jump through, but I've heard that PHP is overall helpful and advocate for your training and wellness. 

In term of disclosing, you will have to disclose perhaps your specific medical condition to the Wellness director at your university. Beyond this person, I will not disclose what is your medical condition to anyone ELSE. As medicine is ultra-competitive as it is, a medical student or resident with medical condition or disability are viewed differently and sometimes in a negative way, even though you have to work extra hard to be where you are right now with your eating condition. 

Best of luck and first of all, be kind to yourself. 

[Vivieeeeeee]

I can't contribute anything information wise but I just want to wish all the best for you. As "fake" as it sounds, no amount of achievement/money earned is worth if it means losing our physical and mental well-being. I have experienced an extremely traumatic personal event in my undergrad which resulted in a year of suboptimal performance due to a bad mental state, and I am extremely grateful that my med school did not deem me unworthy because of it. In a way, I was once in your shoes to some extent and I can relate to how awful that feels. Even if not all residency selection committees believe this, you have to believe that your worth/talents as a doctor is in no way diminished because you proactively, unapologetically took time to look after your damn self before you take care of your patients.

Good luck 

[brady23]

3 hours ago, Vivieeeeeee said:

I can't contribute anything information wise but I just want to wish all the best for you. As "fake" as it sounds, no amount of achievement/money earned is worth if it means losing our physical and mental well-being. I have experienced an extremely traumatic personal event in my undergrad which resulted in a year of suboptimal performance due to a bad mental state, and I am extremely grateful that my med school did not deem me unworthy because of it. In a way, I was once in your shoes to some extent and I can relate to how awful that feels. Even if not all residency selection committees believe this, you have to believe that your worth/talents as a doctor is in no way diminished because you proactively, unapologetically took time to look after your damn self before you take care of your patients.

Good luck 

So well said. 

[mew]

Thanks everyone for your feedback on this issue. 

On 8/8/2019 at 2:18 PM, NLengr said:

My advice: Talk to a lawyer about how much you have to disclose if you take a years leave of absence. Don't lie, but don't offer any more information than is absolutely legally required. The school, residency program or the college may act like they want to help you, but I have only seen people get screwed over in those situations.

Get the care you need but always protect yourself, because nobody else will do it. As bad as it sounds: trust nobody in administration.

 

On 8/8/2019 at 3:31 PM, freewheeler said:

This ^^^. Always disclose the minimum possible. Exercise caution around any admin. Don't talk about it with your preceptors.

On 8/11/2019 at 12:50 PM, blah1234 said:

I have seen too many colleagues get burned for disclosure. Never reveal more than you have to. The profession does not treat mental health kindly and can heap on additional stress that you don't need. 

For better or worse, the preclerkship lead and dean of student affairs are already aware of my issues, as I have been communicating with them since early M1. They have been very supportive and accommodating of my issues through first year but I sense their patience for me is running out fast.  

On 8/11/2019 at 11:48 PM, LittleDaisy said:

But that's too far down the road to worry about CPSO for now. I would say focus on your wellness and get the treatments that you needed. Struggling with eating disorders can be extremely hard during medical school & residency, I have a few friends who were put on mandatory leave because they passed out in rotations. I don't want you end up being that person because you don't want to seem "weak" or take "medical leave". 

Essentially everyone in my life has advised me to take the leave, but I find myself unable to actually initiate the process. I'm realizing that I have been struggling immensely with impostor syndrome- that I didn't really earn my seat, that I don't stack up to my peers, that I'll be a bad doctor- and that taking the leave will be the ultimate confirmation that I don't belong here. On one hand I feel like I need to "push through" to prove to myself I can cut it but on the other I'm starting to rethink my decision to go into medicine and wonder if there isn't another career I may be better suited for.

Thanks again all for your feedback and advice on my situation. 

[frenchpress]

1 hour ago, mew said:

Thanks everyone for your feedback on this issue. 

For better or worse, the preclerkship lead and dean of student affairs are already aware of my issues, as I have been communicating with them since early M1. They have been very supportive and accommodating of my issues through first year but I sense their patience for me is running out fast.  

Essentially everyone in my life has advised me to take the leave, but I find myself unable to actually initiate the process. I'm realizing that I have been struggling immensely with impostor syndrome- that I didn't really earn my seat, that I don't stack up to my peers, that I'll be a bad doctor- and that taking the leave will be the ultimate confirmation that I don't belong here. On one hand I feel like I need to "push through" to prove to myself I can cut it but on the other I'm starting to rethink my decision to go into medicine and wonder if there isn't another career I may be better suited for.

Thanks again all for your feedback and advice on my situation. 

One thing to keep in mind is that, if you take a leave, you don’t have to come back. Even if you’re already feeling like maybe medicine isn’t for you, the leave gives you some space to recover and think about what you’d like to do without some of the current pressure that it sounds like you’re feeling right now. After you’ve had a chance to seek treatment and had some space, you may want to return and you’ll likely be much more personally equipped to do so and succeed. Or you may have had even more time to realize that you really are better suited for another career, and at least then you might feel a bit more confident about a choice to withdraw. 

[LittleDaisy]

2 hours ago, mew said:

Thanks everyone for your feedback on this issue. 

For better or worse, the preclerkship lead and dean of student affairs are already aware of my issues, as I have been communicating with them since early M1. They have been very supportive and accommodating of my issues through first year but I sense their patience for me is running out fast.  

Essentially everyone in my life has advised me to take the leave, but I find myself unable to actually initiate the process. I'm realizing that I have been struggling immensely with impostor syndrome- that I didn't really earn my seat, that I don't stack up to my peers, that I'll be a bad doctor- and that taking the leave will be the ultimate confirmation that I don't belong here. On one hand I feel like I need to "push through" to prove to myself I can cut it but on the other I'm starting to rethink my decision to go into medicine and wonder if there isn't another career I may be better suited for.

Thanks again all for your feedback and advice on my situation. 

I know a few people who struggled with eating disorders. They were thinking that medicine contributed to their eating disorders and wondered if there were another career out for them. After taking a medical leave, they come back as stronger medical students and residents and more committed to medicine. I won't advise that you quit medicine at this moment given how vulnerable you are and you might regret your decision. Given that your dean is aware of your case, they might even advocate or strongly suggest for a leave, they don't want you to push through your second year of medical school being not well. Please worry about one step at a time, I know that it's difficult to do in our career where we all think ahead. 
Best of luck!