Featured, Opinions
Leave a comment

It Is Right to Leave: Rank List Decisions as a Minoritized Medical Trainee

Content warning: This piece contains descriptions of suicide. If you or someone you know is in crisis, please contact the National Suicide Prevention Lifeline at 1-800-273-8255.


“Look at what you taught me
And for that, I say
Thank you, next (next)”
–“Thank U, Next” by Ariana Grande

My fingers tense. Frozen not of my own accord. I want to do this, but I can’t. I need to do this, yet the anxiety grips at my mind and throat, stalling what should be an easy decision. I physically cannot do what needs to be done. My breath hitches. Thoughts I’ve had millions of times chase each other around my mind with gleeful abandon. As a Black, gay medical student in my fourth year, what I’m about to do has so many repercussions and permutations. So much so that I feel stuck, unable to be decisive when decisiveness is necessary.

It should be easy to certify my rank list. It should be easy to lock in my ranking of the 10 programs where I interviewed for psychiatry residency. It should be one of the easiest things I’ve done in medical school. Yet, after working towards this for over three years, strategizing my escape from the nightmare that has been the last few years, here I am, unable to click a simple button. All my heart has longed for has been to flee. To fly from Chicago and return to my friends from college and graduate school at MIT who still reside in Boston. To return home to their waiting arms. 

How could I not want to leave, especially after everything that’s happened?  

My tenure as class president in medical school has been the worst four years of my life. I once thought middle school and high school were the hardest years, with being called the N-word, homophobic slurs, and more. But those instances of discrimination were nowhere as nefarious when compared with interactions during medical school. Over my years here, I’ve seen and experienced how calculating some who are supposed to heal can be in their cruelty. 

I’ll never forget the meetings with administrators where my ideas were too often met with derision, only to watch those same ideas met with praise when presented by non-Black medical school classmates. I wish I could wipe from my mind when a classmate said, “People being discriminated against in medicine doesn’t happen anymore,” after telling me that being African-American and gay helped me win class president in recent history. There are too many such experiences to count. Sadly, I’ll remember them all acutely even years later. 

All of those occurrences cause my mind to break. Shatter. 

I’d lived with depression, anxiety and suicidal thoughts from seventh grade through college. Then, because of friendships and the supportive environment at MIT, I entered what friends fondly call The Golden Years. A two-year period as a graduate student at MIT where I had complete remission from my symptoms — I thought I was cured for good. Medical school proved that supposition wrong. My daily symptoms of depression, anxiety and suicidal ideation came back with a vengeance not six months into training. There was even a night during my third year where I made plans and had every intention to suicide. Sure, I’d enter a partial remission at the end of my third year through a combination of finding allies in medical school, old friendships, going to therapy for the first time, and taking antidepressants for the first time, but even in my fourth year my symptoms flare when I experience racism, homophobia or see others experience bigotry. 

There’s something that wounds more than all of those, though. 

I love my classmates, my younger classmates, the administration, this university. Even though being here destroyed my heart, even though too many of my classmates and administrators fractured my mind or were complicit with their silence, I don’t think I’ll ever stop loving every person I’ve met here. 

Even now, after everything, I have this deep, unending tenderness for every single person I’ve met in medical school. If I didn’t care, I wouldn’t have worked with others to help alter the curriculum and change parts that caused consternation for my classmates. If I didn’t think about them every moment of every day, I wouldn’t have done everything I could to support their wellbeing when two classmates died over the course of our second year. If I didn’t love them, I wouldn’t have continued to be their advocate even when personally facing bigotry at our institution. If I didn’t have an unrelenting affection for each of them, I wouldn’t have continued to let myself lose parts of my soul as I tried to inspire the best I forever see in all of us. 

Loving them doesn’t mean I don’t need to flee, though. So, I turn back to my rank list — my way out of this perpetual nightmare. 

Even with the depression in partial remission, ruminations seek to trap me like acidic webs:  

Everything that’s happened here is your fault. Stop. You didn’t ask to be discriminated against. If the past three years have taught you anything, you’re never going to fit in medicine. You fit, thrived, and were far and away accepted and loved at MIT; if a world like that can exist and be crafted by so many people, medicine can be like that too. Can it? Or was that simply a lucky aberration, never to happen again?  

Ignoring that last, most feared thought, I commence running my internal checklist one last time. Have I left my current institution off my rank list? Because I can’t stay — even if I did, I’m not sure I could ever unravel how I feel about being here, how those discriminatory events have bled into my every thought about being here: check. Did I ask during residency interviews about discrimination at their institutions and arrange them by their answers: check. Did I use my number one slot on the place that told me they hadn’t experienced significant issues and they’d support me if anything did happen first: check. Did I email that school to tell them they were my first choice: check. 

One stream of thought overrides all computations: Get out. Get home to your friends. With them, you can put yourself back together fully again. Like your friends said, you’ve done more than enough when you shouldn’t have had to do this much. You’re so close to the end. Get out. Run. 

As assured as I can be, I click the button. I certify my rank list. 

The years of calculations work. I match in Boston. Others and myself support my class through the final few months, then I gratefully set down the moniker of class president. I work with others to lay groundwork for the younger classes to hopefully continue the process of their path being easier than ours. I wrap up everything I need to do. 

Then I run. 

I run while looking, for all intents and purposes, triumphant. I fly back to the waiting arms of my friends with my arms open as well, the scars from the last four years mostly hidden. I return to the place that had once been and was again my home in the hope that I can repair my broken wings and heal my fragmented soul. 

Only to find myself in the exact same position three years later. 

Well, not the exact same. Now I’m a third-year psychiatry resident. My rank list for child and adolescent psychiatry fellowship sits open on my laptop. Around me, my colleagues, my residency classmates, my friends who are family in so many ways, converse during a break between lectures. Their words are in the background as I focus on my list. None of them know that panic is shooting through me like lightning, again. I’m stuck. I can’t submit my rankings. 

Why? 

Well, it feels like I’m playing out the same pattern I did in medical school. There’s this terror that I’m now eternally bound to a broken wheel. That knowledge frightens me to no end. I’m now pretty sure there may truly be no safe place for me to be a Black, gay physician who once was seen as so much more than only those facets of myself.

In psychiatry residency, trainees can stay for a fourth year. However, there is the option to “fast-track,” where you leave adult psychiatry residency after your third year to start your child and adolescent psychiatry fellowship early. 

I made the choice at the end of my second year to fast-track. I’m leaving early because this place has been one of the most threatening I’ve ever encountered as a minoritized person. If we went by the university’s own policy, I’ve been continually discriminated against. My colleagues who saw it happen have said it. My friends have said it. Later, I’ll even craft a 27-page document of all the events and everyone involved as proof — and send it to key people in the upper echelons of the university’s administration before I leave as a chess maneuver to protect myself — in case the university ever tries to attack me for writing about my experiences. Like I did for medical school, where I wrote a memoir about the whole four years, I’ll create that 27-page document as catharsis, preparation, and to use to help heal others as I utilize parts of the memoir and document for op-eds.

Although I know it wouldn’t be cute to attack a previous resident of your program who experienced discrimination, became depressed there, and is only writing about his story in a nuanced and thoughtful way to help others, this is America.

I must forever prepare and keep receipts, when all I want is to be left alone to breathe and heal.

And believe me, the choice to leave wasn’t easy. There is the eternal thought that I haven’t done enough, haven’t worked hard enough to change the bigotry here, One of my program directors described it as not even just my “second job,” but also my “third, fourth, and fifth job.” Forever on my mind is how, if the administration somehow gets my fellow colleague who is Black to stay, then they’ll say it was me, that I was the problem — even with other minoritized people in classes before mine continually leaving, too. As in medical school, I once more have this unyielding love for everyone here, for the best I see in us, for the work I have seen some put into changing the institution for the better. But it’s moving too slowly. It’s moving too slowly, and now I know better than to keep hoping. It’s too damaging to keep trying so hard without the support I need and have too often found sorely lacking.

Thus, I’m intentionally leaving early to escape this place of false promises where dreams are shattered.

I am leaving this place where it is dangerous to be a minoritized person who advocates, no matter how much our program tries to spin it.

These past three years in residency have been just as horrendous as the previous four in medical school. More devastating in some ways, less so in others, and alarmingly similar in others. This time the “hits” that crushed my sense of self mainly came from various attendings, staff and administrators. There was the attending who continually told me my answers were wrong even when I quoted directly from a book section they helped write, but lauded my white colleagues. A different attending tried to create a “clothing policy” for a rotation because I was “unprofessional” for not wearing a tie, when a white colleague who hadn’t worn one didn’t experience a single repercussion. 

I know that every minoritized trainee here has suffered instances of bias and discrimination. Even one was too many, and there have been hundreds if not thousands of similar events. 

My mind is once again damaged. I’m living through my third rodeo with the depression, anxiety and suicidal ideation. Though I know so much more about my mental health this time, I’m still depressed because of the constant discrimination and targeted blowback from daring to speak up. I’ll never be able to forget the morning my second year of residency where I planned my suicide in the shower as the passive suicidal ideation became very active after the constant discrimination and gaslighting. I’ll never have the luxury of forgetting how I still rush to the bathroom before rounds sometimes because I’m afraid of certain attendings.

I wish I could have just one day without a passive suicidal thought. 

Worse? This time I don’t know if my mind will ever be able to fully heal again like it did at MIT, even if I somehow manage to find a place where I feel safer.

You’ll never find a place that accepts you as yourself, a person who only wants to heal the world. You had that place. Good gods, you were happy once. You literally used to dance in the rain because you weren’t depressed anymore. What’s happened here is forcing you out. The discrimination here is chasing you from your home. You simply wanted to be home with your friends. No, that one’s accurate. When will you learn there’s no place for you to be truly safe in medicine? Please. There has to be a place where the minoritized don’t have to constantly struggle for a seat at the table, a table we continually fix and bear on our backs like the weight of the world. The place you have in first position was honest. You asked the right questions. You might be okay there. But I’ve been trapped before

Caught in consternation, I glance at one of my best friends in residency seated beside me. The man who is like a brother to me sees me. Truly sees me. He sees past the masks I wear to hide my anxiety. He’s the friend who I texted when I was crying on the way to a fellowship interview, scared fellowship would just be more of the same. He’s leaving early as well, like four others — six of us total — in our class of 16, and feels the same as I about our program for different reasons.  

Without a pause, he tells me it’s going to be okay. He gently tells me to submit my list. The certainty in his voice reminds me of something another colleague said a year before when I was deciding whether or not to leave for fellowship early: “If, even after all your efforts to make this place better, so many people here are still like this, what is staying here going to do? You’re going to end up burned out. And just think, why are you using all this effort on this place when you could be using it for people who really could benefit from your help, want your help, and need your help? What if you could’ve helped 50 people with all the effort you put into changing that one person, this one place?” 

And there it is. Something I often forget and am only starting to truly believe after these seven years. There’s one key factor among many that’s different this time. 

I’m different this time. The cards I deal, I now know how to deal faster. My masks I wear, the personalities I throw on every day to protect myself, are that much more honed and powerful. I now understand my mental illness is driven completely by minority stress. Every time I go through this mess, I get that much faster at adapting, finding allies, making changes. And, because of all those pieces of knowledge, I have finally remembered that I deserve more.  

I deserve to be happy. I deserve to be at a university where I’m not simply a diversity statistic, a fulfillment of some quota. I deserve to be somewhere where people don’t call minoritized individuals “unprofessional” as coded racism. I deserve to be at a program that doesn’t eventually force minoritized people to leave for their safety. I deserve to feel safe and supported. I deserve to not have to continually prove I’m right. I deserve to be at a place that doesn’t drive me to become suicidal. I deserve to be at a place that uplifts me as a person. I deserve to not be splashed across a website while my voice is silenced behind the diversity advertisements. I deserve to see who I can be as a physician without constant onslaught on my race or sexual orientation. I deserve to be at a university where the love I so naturally give is mirrored back. I deserve to be at a place where humility is expected, and apologies are not so sparing or never arrive. I deserve to be at a place where I am celebrated, not barely tolerated. 

I deserve that respect because every human being deserves to be respected. 

Our world deserves to have such “privileges” be the bare minimum. 

One final time, I run my internal checklist. A checklist I wrote specifically as a minoritized applicant trying to find a place where I could be happy, supported in every aspect of myself and my voice, free to be myself, and safe in equal measures.

Did I rank the place last where someone said they hadn’t heard of many issues around diversity: check. Did I rank first the place that my friends said I couldn’t stop talking about: check. Did I speak to at least three people at each university about diversity there: check. If I couldn’t find three people to speak with, did I recognize that enormous red flag: check. Did I rank places based on if they had diverse faculty: check. Did I rank places based on if the program leadership were able to speak to diversity with a level of comfort and didn’t hide issues, didn’t seem to be rushing to say how much they were doing around diversity, and had policies to help the minoritized: check. Did I rank programs based on leadership not tokenizing me: check. Did I realize the trap whenever someone said, “You could be the first” with regards to something around diversity: check. Did I better listen to my gut this time, instead of focusing solely on getting back to my friends and thinking of prestige: check.  

With one last deep breath, I click the button and certify my rank list. All while desperately hoping I’m not making another mistake. 

I match at my top program. Over the next few months, during the COVID-19 pandemic, I began my exodus from Boston. Saying goodbye for now to my new friends and my old friends once more, tears at my heartstrings — I can’t even say goodbye with one those hugs that say everything. Every one of them understands, but that doesn’t stop them from saying they wished I could stay, from being furious and sorrowful at the circumstances of my departure. We plan how to maintain the ties that bind us eternally as family. We have our last hangouts for the time being. But that’s a story for another day. 

Then I leave the place that has twice been my home. 

Tears cascade down my face the night I arrive in San Francisco. There is nothing that I want more than to fly back to Boston, back to my friends. Alone in my apartment, I cry myself to sleep and hope that I have finally made the right choice. 

That was six months ago. How are things now? 

For the first time in seven years, I am consistently happy about where I work and the work I do. I finally have time to write, and this serves as my fifteenth piece, this one written for applicants so they know they deserve happiness and to give them a possible checklist to make their rank list. Through Twitter, guest talks, and panels — one even done at one of my old institutions! — I’ve been fortunate enough to be able to reach the people I always wanted to help most: those who feel as though they don’t have a voice. The ties to my friends remain strong. My depression is in remission, my anxiety is mostly fading, and my mind is healing. I’m getting to repair my sense of self. Things are not perfect — for no place is, and I’m still very much in the beginning stages of healing — but for the first time in seven years I feel as though I belong. I feel fully supported and get to celebrate those around me. 

For the first time in seven years, I’m not continually planning how to flee. So far, there is no need to concoct an exit strategy. If this safer environment continues as it has, for the first time in seven years I’ll be able to do something I’ve longed for for a long time: I’ll be able to start planning what it means to stay. 

And just the thought of that perpetually brings a smile to my lips.  

Image credit: 32/365 by chattygd licensed under CC BY 2.0.


Editor’s note: Articles on in-House are the writer’s own and do not necessarily reflect the views or opinions of their educational institutions, in-House, the in-House editorial board, or Pager Publications, Inc., the supporting organization of in-House.

Chase T.M. Anderson, MD, MS Chase T.M. Anderson, MD, MS (3 Posts)

Fellow Physician Contributing Author

University of California, San Francisco


Chase T.M. Anderson is a child and adolescent psychiatry fellow at the University of California, San Francisco. He received his B.S. and M.S. from The Massachusetts Institute of Technology and an M.D. from The Northwestern University Feinberg School of Medicine. And he completed his residency training in adult psychiatry at Massachusetts General Hospital and McLean Hospital.