HI,
I am about to finish a residency in a different specialty, and I consider to apply for an ophthalmology residency thereafter.
Anybody out there who has done an ophthalmology residency as a second residency? I am curious about experiences.

I have heard that government-funded residency positions are limited to 5 years of training. Thus, if one were to start ophthalmology as a second residency, the program would need to fund most of that residency with own means. Would that minimize chances?
Or is it almost impossible to do ophthalmology as a second residency?
Thanks!
Xel9

I don't think that it's impossible at all to go back to do ophthalmology after you have finished a separate residency. I know two individuals who have done so and if anything I think it makes them even better ophthalmologists as I think they do a better job managing the whole patient rather than treating them as if their eyes existed in a vacuum.
Just my opinion, but I don't think that it will hurt you.
Regarding the 5 year limit, I think that applies only to one residency...meaning if you were to go back to a separate residency you would be OK if the cumulative time is more than 5 years as long as ONE residency is not more than five total - don't take that as gospel truth though. Just think of all the people who switch from one program to another in mid-stream, many of them accrue more than 5 years total training to finish residency, but each program is less than 5 individually.

Thanks for this quick reply!
I agree with you, and I also guess that especially many people who started out in surgery switched to other specialties after 3 years or so. However, some people told me that it is the total of 5 years and not 5 years per residency. Is there a way to find that out with more certainty?
I am not sure who would be the proper source that I should talk to.
Thanks!
AGM6

It's not a 5 year limit but can be 3-6 years.

The federal government funds residency programs through a complicated system called indirect and direct payments. In short, if you start out in internal medicine, a 3 year residency, then your first 3 years of residency gets full funding. If you started in an integrated plastic surgery residency, then 6 years is funded. If you're one of those plastic surgery residents and did 2 years of the integrated plastics program, you could switch to, say, ophthalmology and do 3 years of fully funded residency. If you're a medicine resident that did 2 years of medicine, then not all the ophthalmology residency years will be fully funded.

On the other hand, the amount of reduced payments that a hospital receives if you are not fully funded is not very much. Some program directors use the funding situation as an excuse not to take a resident. In fact, the vast majority of funding is not affected by prior residency training.

I have known of people who have switched into ophtho thorugh different methods:
-Matching into a medicine prelim, going through the ophtho match again
-Doing 2 years of surgery, a year of ophtho research, and matching
-Matching after 2 years of Internal Medicine residency
-Doing an IM residency, even publishing a review book, and switching

Some questions I'm wondering too:

Do ophtho programs look more highly at surgical applicants than medicine because on average the surgeons might have better board scores and surgical experience, and would be less likely to burn through their funding allocation?

Would they look at an app if you've done residency plus a fellowship in another specialty? What about if you've been out in practice for 10 years? Switching mid-career?

And I wonder which programs will cover the difference if you aren't fully funded...I doubt this is public information.

The ophtho PD at my med school told me that I could do 10 residencies and they'd still look at the application...I don't think I'm gonna test that assertion!

This is encouraging!
So I guess this means, you would not drop out of a current residency that you could finish while you are applying for the Ophthalmology spot, just to not accumulate funding years?

P.S.: Do you think the bigger and more competitive programs, such as MEEI, would be more flexible regarding this 5-year funding issue (simply being a larger institution), or would they be rather more strict (simply because they get more highly qualified applicants who rank them highly)?

Anyone knows of people at the larger programs who have done a previous residency in the US?

Thanks!

This is encouraging!
So I guess this means, you would not drop out of a current residency that you could finish while you are applying for the Ophthalmology spot, just to not accumulate funding years?

P.S.: Do you think the bigger and more competitive programs, such as MEEI, would be more flexible regarding this 5-year funding issue (simply being a larger institution), or would they be rather more strict (simply because they get more highly qualified applicants who rank them highly)?

Anyone knows of people at the larger programs who have done a previous residency in the US?

Thanks!

Why would you drop out of a current residency? If you don't match ophtho then you'd be out of a job. Yes the gov't funding is a bothersome issue that I wish we didn't have to deal with, which discourages people from switching fields.

The more competitive programs have better funding, so I think that would be less of an issue for some, but yes the applicants are more competitive so unless you have something on your app that's above and beyond, then by merit it would still be hard to get an interview much less be ranked to match...personally I'm waiting for ophtho to become less competitive before I think about trying...

I have heard that government-funded residency positions are limited to 5 years of training. Thus, if one were to start ophthalmology as a second residency, the program would need to fund most of that residency with own means. Would that minimize chances?

Here is how residency funding works:

The goverment gives 2 types of money to the hospital 'direct' GME payments (DGME) and 'indirect' GME payments (IGME). On average, DGME is $30.000/year, IGME is $70.000.

The length for how long the goverment fully pays for a particular social security number in connection with residency is limited by the length of the residency the resident started first. So for IM it would be 3 years, for ophtho 4 and for general surgery 5 years.

After that time is up, the DGME payment gets cut in half, the IGME payment remains the same. So once you exceeded your funded length (your 'initial residency' in the goverments lingo), the payment to the hospital goes from something like 100k to 85k.

Many residency programs don't care, some can't hire residents who are beyond the full funding due to a veto from administration.

Here is a brochure from the american association of medical colleges on this issue:

http://www.aamc.org/advocacy/library/gme/dgmebroc.pdf

Thanks, that's is excellent information!

If the direct GM costs are cut in have after the initial residency period, it seems to me that all fellowship trainings would be affected by this? Then, programs would have to deal with this issue all the time.
It seems to be that in reality programs would have to find funding only for a relatively small part of the resident who starts a second residency, and thus it should be not much of an issue if the program really likes the particular applicant?

More specific question: does anyone know if MEEI in Boston supports residency applications for people who have done a residency in a previous specialty before?

Thanks!
xel9

If the direct GM costs are cut in have after the initial residency period, it seems to me that all fellowship trainings would be affected by this?

That is why in some specialties fellowships pay less than residencies (e.g. some medicine fellowships require the first year fellows to apply for nih training grants in order to pay the second years salary).


Then, programs would have to deal with this issue all the time.

In the old days, they had to deal with this every time someone did his intern year at a medicine program rather than a transitional year. The rules got changed, but residency directors are usually familiar with the issue.

and thus it should be not much of an issue if the program really likes the particular applicant?

It tends to be administration that objects to hiring of residents who don't have enough funding left. I had that issue, but my residency director managed to persuade them somehow (stubborn old irish guy).