Gov't reimbursing hospitals for training residents

[Chief Resident]

Can somebody set me straight on how it works that the government pays hospitals for training residents for a certain number of years and if the resident exceeds those years then the gov't doesn't pay the hospital anymore for training that resident?

I heard this works only if you as a resident start a residency that leads to board certification (categorical resident in FP, IM, General Surgery,etc.) but not if you are an undesignated prelim resident in say surgery. So does this mean you can keep doing an undesignated prelim residency and those years won't count towards your gov't reimbursement years since you're not in a categorical program?

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[Miklos]

Can somebody set me straight on how it works that the government pays hospitals for training residents for a certain number of years and if the resident exceeds those years then the gov't doesn't pay the hospital anymore for training that resident?

I heard this works only if you as a resident start a residency that leads to board certification (categorical resident in FP, IM, General Surgery,etc.) but not if you are an undesignated prelim resident in say surgery. So does this mean you can keep doing an undesignated prelim residency and those years won't count towards your gov't reimbursement years since you're not in a categorical program?

I don't have the answer to your question, but I think that you might find it here http://www.aamc.org/advocacy/library/gme/gme0001.htm and http://www.aamc.org/advocacy/library/gme/dgmebroc.pdf

 

[southerndoc]

Chief Resident (oddly how you're a chief and do not know this -- haha), here is the scoop:

The federal government pays each program a set amount of money, based on the program, number of residents, etc. It usually comes out to between $90,000-$120,000 per resident per year.

They pay only for "designated years," which basically means the years leading to your board certification. Preliminary years do not count as far as I know. The program sets minimum qualifications needed for each residency (i.e., emergency medicine, 3 years; general surgery, 5 years; internal medicine, 3 years; OB/gyn, 3 years (not counting the preliminary year); etc.).

If you exceed those years, then the program eats the cost. It doesn't matter if you extend it, the program requires you to stay extra, or the program requires all residents to spend additional time. Surgery residents who are required to do 2 years of research (i.e., a 7-year program) are at a program that eats the cost for the extra 2 years. My emergency medicine program is 4 years in length, so my program pays our fourth-year salary out of their own pocket.

Because of this, you'll find that most community programs adhere to the standards strictly. Large, academic programs have more flexibility in lengthening programs because they have large cash endowments that help offset the cost.

 

[Chief Resident]

They pay only for "designated years," which basically means the years leading to your board certification. Preliminary years do not count as far as I know.

Does this mean a resident can go from hospital to hospital as an undesignated prelim or stay at the same hospital in a prelim spot indefinetly? Not that it would be a good idea, but technically speaking couldn't they do so?

 

[Museless]

No - because "prelim" is by definition PGY-1 and once you complete such a year successfully, you won't be a PGY-1 in that field again.

 

[Chief Resident]

No - because "prelim" is by definition PGY-1 and once you complete such a year successfully, you won't be a PGY-1 in that field again.

What about those general surgery residents who repeat a prelim PGY1 one or more times until they finally land a categorical PGY1 spot in general surgery?

 

[Miklos]

Chief Resident (oddly how you're a chief and do not know this -- haha), here is the scoop:

The federal government pays each program a set amount of money, based on the program, number of residents, etc. It usually comes out to between $90,000-$120,000 per resident per year.

They pay only for "designated years," which basically means the years leading to your board certification. Preliminary years do not count as far as I know. The program sets minimum qualifications needed for each residency (i.e., emergency medicine, 3 years; general surgery, 5 years; internal medicine, 3 years; OB/gyn, 3 years (not counting the preliminary year); etc.).

If you exceed those years, then the program eats the cost. It doesn't matter if you extend it, the program requires you to stay extra, or the program requires all residents to spend additional time. Surgery residents who are required to do 2 years of research (i.e., a 7-year program) are at a program that eats the cost for the extra 2 years. My emergency medicine program is 4 years in length, so my program pays our fourth-year salary out of their own pocket.

Because of this, you'll find that most community programs adhere to the standards strictly. Large, academic programs have more flexibility in lengthening programs because they have large cash endowments that help offset the cost.

You sure about this?

The brochure says this:

8. I intend to train in a specialty that requires me to complete a prerequisite year in another specialty. How will this affect my initial residency period limitation?

Some specialties require a year or more of generalized training
in a specialty other than the one in which you are seeking
board certification. Since the law requires that the initial residency
period be determined at the time a resident enters a
training program, your initial residency period will be based
on the specialty that you begin training in even if you ultimately
intend to train in another specialty. For instance, if
you begin training in internal medicine your initial residency
period is 3 years even if you intend to train in another specialty
which requires a total of 4 years of training, such as
anesthesiology. In this example, you will be weighted as a
0.5 FTE for your fourth year of training. Some programs, however,
are accredited as transitional year programs. Typically,
transitional year programs can be used to meet the required
year of generalized training. HCFA has said that it will count
training in a transitional year program as an additional year
beyond the initial residency period at a full FTE if the resident
has chosen a career specialty that requires as a prerequisite
an entry year of fundamental clinical education. Continuing
with the earlier example, if you complete the transitional
year and then do 4 years of training where a total of 5 years
of training is required, you can be counted as a full FTE for up
to 5 years of total training. If there is not a requirement of a
year of basic clinical training and you desire to complete a transitional
year program because you desire a broader base of
clinical experience, the transitional year will count
against your initial residency period and could result in
you being counted as a 0.5 FTE for the final year of subsequent
clinical training.

 

[fedor]

Chief Resident (oddly how you're a chief and do not know this -- haha), here is the scoop:

The federal government pays each program a set amount of money, based on the program, number of residents, etc. It usually comes out to between $90,000-$120,000 per resident per year.

They pay only for "designated years," which basically means the years leading to your board certification. Preliminary years do not count as far as I know. The program sets minimum qualifications needed for each residency (i.e., emergency medicine, 3 years; general surgery, 5 years; internal medicine, 3 years; OB/gyn, 3 years (not counting the preliminary year); etc.).

If you exceed those years, then the program eats the cost. It doesn't matter if you extend it, the program requires you to stay extra, or the program requires all residents to spend additional time. Surgery residents who are required to do 2 years of research (i.e., a 7-year program) are at a program that eats the cost for the extra 2 years. My emergency medicine program is 4 years in length, so my program pays our fourth-year salary out of their own pocket.

Because of this, you'll find that most community programs adhere to the standards strictly. Large, academic programs have more flexibility in lengthening programs because they have large cash endowments that help offset the cost.

How about fellowships? Does the government pay the programs anything or do the programs pay the fellows out of pocket?

 

[f_w]

I allways understood it in the way how Miklos quotes it from the AAMC brochure. This is also how the director of GME at my residency hospital explained it to me a couple of years ago (and she was in charge of writing the GME budget, so she should know).

It doesn't matter whether your PGY-1 in IM or GS is a designated prelim spot, after all it CAN be credited towards board eligibility and therefore triggers the clock. The only type of program that doesn't trigger the 'initial residency' clock is a TY.

 

[f_w]

How about fellowships? Does the government pay the programs anything or do the programs pay the fellows out of pocket?

Most fellowships, the hospital pays you out of patient care revenue. Sometimes the faculty practice plan will chip in, after all you are taking their call. Some of the incredibly long IM fellowships have some NSF or NIH funding for the higher years (restricting access to these fellowships for non-citizens).

 

[southerndoc]

How about fellowships? Does the government pay the programs anything or do the programs pay the fellows out of pocket?

Most fellowships, the hospital pays you out of patient care revenue. Sometimes the faculty practice plan will chip in, after all you are taking their call. Some of the incredibly long IM fellowships have some NSF or NIH funding for the higher years (restricting access to these fellowships for non-citizens).

As Miklos pointed out, apparently I'm wrong about the prelim year thing.

Fellowships are usually paid for by the program. Almost all require you to work clinical hours as an attending, and that's where you actually earn your pay.

There are some government-funded fellowships (like a lot of tox programs). Those do not require clinical hours.

 

[Chief Resident]

The only type of program that doesn't trigger the 'initial residency' clock is a TY.

Then does that mean you can keep doing a TY at the same hospital or different hospitals year to year indefinetly and your funding will never run out?

 

[Idiopathic]

Then does that mean you can keep doing a TY at the same hospital or different hospitals year to year indefinetly and your funding will never run out?

I think that CR is really interested in this as a career, no?