switching specialties, funding question

[medsend]

I graduated from a US allopathic med school, completed internship, and am now in my PGY-2 year of an advanced field. I have 3 more years in this field.

In the past year, I have decided I would rather do psychiatry. It is too late in the application cycle currently and I have not had much luck in finding an open psychiatry spot in the location I need to be in (location limited due to family). I am planning on applying to psychiatry in the upcoming ERAS cycle. I have two options:

1) quit my current residency in the field I am in and retain whatever GME funding I have for psychiatry residency (PGY 3-5 left).
2) continue onto my PGY 3 year, interview for psychiatry during this time. By keeping my residency spot, I don't have to pay back my loans and I would have a stable source of income. I would lose my GME funding for the PGY 3 year though. This year would also be miserable as I really dislike my field and the fact that I am away from family…

My PD is aware of all this and supportive. I would leave the program in a lurch by quitting.

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[NotAProgDirector]

Don't worry about the funding. Make the decision based upon financial / family issues.

 

[MadHopsMD]

The general rule is that the hospitals get two funding: one from the federal government (Medicare) and one from states. Each resident on average provides the hospital with 250K.
Some hospitals get ALL the funding for the residents through one stream mostly Medicare. But certain MANY programs get from the states too.

Here is the thing that is important to you. If you are Advanced field that is 5 years long than Medicare will only support you for 5 years. No extra years. BUt as I mentioned that many programs also get money from states too. So the PD will substitute that income from your final years from the state.

Sometimes the schools can save money as well as granting you some credit (eg. surgery/ICU months) so you can graduate early (even though PDs dont like doing this because of coverage issues). But heck you can start earning earlier than your classmates.

Hope that is clear to you. I can explain it again if you wish. BUt the bottom line is DO NOT WORRY. Especially as an american grad who is going into a less competitive speciality, you should really have no problems.

If you are faculty is behind you, I would continue working. But, you going to cause lots of headaches for them. Eg. coverage issues when you go interviewing again. Have you thought of looking at opportunities for paid research at your school or the one you graduated at? It might be a more relaxing year with some potential of poking your head/opening doors at the psychiatric field instead of a miserable surgical year. Plus it would be helpful for some transferring student who is looking to get into your program out there who really wants to do surgery

P.S I am presuming its surgery because of the 5 years.

 

[Winged Scapula]

The general rule is that the hospitals get two funding: one from the federal government (Medicare) and one from states. Each resident on average provides the hospital with 250K.
Some hospitals get ALL the funding for the residents through one stream mostly Medicare. But certain MANY programs get from the states too.

Here is the thing that is important to you. If you are Advanced field that is 5 years long than Medicare will only support you for 5 years. No extra years. BUt as I mentioned that many programs also get money from states too. So the PD will substitute that income from your final years from the state.

There are some inaccuracies above.

Although GME funding is complicated and there are several sources of funding, the Centers for Medicare & Medicaid Services (CMS) is the largest funder of GME training through its Medicare and Medicaid programs. State funding usually comes from Medicaid programs as we'll. There are two types of payments:

Direct payments (DME): These payments cover a portion of the direct costs of training residents, including stipends, teaching physician and resident salaries and benefits, and educational activity costs. DME is based on a prospectively determined per-resident amount, weighted FTEs, and Medicare patient load.

Indirect payments (IME): These payments compensate for the anticipated higher cost of care in teaching hospitals based on the ratio of FTEs to hospital beds. A portion of these funds are disproportionate care funding, which subsidizes inefficiencies in training.

Additional federal agencies, such as the Departments of Defense and Veterans Affairs, as well as the National Institutes of Health and the Health Resources and Services Administration also contribute funds to GME. Indirectly, private insurance companies pay toward funding GME as they tend to reimburse teaching hospitals at a higher rate than other hospitals.

When divided per resident in training, this level of support equals close to $100,000 of funding per resident per year, not $250,000.

The "initial residency period" (ie, when terminal training is entered), is funded at 100% of DME and IME. Once you have exceeded your IRP (say by doing a fellowship or switching residencies), DME is still funded at 50% and IME at 100%. Funding is available from CMS sources, just at a reduced rate. If you are a desirable candidate, then there are programs for whom the reduction in funding will not matter.

Sometimes the schools can save money as well as granting you some credit (eg. surgery/ICU months) so you can graduate early (even though PDs dont like doing this because of coverage issues). But heck you can start earning earlier than your classmates.

In most cases, residents switching fields should not count on being credited enough months to allow them to complete residency early. This is particularly the case when switching between 2 very different fields with different board requirements for length of training and required rotations. Worth asking about but may not be granted.

Finally, I believe the OP is thinking of switching from Rads (based on prior posts) not Surgery.

 

[gutonc]

There are some inaccuracies above.

It's only mid-February but I'm just going to go ahead and call it. SDN understatement of the year, 2014.