residency - funding eligibility

zinjanthropus · Oct 22, 2006

Hello:

After poking around on a couple of FAQ sites for some residency programs I am considering, a question arose. A number of institutions note that they do not accept anyone switching from another residency program in a seperate speciality if they do not have enough "remaining eligible funding".

How does funding for an individual work during residency? More specifically, say you match into general surgery (5 years) - does this mean that you have been given 5 years of ACGME funding? If you decided to switch specialties 2 years into your general surgery residency, does this mean that you would have up to 3 years left on your eligibility? How about vice versa - e.g. starting you in IM (3 years) and trying to switch to gen surg - does this mean you would not have enough funding eligilibility remaining to do so?

I have never considered how any of this works before, so any insight would be appreciated. Thanks!

Bevo · Oct 22, 2006

basically that is my understanding. Once accepted into a residency that is how much training funding you get. So moving from a 3 to 5 year residency would require the hospital pay you for those extra 2 years instead of the government.

Normally each hospital gets paid like $200,000 per resident and they give a portion of that to the resident. Essentially the hospital would have to come up with that money if the acgme won't cover you.

So instead of making money off of you, they'd lose money.

NotAProgDirector · Oct 23, 2006

You are mostly correct.

Once you "declare" a field by starting training, the federal gov't locks you into the minimum number of years of funding to obtain board certification in that field. So, as the previous poster mentioned, if you start as a surgeon you get 5 years of funding -- if you change your mind and switch to Medicine, you get to keep that 5 total years. If you start in IM and switch to medicine, you only get the 3 years of funding.

If you do a transitional / prelim year, you use a year of funding but you don't get capped until you start in your true field.

Here's where it's not so clear: Gov't funding comes in two flavors -- DME (Direct Medicine Expense) and IME (Indirect Medical Expenses). DME is supposed to pay for resident salary and benefits. IME is supposed to pay for the "invisible" costs of training residents -- variously translated as overordering tests, ineffiencies in the system, caring for uninsured patients, etc. Once you exceed your funding limit, the sponsoring institution gets 50% of the DME and 100% of the IME. So, as you can see, it's not that a program gets no money for you, they just get less.

For example, all IM specialty fellowships are beyond the GME funding clock and all are paid 50% DME.

Still, many GME budgets are limited, and getting half the money is not an option.

residency - funding eligibility

zinjanthropus

Full Member

Bevo

Radiology, R1

NotAProgDirector

Pastafarians Unite!

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