After Neurology residency, an attempt to find Neurosurg residency?

[Domenech]

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This MAY sound as if I'm asking what my chances are, but I hate asking such question because I know you don't have a magical globe infront of you which can examine all permutations and tell me my chances. But there's this thing bugging me that I must ask, and would request that you kindly throw your 2 cents at it (please, it would mean a LOT to me!)

I was thinking after finishing my neurology interviews and submitting rank list, where I would stand if I wished to apply for a neurosurgery residency. I was thinking that there's a bit of an overlap in elective rotations between the two subspecialties (Neurocritical care, neuro-surg elective in neurology residency, neuro-path, neuro-radio), and also clinical research. It also gives me 4 years of the best form of USCE, as a resident physician.

Of course it may not matter at the end! I might just continue on with fellowship, but I think I have a little bit of a problem with my motivations here, behind neurology residency.

There's another extremely important question. Please enlighten me a bit about federal funding for dual residencies. Thank you. EDIT: Okay I got to know a bit about it, but another curiosity is that, if you are completing a preliminary residency (whether gen surg or medicine), I presume going later into a terminal residency would not create any issues with funding, true?

 

[NotAProgDirector]

I think it's fair to say that a neurology residency will not help your chances of getting an NS residency. If you're not competitive for NS now, you won't be any more competitive in 4 years. There always is a chance that, if the program where you're doing Neuro is located has an NS program, that you might impress them enough to consider taking you. But it's a huge longshot, and you shouldn't count on it.

The answer to your question about funding is difficult to explain. Doing a prelim year "counts" as a year of funding, but doesn't "set the clock". So, let's say you match into prelim IM and neuro as a PGY-2. You'd do your first prelim year, which counts as 1 year of funding. You'd then start neurology. This sets your maxiumum funding at the minimum time needed for neuro training, which is 4 years (1 prelim + 3 neuro). Hence, you're all set.

Instead, let's say you complete a prelim year, but then get an ED PGY-1 spot for your second year. In that case, your total funding time would be set to 3 years (Min training for ED). But, your prelim counts as 1. So, you'd have decreased funding in your last year of ED.

 

[Domenech]

Hi aPD,

Thanks for a very prompt response! Decreased funding should not be a huge concern for me, as having an international medical graduate profile, it's a long shot to be applying for residency in the first place anyway, so my priority is simply to complete an accredited residency program so I'll at least enter the American physician circle.

While I was doing rotations as a visiting MS, I noticed quite a few American attendings had dual residencies. Not a prelim and later another residency, but two quite un-related fields. You could say, first neurosurg and then orthopedic surgery. How does funding work here exactly? I mean to ask, wouldn't the councils responsible for arranging fundings for PGY spots disapprove completion of two different and long residencies (5 years and 7 years)?

I have quite a handful neurology programs offering H1s. My goal is obviously towards GC/PR. Do you feel that ranking H1 neurology before J1 neurology should really be a no-brainer? I have read specifics about H1 and J1 on your VISA thread and ALL other posts also, but I just need to know that if I rank H1 neurology programs higher (even if they're not very competitive compared to J1 ones), would it really be wise if my motivation is to grab a GC as soon as possible?

Thank you for your time!

 

[Buzz Me]

I think it's fair to say that a neurology residency will not help your chances of getting an NS residency. If you're not competitive for NS now, you won't be any more competitive in 4 years.

Totally agree.

 

[NotAProgDirector]

Decreased funding should not be a huge concern for me, as having an international medical graduate profile, it's a long shot to be applying for residency in the first place anyway, so my priority is simply to complete an accredited residency program so I'll at least enter the American physician circle.

You misunderstand. The decreased funding is to the program. You will still get the same salary and benefits as everyone else at your same level. Only the program loses money, so you will be much less financially attractive than everyone else

While I was doing rotations as a visiting MS, I noticed quite a few American attendings had dual residencies. Not a prelim and later another residency, but two quite un-related fields. You could say, first neurosurg and then orthopedic surgery. How does funding work here exactly? I mean to ask, wouldn't the councils responsible for arranging fundings for PGY spots disapprove completion of two different and long residencies (5 years and 7 years)?

The group that "disapproves" is Medicare. As above, you only get full funding for your first residency. A combined residency (like Med/Psych) counts as a single residency, so is fully funded. But, if someone trained in NS and then switched to ortho, the ortho residency would not get full funding. Sometimes this is an issue, sometimes not.

I have quite a handful neurology programs offering H1s. My goal is obviously towards GC/PR. Do you feel that ranking H1 neurology before J1 neurology should really be a no-brainer? I have read specifics about H1 and J1 on your VISA thread and ALL other posts also, but I just need to know that if I rank H1 neurology programs higher (even if they're not very competitive compared to J1 ones), would it really be wise if my motivation is to grab a GC as soon as possible?

If your only goal is to get a GC, then an H1b is the way to go. But, if you do a less competitive / prestigious residency, chances of getting something else in the future would be less.

 

[Domenech]

You misunderstand. The decreased funding is to the program. You will still get the same salary and benefits as everyone else at your same level. Only the program loses money, so you will be much less financially attractive than everyone else

The group that "disapproves" is Medicare. As above, you only get full funding for your first residency. A combined residency (like Med/Psych) counts as a single residency, so is fully funded. But, if someone trained in NS and then switched to ortho, the ortho residency would not get full funding. Sometimes this is an issue, sometimes not.
.

In that case, this would mean I'd have to prove that I am good enough to take a bet on, even with decreased funding for another residency, right?

Thank you very much for your help in answering my questions! At least now I know that I must rank all H1Bs before J1s. A H1B would go a long way in helping me, esp avoid the waiver job (or going back to my country and wondering what I'm gonna do back for 2 years), and hopefully secure a GC.

 

[Domenech]

I need a little clarification of a fact. I was informed by an acquaintance about some specifics concerning J1 visa. I was told once you enroll into PGY-2 of any program (be it a second year preliminary position, or a second year categorical), it is not possible to transfer to the PGY-1 of any program (be it another preliminary, or a cateogorical), except for finding a PGY-2 position of any program.

I read over your thread concerning J1 vs H1B, that specialties can only be switched once on the J1 visa, but is it true that this means only finding a program that offers either the same PGY year, or a higher PGY year but not any lower?

I presume this also applies to being unable to find a second residency after completing the first, on J1 visa, unless I find a J1 waiver job first and get the J visa off my records?

 

[NotAProgDirector]

I need a little clarification of a fact. I was informed by an acquaintance about some specifics concerning J1 visa. I was told once you enroll into PGY-2 of any program (be it a second year preliminary position, or a second year categorical), it is not possible to transfer to the PGY-1 of any program (be it another preliminary, or a cateogorical), except for finding a PGY-2 position of any program.

I read over your thread concerning J1 vs H1B, that specialties can only be switched once on the J1 visa, but is it true that this means only finding a program that offers either the same PGY year, or a higher PGY year but not any lower?

I presume this also applies to being unable to find a second residency after completing the first, on J1 visa, unless I find a J1 waiver job first and get the J visa off my records?

On a J visa, you are only allowed to change specialties once, before the end of the PGY2. Other than that, I am not aware of any other rules about changing specilaties.

 

[Domenech]

On a J visa, you are only allowed to change specialties once, before the end of the PGY2. Other than that, I am not aware of any other rules about changing specilaties.

Oh I see. Even if that means changing from PGY2 towards PGY1? I guess in that case, J1 visa wouldn't be as bad as I might have considered it initially, depending on circumstances of course.