Anyone do a second residency?

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nancysinatra

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I'm curious if anyone around here has done a second residency, or thought about it? If so what were the two specialties? What was the reason?

It's something I have in the back of my mind as a possibility, but it seems like it would be really grueling to go through residency again.

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I know switching residency is more common than some people think- it happens frequently, same specialty different location or different specialty whatever location. Now this is something entirely different from completing a residency and starting from square one in another. Maybe you are ambitious enough to try for the coveted "double boarded" position? In any case, the feds fund only X amount of years for residency, thus for a program to take you it would have to be on their dime...which seems possible but highly unlikely IMO.
 
Its possible but I do not believe it is that common. I am aware of someone who was completing an IM residency at a strong institution and then after deciding later in the program she wanted to do EM as well managed to arrange to come in as a EM-2 in a 4 year program. So for 6 years of training she will be double boarded in IM and EM. Unique situation that only worked because she set it up in house and the hospital is wealthy enough to eat the loss of Fed funds. I am sure the IM PD advocated as well and she was well liked.
 
I have a friend who went through Family Practice residency because he didn't match initially into general surgery. He worked a few years and saved his money while applying to general surgery after FP. He went through the GS residency eventually and now that's all he does. I doubt he got paid for the second residency and probably moonlighted on the weekends to supplement.


I have another friend who only wanted to be an orthopedicsurgeon. He didn't match either. He finished intern year, got his licenses. Worked urgent care for 3 years while applying to ortho residency and finally got in. He did a spine fellowship after that. One of the best ortho guys I know.

Both are DO.
 
wow, can one get a residency without getting paid for it? I would do that. How do you find a program that will do that?
 
There is a resident in my class who did a previous residency. She is getting paid. I couldn't do it without getting paid. I'm thinking about a few years in the future, not anytime soon.
 
From what I undestand resident funding comes from CMS. They don't double pay for the same class level for 2 separate residencies. So if you did a 3 yr FP residency, finished, then went into a 5 year surgical residency, my understanding is you would only get paid by CMS for the last 2 years. Some programs have alternate funding that is not CMS based and that may be why the person you know is getting paid.

You're wrong on almost every point. It's really, really complicated how CMS funds residents doing more than one specialty, but the general gist of it is this:

Roughly 2/3 of the pot of money paid per resident is "direct medical education" money, which basically covers the salary +/- some benefits. The other 1/3 is "indirect medical education" money, which pays the hospital to fund everything else.

If you use up all of your funding and continue as a resident in a different program, CMS will still fund the hospital the full amount of DME, and somewhere around half the IME. So rather than the hospital receiving ~$100,000 for you, they'll receive ~$75,000.

How many years of full funding you get is also complicated, but it basically depends on what residency you started with. It's the minimum number of years it would take to complete your initial specialty. So if you matched into General Surgery, you're "assigned" 5 years of full funding. If you then completed 2 years of GS, decided you hated it, and dropped out, you would have 3 full years of funding left. You could then match FM and would be able to complete the entire program without your hospital ever being given less than the full amount of $.

If you did the opposite, and did 2/3 years of a FM residency first, then dropped out and did gen surg, you'd only have 1 full year of funding remaining for your gen surg program, and all of the remaining years would still be funded by CMS, but at a decreased price.

This all leads to some interesting stuff. For example, as the minimum number of years to do EM is 3, all 4 year EM programs basically fund that year themselves, as CMS doesn't see why they would need to pay for it themselves. Ditto for programs in other specialties with things like research years.

Why is the system so ass-backwards and make no sense? I have no idea. Ask the government.

As for anyone doing a residency for free, that's 100% impossible. At least for any ACGME-accredited program, they're required to pay all their residents the same. You can't do it for free, and programs can't add spots willy nilly without the ACGME's approval.

(Edit to add this note: This is all to the best of my understanding. Someone like APD would know much more about this than I would, but I think the above is generally accurate.)
 
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wow, can one get a residency without getting paid for it? I would do that. How do you find a program that will do that?

You would be willing to do a residency for free? In spite of the fact that you probably have loans to pay off, and need to support yourself and pay your bills?
 
that's basically what I said, just not as complicated. Wasn't trying to be the authority, just putting the jist out there. Jeez
But you said you could do FM then go to GS and get the last 2 years funded, which Raryn pointed out is not the case. The hospital would only get half of their usual reimbursement.
 
You're wrong on almost every point. It's really, really complicated how CMS funds residents doing more than one specialty, but the general gist of it is this:

Roughly 2/3 of the pot of money paid per resident is "direct medical education" money, which basically covers the salary +/- some benefits. The other 1/3 is "indirect medical education" money, which pays the hospital to fund everything else.

If you use up all of your funding and continue as a resident in a different program, CMS will still fund the hospital the full amount of DME, and somewhere around half the IME. So rather than the hospital receiving ~$100,000 for you, they'll receive ~$75,000.

How many years of full funding you get is also complicated, but it basically depends on what residency you started with. It's the minimum number of years it would take to complete your initial specialty. So if you matched into General Surgery, you're "assigned" 5 years of full funding. If you then completed 2 years of GS, decided you hated it, and dropped out, you would have 3 full years of funding left. You could then match FM and would be able to complete the entire program without your hospital ever being given less than the full amount of $.

If you did the opposite, and did 2/3 years of a FM residency first, then dropped out and did gen surg, you'd only have 1 full year of funding remaining for your gen surg program, and all of the remaining years would still be funded by CMS, but at a decreased price.

This all leads to some interesting stuff. For example, as the minimum number of years to do EM is 3, all 4 year EM programs basically fund that year themselves, as CMS doesn't see why they would need to pay for it themselves. Ditto for programs in other specialties with things like research years.

Why is the system so ass-backwards and make no sense? I have no idea. Ask the government.

As for anyone doing a residency for free, that's 100% impossible. At least for any ACGME-accredited program, they're required to pay all their residents the same. You can't do it for free, and programs can't add spots willy nilly without the ACGME's approval.

(Edit to add this note: This is all to the best of my understanding. Someone like APD would know much more about this than I would, but I think the above is generally accurate.)
This is mostly right.

I think you have DME and IME confused. IME is the bigger payment -- but that's complicated. DME is the same for every resident at all programs. IME is different at each program -- can be 10x bigger at some programs (a source of much frustration in the GME world). When you go beyond your initial residency period, the institution gets 50% DME and 100% IME. Hence, programs with large IME rates have less impact from training residents beyond their initial periods.

ACGME programs must pay residents. AOA programs apparently can get away with this (not paying residents) -- but I expect that will end as the AOA becomes a subsiderary of the ACGME.
 
I have a friend who went through Family Practice residency because he didn't match initially into general surgery. He worked a few years and saved his money while applying to general surgery after FP. He went through the GS residency eventually and now that's all he does. I doubt he got paid for the second residency and probably moonlighted on the weekends to supplement.


I have another friend who only wanted to be an orthopedicsurgeon. He didn't match either. He finished intern year, got his licenses. Worked urgent care for 3 years while applying to ortho residency and finally got in. He did a spine fellowship after that. One of the best ortho guys I know.

Both are DO.

cabinbuilder--were these second residencies and fellowships osteopathic? Have you heard of a DO doing a second residency but at an MD institution?
 
cabinbuilder--were these second residencies and fellowships osteopathic? Have you heard of a DO doing a second residency but at an MD institution?

I don't know. Both doctors are DO's but I don't know what type of residency program they went to. Didn't matter to me to ask.
 
In our program, we have had a handful of residents who had already completed their residency, were boarded, in practice, but then decided to pursue a different specialty. Since we had openings at the time, we welcomed them in, and they have been wonderful. They did get paid a paycheck, just like any other resident. Now how the institution got paid, I don't know, because we are so far over the stupid cap, it is not even funny.
 
can people just arrange to pay the residency program back the salary in the form of a gift? if it's a non-profit hospital, gifts should have no taxable limits. or if it's taxable, a resident could give all of it back and report it as part of his/her lifetime gift exclusion?
 
can people just arrange to pay the residency program back the salary in the form of a gift? if it's a non-profit hospital, gifts should have no taxable limits. or if it's taxable, a resident could give all of it back and report it as part of his/her lifetime gift exclusion?

Contrary to the television show "ER", I don't think this is practical. Yes, a resident could probably make donations to the residency program/hospital. However, I don't think it could be a contractual obligation. In other words, if a resident signed over his first paycheck (or donated an equivalent amount to the hospital); he could change his mind, stop donating in the future, and the hospital/residency couldn't do a thing about it.
 
what if the resident had a really trustworthy face?
 
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