Von Hohenheim

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It seems to me that non-designated prelim positions only exist as a means either to unofficially continue the now illegal pyramidal program, or to exploit the cheap labor of these ill-fated residents. Yes, there's a hefty attrition rate in surgery. Maybe that would be lower if programs had to do something about the reasons for it. As long as they have this convenient bunch of substitutes hanging around, there isn't really any incentive to do that, is there? As it is, the way surgery programs are organized, it's simply not possible to get all the floor/scut work done without taking in prelims. Or is it? Hell yes. All they have to do is hire some PA's and NP's. The reason they don't is simple. The bottom line. It's just cheaper to keep taking in a fresh batch of young hopefulls each year and working them to the bone before unceremoniously sheding them. Is this situation a disgrace or am I missing something? Are we really so naive as to believe pyramidal programs don't exist while this is going on?
 

Casey James

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Interesting question. I've never really thought about that. It doesn't seem to be completely kosher, now that I chew it over.
 

Amy

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As long as there are people willing to take these spots, I believe they will continue to exist. You're right that they're simply cheap labor, but the residetns know that going into it. And undesignated prelims do occasionally land a categorical spot.

And yes, I definately wish we'd hire some PA's/NP's. :)
 
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Hurricane

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What exactly is a nondesignated prelim spot? Are prelim years usually tied to a PGY2 spot in another program? Pardon my ignorance, but I'm applying to a specialty that doesn't require a prelim year, and I'm curious.
 

Amy

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Hurricane said:
What exactly is a nondesignated prelim spot? Are prelim years usually tied to a PGY2 spot in another program? Pardon my ignorance, but I'm applying to a specialty that doesn't require a prelim year, and I'm curious.
Yes, many prelims do have a residency lined up after their intern year. They are called designated prelims. Undesignated prelims ONLY have the intern year guaranteed for them. Often these spots are filled by people who didn't match and got the prelim spot in the scramble. You can get a prelim spot in the Match as well.

P.S. Love your cat. ;)
 

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Von Hohenheim said:
It seems to me that non-designated prelim positions only exist as a means either to unofficially continue the now illegal pyramidal program, or to exploit the cheap labor of these ill-fated residents. Yes, there's a hefty attrition rate in surgery. Maybe that would be lower if programs had to do something about the reasons for it. As long as they have this convenient bunch of substitutes hanging around, there isn't really any incentive to do that, is there? As it is, the way surgery programs are organized, it's simply not possible to get all the floor/scut work done without taking in prelims. Or is it? Hell yes. All they have to do is hire some PA's and NP's. The reason they don't is simple. The bottom line. It's just cheaper to keep taking in a fresh batch of young hopefulls each year and working them to the bone before unceremoniously sheding them. Is this situation a disgrace or am I missing something? Are we really so naive as to believe pyramidal programs don't exist while this is going on?
Many residencies are note tied together with internship. So poeple who have matched for pgy2 slots need to have undesignated prelim slots around. For example, neurology has to do a prelim year (usually in medicine) before starting residency as a pgy2.
 

Von Hohenheim

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Sledge2005 said:
Many residencies are note tied together with internship. So poeple who have matched for pgy2 slots need to have undesignated prelim slots around. For example, neurology has to do a prelim year (usually in medicine) before starting residency as a pgy2.
Well, that would be a designated prelim position. It doesn't matter if your residency is in the same center as the prelim internship. As long as you're lined up then you're "designated". But the prelim issue (cheap labor, pyramidal programs) is generally a surgery issue, not medicine.
 

Von Hohenheim

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Amy said:
As long as there are people willing to take these spots, I believe they will continue to exist. You're right that they're simply cheap labor, but the residetns know that going into it. And undesignated prelims do occasionally land a categorical spot.

And yes, I definately wish we'd hire some PA's/NP's. :)

I'd agree that there's no market incentive for programs to stop taking in expendable interns. Unlike, the 80 hour work week, there's probably no political incentive to tackle the issue either. It would be difficult to make a public safety claim and the population affected is probably too small for any effective advocacy campaign. There is, however, one way in which the situation is likely to change. Residency candidates are becomming a lot more savvy about the reality of stealth pyramidal programs. A lot of programs are now boasting "this program is rectangular - we have no non-designated prelims". These two statements are gradually becomming synonymous. As top candidates are gravitating to rectangular programs I would expect that their traditional pyramidal competitors will have to adapt in order to attract qualified trainees.

I have to laugh at programs with a lot on non-designated prelims, who have a significant drop-out rate and who regularly promote prelims, when they make they claim "We are definately a rectangular progam". Do people actually buy that?
 
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