Applying to categorical medicine after completing a prelim year

[eggsbenedict]

Hi everyone,

I'm currently completing a preliminary medicine year, but did not match into an advanced position in dermatology. I've since decided that I would rather pursue an internal medicine residency. I'm definitely planning on looking into PGY-2 openings for next year, but I was also wondering if it would be possible to repeat a PGY-1 year if a second year position doesn't become available. Does anyone know how that works?

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[NotAProgDirector]

YOu certainly can repeat a PGY-1, but all of those spots are filled already (from the match). You should be able to get a PGY-2, there really shouldn't be a need to repeat a PGY-1 unless you are struggling in your current prelim year, there is some other problem with your application, or if you are severely limited by geography.

There is no central list of PGY-2 openings.

You should speak to your IM PD. They may be willing to work with you to find an IM PGY-2 spot.

 

[RussianJoo]

YOu certainly can repeat a PGY-1, but all of those spots are filled already (from the match). You should be able to get a PGY-2, there really shouldn't be a need to repeat a PGY-1 unless you are struggling in your current prelim year, there is some other problem with your application, or if you are severely limited by geography.

There is no central list of PGY-2 openings.

You should speak to your IM PD. They may be willing to work with you to find an IM PGY-2 spot.

will there be any issues with funding? I know that switching from one residency to a longer residency can cause issues with lack of funding, would such issues occur in this case?

thanks for your reply.

 

[dragonfly99]

Russianjoo,
my understanding is that prelim years do not "count" when it comes to setting the Medicare clock for years that a resident is allowed to have funding to be paid as a resident. So this intern's prelim year won't hurt him/her in that regard when looking for another position (PGY 1 or 2). One of the attendings please correct me if I am wrong...

OP, do you really want to be an intern again? Man, you are a glutton for punishment! It's pretty late now, but I would go to your IM PD ASAP and tell him/her that you now want to do medicine. He/she may be able to even offer you a PGY2 position in your program (though likely those are all taken now...) or if that fails, how about doing a year of research in the lab of some IM attending? That is if you don't hate research. It might be a feather in your cap at some point later, even if you decide to pursue hospitalist or academic primary care or something. You could even consider working on an MPH or MBA or something (just an idea, and I realize might not be practical given you'd likely have to cough up tuition for that).

You can also put out the word with other medicine attendings with whom you have a good relationship, and see if they know of any program(s) looking for a PGY2 resident. You could sign up for FindAResident on the NRMP web site, too...I'm pretty sure that as the year goes on, there will be IM spots that open up. Unfortunately, some might not be at programs as good as your current one (depending on program you are in) and I'll bet the best openings are not advertised, so that's why it behooves you to talk to your PD and attendings that you know.

 

[NotAProgDirector]

my understanding is that prelim years do not "count" when it comes to setting the Medicare clock for years that a resident is allowed to have funding to be paid as a resident. So this intern's prelim year won't hurt him/her in that regard when looking for another position (PGY 1 or 2). One of the attendings please correct me if I am wrong...

I believe you are half right.

Prelim years do not SET the medicare clock, but they do CONSUME funding years. (This is incorrect, see post below)

Hence, if the OP gets a PGY-2 spot, they are fine. Once they start training in a PGY-2 IM program, the clock is set at 3 years. They used one year as a prelim, and the next two will be the PGY-2/3.

If they get a PGY-1 spot, they will end up short for funding their final year. Again, remember that this does not mean NO funding -- it means 50% DME and 100% IME, so some programs will not care.

Still, all things considered, it would be easier to simply get a PGY-2 spot.

 

[dragonfly99]

I don't get it. I thought prelim years didn't "count" against the Medicare clock? So even if the person starts over as a PGY 1 in a categorical program, I thought they'd still have 3 years of funding...that sucks if they would not.

 

[Ludicolo]

I don't get it. I thought prelim years didn't "count" against the Medicare clock? So even if the person starts over as a PGY 1 in a categorical program, I thought they'd still have 3 years of funding...that sucks if they would not.

They would get 3 years of funding total. Not 3 additional years.

Look at it this way. Prelim years do “count”, but they count retroactively. So if you decide to pursue categorical IM after prelim IM, your total clock is set at 3 years, of which the prelim year you’ve completed already counts as one. So if you land a PGY2 spot (regardless of specialty) you’ll be fine. If you land a different PGY1 spot (regardless of specialty), your final year of residency will only receive 50% DME funding.

 

[RussianJoo]

eek thanks for the explination guys i guess doing a prelim in IM isn't a great idea unless you can match into a pgy2 im program after it... what will happen if you do a transitional year and then match into a pgy1 IM program? would you have enough funding then or would you still fall short?

 

[RussianJoo]

also what if you do a prelim medicine year and then match into a categorical gen surgery residency how will the funding clock work for that?

thanks in advance for your replies.

 

[NotAProgDirector]

eek thanks for the explination guys i guess doing a prelim in IM isn't a great idea unless you can match into a pgy2 im program after it... what will happen if you do a transitional year and then match into a pgy1 IM program? would you have enough funding then or would you still fall short?

You would be short one year.

also what if you do a prelim medicine year and then match into a categorical gen surgery residency how will the funding clock work for that?

You would also be short one year. Once you start training in GS, your funding clock is set at a max of 5 years. You'll use one year for your TY, then use 5 for your GS residency.

As should be clear, after doing a prelim IM/TY and then starting a PGY-1 anything, you will be short one year.

Unless you do something crazy -- TY, then start training in GS, drop out after 1 year, then start an IM PGY-1. In that case, you'd actually have full funding for the whole thing. Wouldn't recommend it, though.

 

[RussianJoo]

You would be short one year.



You would also be short one year. Once you start training in GS, your funding clock is set at a max of 5 years. You'll use one year for your TY, then use 5 for your GS residency.

As should be clear, after doing a prelim IM/TY and then starting a PGY-1 anything, you will be short one year.

Unless you do something crazy -- TY, then start training in GS, drop out after 1 year, then start an IM PGY-1. In that case, you'd actually have full funding for the whole thing. Wouldn't recommend it, though.

thank you for the explanation.

 

[Dave89]

You would be short one year.



You would also be short one year. Once you start training in GS, your funding clock is set at a max of 5 years. You'll use one year for your TY, then use 5 for your GS residency.

As should be clear, after doing a prelim IM/TY and then starting a PGY-1 anything, you will be short one year.

Unless you do something crazy -- TY, then start training in GS, drop out after 1 year, then start an IM PGY-1. In that case, you'd actually have full funding for the whole thing. Wouldn't recommend it, though.

Does the same apply in the hypothetical of one reapplying to, say, Derm as a PGY-1?

That is, can one do back-to-back prelim and/or TYs, or does Medicare essentially say, "Derms are only supposed to use four years total, so we're reducing the funding for your final year"?

 

[mvenus929]

Does the same apply in the hypothetical of one reapplying to, say, Derm as a PGY-1?

That is, can one do back-to-back prelim and/or TYs, or does Medicare essentially say, "Derms are only supposed to use four years total, so we're reducing the funding for your final year"?

Derm is an advanced specialty, so you could apply to Derm and have your intern year count and not need to redo it. If you matched into a categorical program and then apply to Derm your intern year, you could run into funding issues due to your first specialty being shorter than a Derm residency, but you could take a year off before your Derm residency starts and not have to repeat your intern year. This is what happened to one of my coresidents. The program wasn't concerned about funding, so she was going to stay for the second year of Peds, but got a position doing research in the year prior to starting Derm and went that route instead.

 

[NotAProgDirector]

I believe you are half right.

Prelim years do not SET the medicare clock, but they do CONSUME funding years.

Hence, if the OP gets a PGY-2 spot, they are fine. Once they start training in a PGY-2 IM program, the clock is set at 3 years. They used one year as a prelim, and the next two will be the PGY-2/3.

If they get a PGY-1 spot, they will end up short for funding their final year. Again, remember that this does not mean NO funding -- it means 50% DME and 100% IME, so some programs will not care.

Still, all things considered, it would be easier to simpply get a PGY-2 spot.

It turns out I am completely wrong here.

If you match into prelim IM and no PGY-2, your clock gets set at 3 years (internal medicine).
If you match into prelim GS and no PGY-2, your clock gets set at 5 years (gen surg)
If you match into a TY and no PGY-2, then (I think) your clock is undefined until you start your PGY-2.

This is explained in the new brochure here: https://members.aamc.org/eweb/upload/Medicare Payments for Graduate Medical Education 2013.pdf, Page 6, last paragraph.

 

[NotAProgDirector]

Does the same apply in the hypothetical of one reapplying to, say, Derm as a PGY-1?

That is, can one do back-to-back prelim and/or TYs, or does Medicare essentially say, "Derms are only supposed to use four years total, so we're reducing the funding for your final year"?

So, with the new information, if you applied to Derm and didn't match but did match to a prelim IM year, you would have 3 years of funding. You could then apply again to derm and NOT to prelim again, and you'd have 2 years of funding for the 3 year derm residency. But, if you matched to a prelim GS program, you'd have 4 years of full funding left -- you could repeat your prelim year if you wanted without a funding problem.