April/May issue of EMResident: EM as a DO

[deejayshakur]

anybody see the article/rant by Dr. Olstyn, a DO?

she says that her TRI may prove to be a disadvantage for her as an applicant because 3-year programs only get 3 years worth of funding from the government. thus, when she is in her PGY4 year, the program will only get half the funding for her... i thought that since she is entering the program as a PGY2, the program should still get all 3 years of funding. can anybody clarify? just a little confused.

edit: clarified thread title

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[Seaglass]

She may enter as a PGY-2 but she will still be a first year resident with 3 years total to go. There is going to be one year of funding missing. The transitional year does not count as your 'intern' year of residency for EM.

 

[DeLaughterDO]

anybody see the article/rant by Dr. Olstyn, a DO?

she says that her TRI may prove to be a disadvantage for her as an applicant because 3-year programs only get 3 years worth of funding from the government. thus, when she is in her PGY4 year, the program will only get half the funding for her... i thought that since she is entering the program as a PGY2, the program should still get all 3 years of funding. can anybody clarify? just a little confused.

From my own research and talking to my PD for next year, who also clarified this with the ACGME person at the hospital (geez - that is a mouthful!), I am of the understanding that a TRI does not count against funding since it does not lead to any kind of board certification - it is treated essentially as a PGY0, unless you enter an AOA program, in which case it will serve as a PGY1 year (which is required by the AOA programs, as all AOA residencies are PGY2-4).

The same holds for ACGME Transitional years, as far as I understand. This is not the case for Preliminary years (Medicine, surgery, or whatever other prelims there are), because these can be accepted as PGY1 years for whatever specialty it is prelim for.

Someone correct me (and my PD and ACGME specialist) if this is incorrect.

jd

 

[DeLaughterDO]

She may enter as a PGY-2 but she will still be a first year resident with 3 years total to go. There is going to be one year of funding missing. The transitional year does not count as your 'intern' year of residency for EM.

It is not that one year of funding is "missing," the DME portion is instead paid at only one-half time - IME is still 100% compensated.

All told, most hospitals lose less than one-third of the funding they would have from a "normal" resident who didn't have these "funding issues," if they even apply under these circumstances - see the above reply.

jd

 

[corpsmanUP]

I think the problem is actually the perception of PD's regarding this situation. Many seem to just not want to deal with the confusion and end up avoiding interviewing these very qualified individuals. I don't think in your case D it will be much of an issue with your superb stats, but a lot of ACGME programs may not look hard enough at your situation to even realize you did a TRI. Some don't even know what it is. You may need to go out of your way via email or letter outside the application to individual PD's explaining your situation.

Can someone pick up the red phone to BKN and ask his opinion on this matter? If he is somewhat puzzled by this then you know all the other PD's are way worse off!!

Hey D, check your PM!

 

[BKN]

Can someone pick up the red phone to BKN and ask his opinion on this matter? If he is somewhat puzzled by this then you know all the other PD's are way worse off!!

I'm happy to not care enough to have to find out (?). At least to this point, nobody in my institution is worrying about it. As far as I know, everything the laughing DO has written is correct.

At the same time, there seem to be many PDs who are constrained by their institutions to recruit for those with complete availability of funds. All the more highly qualiified apps for me, Bu-wa-ha-ha!

I think a couple of sentences in your personal statement indicating that you're still qualified for full medicare funding might be worthwhile, beyond that, i don't know that I'd worry about it.

 

[allendo]

I think the problem is actually the perception of PD's regarding this situation. Many seem to just not want to deal with the confusion and end up avoiding interviewing these very qualified individuals. I don't think in your case D it will be much of an issue with your superb stats, but a lot of ACGME programs may not look hard enough at your situation to even realize you did a TRI. Some don't even know what it is. You may need to go out of your way via email or letter outside the application to individual PD's explaining your situation.

Can someone pick up the red phone to BKN and ask his opinion on this matter? If he is somewhat puzzled by this then you know all the other PD's are way worse off!!

Hey D, check your PM!

Do I have to do the TRI if I don't care about working in the big 5?

 

[8744]

UAMS explicitely told me that they only consider applicants who are fully-funded. Either that or the scrotum I have growing out of my forehead was too much for them to even consider offering me another interview, those bigoted bastards.

 

[LovelyRita]

UAMS explicitely told me that they only consider applicants who are fully-funded. Either that or the scrotum I have growing out of my forehead was too much for them to even consider offering me another interview, those bigoted bastards.

Sorry for the ignorance, but, what does this mean? Esp. the "fully funded" part.

 

[BKN]

Sorry for the ignorance, but, what does this mean? Esp. the "fully funded" part.

Read the whole thread, it's all about this.

In brief, Residency training in the US is mainly paid for by the taxpayer through something called the "medicare adjustment" which is an increase in the amount paid per patient to teaching hospitals (compared to nonteaching) by major diagnosis for admissions. It is paid to the hospitals and is then usually conveyed through contract to the participating medical schools. Each individual physician is tracked through his training and will be "fully funded" for only the minimum number of years that it takes to get trained in the first specialty that he begins training in. Therefore, if he switches or takes a second training, the funding is less. How much less is often a discussion on the boards. In addition, there is a question how much it affects the chances of an applicant to have less or no funding.

So the original comments were about whether a "traditional D.O. internship" affects the availability of funding. The answer should be no. It also should be no for a transitional residency. I think it's yes if one takes a "preliminary year" since I believe they can be counted towards specialty training. Except . . . now that I think about it, I know of at least one physician who took a traditional D.O. and then entered at the PG2 level of a ACGME FP program, completed it in two years and is boarded by ABFM.

It's a measure of how complicated this is that I'm not sure, programs are treating it differently and folks are getting conflicting "facts" from their Dean's offices.

Panda was referring to his successful quest to get an EM residency after a year of training in the "specialty that dare not speak it's name".

 

[LovelyRita]

Read the whole thread, it's all about this.

In brief, Residency training in the US is mainly paid for by the taxpayer through something called the "medicare adjustment" which is an increase in the amount paid per patient to teaching hospitals (compared to nonteaching) by major diagnosis for admissions. It is paid to the hospitals and is then usually conveyed through contract to the participating medical schools. Each individual physician is tracked through his training and will be "fully funded" for only the minimum number of years that it takes to get trained in the first specialty that he begins training in. Therefore, if he switches or takes a second training, the funding is less. How much less is often a discussion on the boards. In addition, there is a question how much it affects the chances of an applicant to have less or no funding.

So the original comments were about whether a "traditional D.O. internship" affects the availability of funding. The answer should be no. It also should be no for a transitional residency. I think it's yes if one takes a "preliminary year" since I believe they can be counted towards specialty training. Except . . . now that I think about it, I know of at least one physician who took a traditional D.O. and then entered at the PG2 level of a ACGME FP program, completed it in two years and is boarded by ABFM.

It's a measure of how complicated this is that I'm not sure, programs are treating it differently and folks are getting conflicting "facts" from their Dean's offices.

Panda was referring to his successful quest to get an EM residency after a year of training in the "specialty that dare not speak it's name".

Thanks. So was Dr. Olstyn's concern that in her PGY-4 year she will only get paid half her salary? Is that what happens when you are not "fully-funded"?

I mean, until now I was familiar with the fact that residents' salaries come from Medicare, but have never been made aware of the implications of doing TRI or of "taking a year off" or switching specialties and its impact on funding, and what, if any difference it will ultimately make to me. (I'm doing TRI next year.)

 

[8744]

Sorry for the ignorance, but, what does this mean? Esp. the "fully funded" part.

The second part of your question came as a relief because at first I thought you were going to ask me what a scrotum was.

 

[Seaglass]

She'll still get her full salary and the program will have to find that money from somewhere. That's the headache (for the program).

 

[8744]

Thanks. So was Dr. Olstyn's concern that in her PGY-4 year she will only get paid half her salary? Is that what happens when you are not "fully-funded"?

I mean, until now I was familiar with the fact that residents' salaries come from Medicare, but have never been made aware of the implications of doing TRI or of "taking a year off" or switching specialties and its impact on funding, and what, if any difference it will ultimately make to me. (I'm doing TRI next year.)

You will not get paid half your salary. The theory is that your program will eat the difference which is why they would be reluctant to take you. It also might be less than half of your salary depending on the amount of medicare payments to your hospital.

It's hard for me to believe that your program will lose money on you if they eat at most a small fraction of their total government compensation. You may not bill for your time as a resident but the attending whose work you will end up doing certainly will. An intern may be a liabilty but a well-trained second or third year resident almost certainly generates a lot of work that can be billed for.