Bizarre residency dilemma

[HDMTX]

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So, I've got a somewhat unique residency dilemma to present on the behalf of a good friend of mine. I'll make it as succinct as possible. So here goes:

1. Matched into FP residency at Program #1.
2. Upon completion of PGY-1, the program essentially lost GME funding, residents had to transfer.
3. Transferred successfully to Program #2.
4. Completed PGY-2 and a few months into PGY-3, contract was terminated due to certain performance issues, personal issues (I don't know all the details).
5. Apparently, one has to complete TWO years at one institution to complete FP training, so now the plan was to transfer into PGY-2 somewhere else despite having successfully completed the year.
6. Recently, emails have been received from a few various programs (different states) with vacancies for PGY-2 stating that transferring would not be possible as FP GME funding (much coming from Medicare) has already been exhausted...

I'm not privy to all the specifics, but this seems so complicated... now the question is, start over? Transfer into IM/Peds hoping for some credit? Work in urgent care as in some states one year of post-grad training is enough for a license...???

Any input would be much appreciated!

 

[dragonfly99]

The person should get a license, if she/he doesn't already have one. I hope he/she already does.

The issue is that if the person does 2 more years, the program will probably only get 1/2 the usual GME funding for the person. This is because Medicare only wants to pay for people to do ONE residency.

This person is in a bad situation, but I would keep trying to find another fp spot. In the mean time, start looking for a job. The military and/or prisons might be an option. Could try urgent care as well.

 

[YOOOUK09]

...

 

[HDMTX]

The person should get a license, if she/he doesn't already have one. I hope he/she already does.

The issue is that if the person does 2 more years, the program will probably only get 1/2 the usual GME funding for the person. This is because Medicare only wants to pay for people to do ONE residency.

This person is in a bad situation, but I would keep trying to find another fp spot. In the mean time, start looking for a job. The military and/or prisons might be an option. Could try urgent care as well.

Yep, this person is applying for a license currently. So completing two years of postgrad training means you're pretty much far enough in so as if you screw up then, you're screwed...

Yep, a broad application is already in process to multiple FP programs across the nation...

So, starting a new residency would essentially be as impossible then it sounds like.

 

[Wednesday]

Where does one find the official GME funding rules?

I'm interested b/c I might try to transfer from psych to EM and I'm wondering if I do a PGY1 1 year of psych if I will still be eligible for 3 years of funding in EM.

Unless the rules have changed, you should have no problem. You get funding for the number of years that your first residency is. So, if you match into psych first, you get four years of funding, since that's a four year residency. If you do one year of psych you can then transfer to a 3 yr EM program and be fully funded (for a total of 4 yrs). If you do it the other way around (3 yr EM program first) you would only be fully funded for three years.

 

[YOOOUK09]

...

 

[dragonfly99]

Wednesday is right.
Medicare allows you the # of years of full funding that are necessary for whatever residency program you started in. So, I started in IM so I only would get 3 years of full GME funding from the feds. Someone who started in general surgery would get 5 years of eligibility, so even if he/she bails after a year of two of general surg., could still get funded for another 4 years of residency.

 

[YOOOUK09]

...

 

[Ludicolo]

Thank you both Wednesday and Dragonfly. That does seem to be the common wisdom around here.

I know it's hard to find - since I can't find it! - but I would love to access the official ACGME literature about this if anyone knows where it is!

http://www.aamc.org/advocacy/library/gme/dgmebroc.pdf

 

[Shinken]

Never mind. I actually paid attention to the original post and my question was answered.

 

[YOOOUK09]

...

 

[IndyXRT]

Yep, this person is applying for a license currently. So completing two years of postgrad training means you're pretty much far enough in so as if you screw up then, you're screwed...

Yep, a broad application is already in process to multiple FP programs across the nation...

So, starting a new residency would essentially be as impossible then it sounds like.

There are some places that have resident positions in excess of the number medicare will pay for (i.e. they have other funding sources for some of their resident positions). Perhaps a possibility would be to look at large multi-residency places that also have FP. If the funding issue were moot, things might be easier.

 

[Undecided18]

I have just matched into a categorical IM program for the upcoming year but I have recently had a change of heart and I would like to pursue a career in Radiology, will I have trouble from a funding standpoint, should I try to pursue a waiver?

 

[Winged Scapula]

I have just matched into a categorical IM program for the upcoming year but I have recently had a change of heart and I would like to pursue a career in Radiology, will I have trouble from a funding standpoint, should I try to pursue a waiver?

In strict terms of funding, yes. Radiology is a longer residency than IM so programs would have to accept not having full funding for you as a resident.

Pursuing a waiver seems to imply that you would give up your IM position. I don't know how competitive you are, but it seems a bit foolish to give up a position you have without another one in hand.

 

[NotAProgDirector]

I have just matched into a categorical IM program for the upcoming year but I have recently had a change of heart and I would like to pursue a career in Radiology, will I have trouble from a funding standpoint, should I try to pursue a waiver?

If you get a waiver, then you have no funding issues. It's not the match that counts, but whether you actually start training.

 

[Undecided18]

If I attend the first year of my categorical IM residency and apply for Rays with the plan of taking a year off after my year in IM, do the same funding rules still apply?

 

[gutonc]

If I attend the first year of my categorical IM residency and apply for Rays with the plan of taking a year off after my year in IM, do the same funding rules still apply?

yes. you will get 3y of 100% DME/IME funding. All subsequent years will be 50% DME, 100% IME.

 

[Undecided18]

Can I swap my categorical IM with someone for a prelim IM, Is that legal, whose approval does it require because I assume that would allow me to avoid this potential funding issue

 

[NotAProgDirector]

Not really. You'd need the NRMP's permission to waive your match, and there is no guarantee that your PD will be interested in whatever prelim person you find to swap. If you want to avoid the funding issue, your best option is to try to convince your current PD to register you as a prelim intern, instead of categorical. They might be willing to do this, but in doing so you are essentially giving up your PGY-2 so if you fail to match in rads, you're on your own for a PGY-2.