Can residencies require us to start early?

[njtrimed]

I realize nobody can actually answer this question, since this entire situation is unprecedented. But I’m curious as to whether program directors and other faculty might have some insight into the discussions right now. My school joined many others in announcing today that most of us will be graduating in just under two weeks so that we can join the work force as physicians. Will this be on a voluntary basis, or should we accept now that we’re expected to start much earlier than mid-June?

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[Lawpy]

@aProgDirector @GoSpursGo might know more

 

[njtrimed]

@aProgDirector @GoSpursGo might know more

Thanks for tagging them! Would this be better moved to the General Residency Issues forum, or is this the right place? I posted here since it will affect many if not most of us who are graduating.

 

[Lawpy]

Thanks for tagging them! Would this be better moved to the General Residency Issues forum, or is this the right place? I posted here since it will affect many if not most of us who are graduating.

I think here is fine

 

[Money-Moniker]

I would hope not. The only contract we've signed thus far is the implicit agreement to start residency via taking part in the match, but I don't think there is any language in there that would compel us to begin prior to the regular start date? Personally I'm not even within 2000 miles of my program and don't plan to be until June. How would they even think about having us drop everything and move across the country/world at short notice during the outbreak, lol?

 

[Epilepsy365]

I would hope not. The only contract we've signed thus far is the implicit agreement to start residency via taking part in the match, but I don't think there is any language in there that would compel us to begin prior to the regular start date? Personally I'm not even within 2000 miles of my program and don't plan to be until June. How would they even think about having us drop everything and move across the country/world at short notice during the outbreak, lol?

Yeah, that's not reasonable. Some of us have family with a spouse and kids, and will need time to get situated before we start.

 

[GoSpursGo]

For the record, @aProgDirector definitely is more of an expert than me, especially when it comes to the ins and outs of residency 🙂

And I have no idea honestly. My residency started a week before 7/1 to allow us to overlap some with the graduating seniors who were best equipped to show us the ropes, so clearly there’s some flexibility in start date. How much would just be a guess on my part

 

[NotAProgDirector]

I don't think that programs can force you to start early, I expect it will be voluntary. So far, I think programs are mostly considering starting students from their home medical school that have matched with them -- no move, much easier to onboard, etc. As the ACGME link suggests, it's not so straightforward, as if residents start early they also (presumably) graduate early creating possible holes later in the schedule.

 

[njtrimed]

Yeah, that's not reasonable. Some of us have family with a spouse and kids, and will need time to get situated before we start.

I have a spouse and kids too, but we don’t have to move.

I don't think that programs can force you to start early, I expect it will be voluntary. So far, I think programs are mostly considering starting students from their home medical school that have matched with them -- no move, much easier to onboard, etc. As the ACGME link suggests, it's not so straightforward, as if residents start early they also (presumably) graduate early creating possible holes later in the schedule.

I did match at my home program. My concern is that I have young kids at home and we’re also taking care of elderly relatives, so I am not even sure if I would come home after going to work in a COVID hot spot. If I was young and single, I would be eager to get to to work early, but as it stands now, I could use all the time I can get before starting residency.

 

[AnatomyGrey12]

There-are-no-files-to-display

"through public info." LMAO. I suspect that is a subtle dig at the AAMC and LCME for pushing this early graduation headline without even consulting the residency accrediting body.

 

[slowthai]

"through public info." LMAO. I suspect that is a subtle dig at the AAMC and LCME for pushing this early graduation headline without even consulting the residency accrediting body.

Nah, I laughed so hard when I saw this loooool. "Public info" you know

 

[slowthai]

"While not the purview of the ACGME, it must be noted that there are serious ramifications to early appointment (CMS reimbursement for DGME/IME and match participation agreements, among many others). The ACGME urges medical schools and graduates to seriously consider these ramifications prior to initiating early graduation for any medical students."

Like think about it hard before you do this guys. I'm just like, is that a threat, ACGME? Sounds like a threat lol

 

[slowthai]

Please, can you explain what they mean by this?@aProgDirector

"While not the purview of the ACGME, it must be noted that there are serious ramifications to early appointment (CMS reimbursement for DGME/IME and match participation agreements, among many others). The ACGME urges medical schools and graduates to seriously consider these ramifications prior to initiating early graduation for any medical students."

Are they saying that that some organization would be losing money because students are starting early?

 

[NotAProgDirector]

What they mean is that the maximum amount of funding is fixed for each resident. So, IM is 36 months long, so you get 36 months of full funding. Let's say you start 2 months early in May 2020. When May 2023 rolls around, you will now have decreased funding. So what happens? Is your residency actually 38 months long with decreased funding? Or do they graduate you at the end of April 2023? or start fellowship early? And whose choice is it?

Any implied threat is to programs. Students can't end up any worse. If you start 2 months early and:
1. Residency becomes 38 instead of 36 months, at least you get paid for 2 more months.
2. Residency stays 36 months, then you graduate 2 months early and can start your next job that much earlier, or moonlight. At worst, if you take 2 months off before starting a fellowship, you're no worse off (financially) since May/June of this year were probably going to be unpaid.

 

[AlteredScale]

What they mean is that the maximum amount of funding is fixed for each resident. So, IM is 36 months long, so you get 36 months of full funding. Let's say you start 2 months early in May 2020. When May 2023 rolls around, you will now have decreased funding. So what happens? Is your residency actually 38 months long with decreased funding? Or do they graduate you at the end of April 2023? or start fellowship early? And whose choice is it?

Any implied threat is to programs. Students can't end up any worse. If you start 2 months early and:
1. Residency becomes 38 instead of 36 months, at least you get paid for 2 more months.
2. Residency stays 36 months, then you graduate 2 months early and can start your next job that much earlier, or moonlight. At worst, if you take 2 months off before starting a fellowship, you're no worse off (financially) since May/June of this year were probably going to be unpaid.

Is this why these programs are asking residents to do this work voluntarily?

 

[slowthai]

What they mean is that the maximum amount of funding is fixed for each resident. So, IM is 36 months long, so you get 36 months of full funding. Let's say you start 2 months early in May 2020. When May 2023 rolls around, you will now have decreased funding. So what happens? Is your residency actually 38 months long with decreased funding? Or do they graduate you at the end of April 2023? or start fellowship early? And whose choice is it?

Any implied threat is to programs. Students can't end up any worse. If you start 2 months early and:
1. Residency becomes 38 instead of 36 months, at least you get paid for 2 more months.
2. Residency stays 36 months, then you graduate 2 months early and can start your next job that much earlier, or moonlight. At worst, if you take 2 months off before starting a fellowship, you're no worse off (financially) since May/June of this year were probably going to be unpaid.

So programs will have to cough up the money if they stay any longer then. That's interesting, especially for the current residents that may have to stay longer or repeat a year.

 

[njtrimed]

What they mean is that the maximum amount of funding is fixed for each resident. So, IM is 36 months long, so you get 36 months of full funding. Let's say you start 2 months early in May 2020. When May 2023 rolls around, you will now have decreased funding. So what happens? Is your residency actually 38 months long with decreased funding? Or do they graduate you at the end of April 2023? or start fellowship early? And whose choice is it?

Any implied threat is to programs. Students can't end up any worse. If you start 2 months early and:
1. Residency becomes 38 instead of 36 months, at least you get paid for 2 more months.
2. Residency stays 36 months, then you graduate 2 months early and can start your next job that much earlier, or moonlight. At worst, if you take 2 months off before starting a fellowship, you're no worse off (financially) since May/June of this year were probably going to be unpaid.

What implications does it have if you’re working in an “all hands on deck” capacity, rather than in your specialty? Potentially two months less of elective time later?