Can we *pay* to get into residency?

[heech]

Hi,

Please no flames, just asking a real question. 🙂

The underlying question I'm trying to ask is: what limits a residency program to a certain number of slots? I realize programs are accredited for a certain number of residents... but is that limitation legally binding, or is that limitation just a reflection of the amount of funding given to the program for teaching residents?

But, if someone has their heart *set* on a specific program... and assuming of course basic credentials match... would program directors ever consider accepting an applicant (outside of the match) willing to work for free? And/or even buy their own insurance?

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[futuredo32]

I think this is an exception to the rule, but I know of one hospital (Mt.Clemens Regional Medical Center) that will allow people to fund their own residencies. One of the current radiology residents does that. He has to pay his salary, health insurance, and maybe his malpractice (I'm not sure about the malpractice) each year and then he gets a check every pay period.

(It's an osteopathic hosptial)

 

[dragonfly99]

wow, futuredo
that is off the wall.
His family must be independently wealthy.
I haven't heard of allopathic hospitals doing this.
I do know there are unaccredited dermatology residencies that may be like this...they aren't really recognized ones, though, just usually when a derm office/practice creates a residency so they can have cheap labor.
I'd like to hear more if anyone knows more...

 

[mcl]

Hi,

Please no flames, just asking a real question. 🙂

The underlying question I'm trying to ask is: what limits a residency program to a certain number of slots? I realize programs are accredited for a certain number of residents... but is that limitation legally binding, or is that limitation just a reflection of the amount of funding given to the program for teaching residents?

But, if someone has their heart *set* on a specific program... and assuming of course basic credentials match... would program directors ever consider accepting an applicant (outside of the match) willing to work for free? And/or even buy their own insurance?

It might theoretically be possible in some specialties, but surgical specialties are limited by the ACGME based on patient census so that all residents get the requisite amount of experience. Programs have to petition for an increase in resident complement (temporary or permanent) and prove that the request meets the educational needs of the program.

 

[NotAProgDirector]

There are two "caps" that residency programs have to deal with.

The first is the ACGME cap. The ACGME limits the number of residents in each training program, presumably based upon the educational resources available. SOme people feel that the ACGME limits spots in some fields to keep supply down / salaries high. If a program is at it's ACGME cap, they cannot take any further residents. Programs can petition the ACGME to increase their cap, either temporarily or permanently, but it's a complex process.

The second is the Medicare cap. Institutions are capped at the total number of residents they can train. They can allocate them to programs as they see fit. Residents above the medicare cap but below the RRC cap are unfunded.

ACGME rules state that you must pay residents a reasonable salary. They cannot be forced to generate their salary in any way. Some DO programs do this, they are held to other rules.

So the answer is no.

 

[JanetteBournes]

I assume if you're that wealthy, you probably don't need to work in medicine.

 

[Law2Doc]

I assume if you're that wealthy, you probably don't need to work in medicine.

That's a silly assumption. Becoming a physician is not about need, it's about wants and interests. There are physicians from many wealthy families. William Kennedy Smith is an example of a physician from an absurdly wealthy family (the Kennedys). Many people aren't going down this road purely for the income. I personally know a number of nontrads who socked away decent income/investments/rental property before going off to med school and certainly don't "need to work in medicine" either.

 

[Law2Doc]

Hi,

Please no flames, just asking a real question. 🙂

The underlying question I'm trying to ask is: what limits a residency program to a certain number of slots? I realize programs are accredited for a certain number of residents... but is that limitation legally binding, or is that limitation just a reflection of the amount of funding given to the program for teaching residents?

But, if someone has their heart *set* on a specific program... and assuming of course basic credentials match... would program directors ever consider accepting an applicant (outside of the match) willing to work for free? And/or even buy their own insurance?

There are rules against folks bypassing the residency rules and paying their own salary. Last year there was a situation at one of the California hospitals where a physician created a significant grant at a hospital and they coincidentally created an extra residency slot for his son. It was deemed scandalous.

 

[rox]

George Washington has international residency programs. International residents must be sponsored by some home institution. GW charges $75,000/year/resident and the sponsoring institution must pay the resident's salary. Here's the link http://www.gwumc.edu/imp/education/internatres.cfm

 

[curiousaboutmed]

does anyone know about, or have used, programs like matcharesident.com?

 

[Shoushu]

There are rules against folks bypassing the residency rules and paying their own salary. Last year there was a situation at one of the California hospitals where a physician created a significant grant at a hospital and they coincidentally created an extra residency slot for his son. It was deemed scandalous.

I suppose if there isn't a rule, then residencies can choose the highest bidder. One resident says he's willing to train for free, no salary needed just to get a spot, and one applicant willing to pay the hospital $50,000 to get a spot, and the next applicant bids $75,000.

a lot of chaos.

 

[Bitterman]

George Washington has international residency programs. International residents must be sponsored by some home institution. GW charges $75,000/year/resident and the sponsoring institution must pay the resident's salary. Here's the link http://www.gwumc.edu/imp/education/internatres.cfm

I know a few IMGs from wealthy countries who were able to get into a few really good residency programs simply because their home government pays for it. So lucky .

I think the basis for this is that these programs don't have the maximum number of residents they're certified to have (due to financial reasons), so they squeeze in a few more residents provided they don't have to pay them salaries/training costs.

 

[adagio]

George Washington has international residency programs. International residents must be sponsored by some home institution. GW charges $75,000/year/resident and the sponsoring institution must pay the resident's salary. Here's the link http://www.gwumc.edu/imp/education/internatres.cfm

This is rampant in Canadian programs.

The funny thing is that these applicants are assigned by their governments. They bypass the PD all together!!! PD has no say which of these applicants to take.

Gov't pays the institution around 4000 dollar per head (+ the resident's salaries)

 

[Law2Doc]

I suppose if there isn't a rule, then residencies can choose the highest bidder. One resident says he's willing to train for free, no salary needed just to get a spot, and one applicant willing to pay the hospital $50,000 to get a spot, and the next applicant bids $75,000.

a lot of chaos.

Even if it were legal, which it isnt, the numbers you are using are too meaningless. The California scandal referenced earlier in the thread involved millions of dollars.

 

[Substance]

This is rampant in Canadian programs.

The funny thing is that these applicants are assigned by their governments. They bypass the PD all together!!! PD has no say which of these applicants to take.

Gov't pays the institution around 4000 dollar per head (+ the resident's salaries)

Totally! Mostly every residency program in Canada (and some medical schools - see Dalhousie) is training some sort of Saudi/Kuwaiti/Syrian/Oil-country resident or residents. These residency programs run the entire spectrum too, from the walk+talk=doc of family medicine to the holy grail of plastic surgery.

In fact, I am vehemently against this kind of bought residency if the citizens of my own country cannot buy their own residencies - its a huge double standard. Heck if I could buy a residency I'd take out a loan and buy myself a nice radiology spot and work my tail off.

 

[adagio]

Saudi/Kuwaiti/Syrian/Oil-country resident

for the sake of factual accuracy:

Countries that are participitating in this (program) are: Saudi Arabia- Kuwait- Qatar- Bahrain- Emirates- and Libya prior to the overthrowing of Gaddafi

Syria and Lebanon (the Levant in general) are not considered oil-countries, do not have the financial means to support such programs.

Heck if I could buy a residency I'd take out a loan and buy myself a nice radiology spot and work my tail off.

loool you can say that again

 

[Substance]

for the sake of factual accuracy:

Countries that are participitating in this (program) are: Saudi Arabia- Kuwait- Qatar- Bahrain- Emirates- and Libya prior to the overthrowing of Gaddafi

Syria and Lebanon (the Levant in general) are not considered oil-countries, do not have the financial means to support such programs.



loool you can say that again

Pardon me. I did not realize Syria was unworthy of paying for Canadian residencies. My bad.

THe worst part is these docs just pack up and go back to their tyrannical home countries after they are done. They provide absolutely zero long term benefit to the public, and they manage to dilute the training process for Canadian grads. It's mind-boggling! The general public has NO clue about how this works. I bet if they did they'd be very miffed.

And how they hell do you actually spell Gaddafi/Ghadafi/Qaddafy/Guhdahfi? Seriously. haha

 

[adagio]

And how they hell do you actually spell Gaddafi/Ghadafi/Qaddafy/Guhdahfi? Seriously. haha

Hahaha ... just google it (and use the cached version of the wiki page ... ya know since they are protesting and all)

 

[adagio]

they manage to dilute the training process for Canadian grads

its a misconception. those dudes do not affect Canuck spots at all. they have their own cap, and they never compete with can grads, and never jeopardize their spots.

 

[Substance]

Anyway here's a Q.

I'm a resident in a Canadian program. I'm pretty sure I want to switch out into something else, but the numbers up here are pretty grim for transfers (there are only a few programs).

Can I apply to the NRMP/ERAS match even though I'm almost finished my Canadian training? I know I have to write the steps and I will do that, if I can apply to American programs with everyone else.

 

[adagio]

Can I apply to the NRMP/ERAS match even though I'm almost finished my Canadian training? I know I have to write the steps and I will do that, if I can apply to American programs with everyone else.

you will be an IMG in this process (A very special IMG though, since your previous can training will be deemed valuable)

What specialty are you going to apply for? if its radically a different milieu than your current training, your odds are slim ...even with the huge US market

 

[gutonc]

Can I apply to the NRMP/ERAS match even though I'm almost finished my Canadian training? I know I have to write the steps and I will do that, if I can apply to American programs with everyone else.

Sure. Your chances will likely be lower now than they would have been when you first graduated, but certainly not zero. Are you a Canuck grad or IMG? Because that will make a difference.

 

[adagio]

Because that will make a difference.

I thought that residency is like a new baptism .. No one cares where you graduated from once you finish a US or Canadian Rez ... No?

 

[Substance]

Sure. Your chances will likely be lower now than they would have been when you first graduated, but certainly not zero. Are you a Canuck grad or IMG? Because that will make a difference.

Canuck with Canadian MD behind my name.

 

[gutonc]

I thought that residency is like a new baptism .. No one cares where you graduated from once you finish a US or Canadian Rez ... No?

Nope. While Canuck med schools are LCME (and therefore identical to US MD schools, at least in theory), Canadian residencies are quite different than US residencies and are basically given no weight at all in the US (i.e. you can't practice in the US with a Canadian residency behind you).

 

[gutonc]

Canuck with Canadian MD behind my name.

Then you'll be considered the same as any US grad who is 2-4 years out from graduation. The fact that you completed a Canadian residency will be helpful, but not as much as you probably think it should be.

 

[adagio]

(i.e. you can't practice in the US with a Canadian residency behind you).

You can sit for most boards if you are RCPSC certified. Not all of them, but most of them. and if you are board certified, you can practice and get malpractice coverage most of the time.

 

[gutonc]

You can sit for most boards if you are RCPSC certified. Not all of them, but most of them. and if you are board certified, you can practice and get malpractice coverage most of the time.

You need a license to practice, not board certification. Every state has a different license. Different states have different rules.

 

[adagio]

Then you'll be considered the same as any US grad who is 2-4 years out from graduation. The fact that you completed a Canadian residency will be helpful, but not as much as you probably think it should be.

And if you are seeking a different specialty, you must convince the PD why you are forsaking your first specialty. It aint easy.

 

[adagio]

You need a license to practice, not board certification. Every state has a different license. Different states have different rules.

Agreed.

I read somewhere that US institutions are recruiting more and more canadian-trained physicians. Surely it depends on specific state rules

for instance, In Alexandria, Minneapolis, it is illegal for a man to have sexual intercourse with a woman with sardines on his breath, and North Carolina has made it illegal to swear in front of dead people

 

[adagio]

Canadian residencies are quite different than US residencies and are basically given no weight at all in the US (i.e. you can't practice in the US with a Canadian residency behind you).

Interestingly, Canadian academia favors highly favors US qualifications!! It is not reciprocal from what I gather.

On a different note, a US green card holder can enter canada freely without needing a visa, a Canadian green card holder needs a visa to enter the US!!!

 

[Bitterman]

Pardon me. I did not realize Syria was unworthy of paying for Canadian residencies. My bad.

THe worst part is these docs just pack up and go back to their tyrannical home countries after they are done. They provide absolutely zero long term benefit to the public, and they manage to dilute the training process for Canadian grads. It's mind-boggling! The general public has NO clue about how this works. I bet if they did they'd be very miffed.

And how they hell do you actually spell Gaddafi/Ghadafi/Qaddafy/Guhdahfi? Seriously. haha

Actually the whole point of it is that they pack up and leave. Their governments are investing in them financially so they go back to their home countries and provide better quality care (at least in theory). US programs get money and WORK (more residents!) in exchange.

 

[wannabeOBGYN]

for instance, In Alexandria, Minneapolis, it is illegal for a man to have sexual intercourse with a woman with sardines on his breath, and North Carolina has made it illegal to swear in front of dead people

👍

 

[gudog]

(i.e. you can't practice in the US with a Canadian residency behind you).

You can in several that I know of, ie - ortho, uro, FM

 

[gutonc]

You can in several that I know of, ie - ortho, uro, FM

Again...you don't need BC/BE to practice, you need a license. If the state you're in will license you, you can practice regardless of specialty.

 

[NotAProgDirector]

Most states accept canadian training and exams as equivalent.

I found the following list online -- no idea how accurate it is:

For U.S. and Canadian medical school graduates the LMCC is accepted with the following caveats:

1. Florida requires that the SPEX exam be taken in addition to being licensed in the U.S. or Canada for at least 10 years.
   
2. Illinois accepts the LMCC if received after 4/1970, otherwise board certification, SPEX or USMLE 3 is required.
   
3. Iowa requires the LMCC be endorsed by a provincial licensing board.
   
4. Missouri requires graduation from a Canadian medical school.
   
5. New Jersey requires that physicians be licensed in another U.S. state and be board certified.
   
6. Pennsylvania accepts the LMCC if received after 5/1970. English version
   
7. Puerto Rico accepts the LMCC if you hold another U.S. medical license.
   
8. Washington accepts the LMCC if received after 1969.
   
9. Wisconsin accepts the LMCC if received after 1/1/78.
   
10. Kansas, Louisiana, Guam and Virgin Islands do not accept the LMCC.