do pyramidal residencies still exist?

[rkaz]

---

Members don't see this ad.

Hi guys. So I was chatting with my parents and sister yesterday as all of them are also in the medical field. My parents did their residency in the 1970s, and they said that there used to be a pyramidal system, in which there would be something like 12 positions for PGY-1, 10 positions for PGY-2, 8 for PGY-3 etc. So basically a couple of people would be forced out every year... not for any real fault of theirs, other than not 'making the cut' (compared to other residents). I thought that was ridiculous and couldn't believe that any such horrible pyramidal system could exist, until my sister chimed in and said that she was also aware of some residency programs not renewing contracts of residents for the following year.

I just wanted to ask... is this really done anymore? It sounds terrible. I can understand if someone is an awful resident and is grossly making errors with patients. But randomly cutting people for no fault of theirs seems like some kind of bad joke. If true, please let me know which programs still do this as I want to avoid applying to such programs. Thanks!

 

[rkaz]

To add to the above, I would like to know... if you do a reasonable job with residency, how likely are you to be reinstated the following year? It's pretty sad to think that this might not be 100%, presuming the resident wanted to continue in the program. I had assumed that residents get a contract for their full program (ie 4 years in psych) and didn't think you'd have to renew your contract yearly. Can someone also clarify this?

 

[michaelrack]

I don't think they have pyramidal residencies any more, but they use to be fairly common in surgery. You may want to ask in the surgery forum if any still exist. I am not aware of any such program in psychiatry.

 

[MacDonaldTriad]

The MOU for our resident’s union allows programs to non-renew contracts without cause as long as the trainee is informed before they are half way through their contract. After that programs have to show substantial reason for not continuing a resident. I have only seen this happen once in psychiatry. It isn’t very common in general, but it seems especially rare for psychiatry.

This would be a fairly clear black mark on someone’s record. Essentially a program would be saying that they were better off without this person.

 

[splik]

you would be accepted into a residency program for 4 years (or 3 years as a PGY-3) but you will sign a contract each year for each PGY year. This is partly because the terms may change (e.g. pay) but also gives both you and the hospital the opportunity to terminate. Would you really want to be in a 4 year contract with no chance of recourse? The vast majority of residents will have their contracts renewed but people leave all the time. This is more often because the resident wishes to leave (Transfer to a different program, specialty, fast track to child psych, or quit medicine altogether, occasionally for reasons of illness, or to become a parent), but programs do terminate residents as well. My program apparently has a termination rate of ~0.06% of residents in the past 16 years or so which works out about 1 every 4 years.

I am unaware of pyramidal schemes for psychiatry, the opposite is often true (i.e. we have more residents and senior residents than interns).

 

[vistaril]

you would be accepted into a residency program for 4 years (or 3 years as a PGY-3) but you will sign a contract each year for each PGY year. This is partly because the terms may change (e.g. pay) but also gives both you and the hospital the opportunity to terminate. Would you really want to be in a 4 year contract with no chance of recourse? The vast majority of residents will have their contracts renewed but people leave all the time. This is more often because the resident wishes to leave (Transfer to a different program, specialty, fast track to child psych, or quit medicine altogether, occasionally for reasons of illness, or to become a parent), but programs do terminate residents as well. My program apparently has a termination rate of ~0.06% of residents in the past 16 years or so which works out about 1 every 4 years.
QUOTE]

a termination rate of 0.06%(even if looking at things on a per year per resident basis) would require that your program have over 400 total residents if it really worked out to about 1 resident terminated every 4 years.

 

[splik]

i think i meant 0.6% typo

 

[BobA]

We almost have a diamond shaped program, where we get people transferring in from other programs during PGY2 and then leaving again for child.

People are terminated rarely here, and even then are usually given several chances (assuming they didn't do something egregious).

 

[rkaz]

Thanks so much everyone for the perspectives. So it seems like residents don't get kicked out unless something particularly egregious happens, and that the pyramidal system is a thing of the past. I can't imagine what that must have been like for those physicians who had to go through it in my parents' generation.

Would you really want to be in a 4 year contract with no chance of recourse?

I hadn't thought of things from this perspective, but yes, it does make sense that no one would want to be locked into a contract for 4 years. 😳