Doing a second residency...Realistic?

[Leukocyte]

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I am a Family Medicine resident who wants to do a second residency in general surgery. If I do all my electives in general surgery, do well on my required general surgery rotations, and get good LORs from surgeons during residency...would it be realistic to seriously plan on doing a second residency in general surgey after completing my FM residency? Fundung will be a big issue, but is there a way around that? I mean, I will be a BC FM physician, can I take advantage of that?

Do many people actually do second residencies? How do they get around the funding issue?

Thank You.

 

[Top Gun]

I am a Family Medicine resident who wants to do a second residency in general surgery. If I do all my electives in general surgery, do well on my required general surgery rotations, and get good LORs from surgeons during residency...would it be realistic to seriously plan on doing a second residency in general surgey after completing my FM residency? Fundung will be a big issue, but is there a way around that? I mean, I will be a BC FM physician, can I take advantage of that?

Do many people actually do second residencies? How do they get around the funding issue?

Thank You.

You're not the first one to ask this question. Of course its possible to do a second residency. I knew a general surgery resident who used to be a PM&R attending. The question is, do you really want to do another residency? General surgery will mean another five years of long call nights and working long hours, not to mention mediocre pay. During that time, you could have a practice going, not to mention more free time to spend with your family. But if you really love surgery, then go for it.

 

[Winged Scapula]

I am a Family Medicine resident who wants to do a second residency in general surgery. If I do all my electives in general surgery, do well on my required general surgery rotations, and get good LORs from surgeons during residency...would it be realistic to seriously plan on doing a second residency in general surgey after completing my FM residency?

Of course its possible although most people go the other way (Surg ---> FM).

Fundung will be a big issue, but is there a way around that? I mean, I will be a BC FM physician, can I take advantage of that?

There is no way around that if programs take CMS funding for the position. Once you "declare" a field by starting training, the federal gov't locks you into the minimum number of years of funding to obtain board certification in that field. If you start in FM, finish that and switch to surgery, you only get the 3 years of full funding.

CMS funding comes in two forms -- DME (Direct Medicine Expense) and IME (Indirect Medical Expenses). DME is supposed to pay for resident salary and benefits. IME is supposed to pay for the "invisible" costs of training residents -- variously translated as overordering tests, ineffiencies in the system, caring for uninsured patients, etc. Once you exceed your funding limit, the sponsoring institution gets 50% of the DME and 100% of the IME.

For example, all fellowships are beyond the GME funding clock and all are paid 50% DME.

Do many people actually do second residencies? How do they get around the funding issue?

Thank You.

It is not uncommon and I suggest you do a search in this forum because there are several threads which deal with this issue. Most people do not "get around" the funding issue. Many GME budgets are limited, and getting half the money is not an option. Either they really want you and are willing and able to take 50% of CMS funding, or they are not.

 

[Faebinder]

Is it doable? Yes. You will even get funding as long as you have completed the first residency successfully (granted not as much money is given for a second residency as the first).

But the question is... is it that bad that you want to spend X number of years of your life (that wont come back) doing something all over again. Don't forget the economic hit you are going to take having to go through residency again. Are you thinking fellowship as well?

On the other hand, if you are miserable then you are miserable... if the pasture looks so green that you have to try it... then I guess the only way for you to settle this is to try.

After residency you will need fresh LoRs from the field you want to go to (so in your case, surgeons you rotated with) and you need a decent program director letter. You need to write a killer PS and you need to have no repeats in the USMLE to have a fair chance for surgery. If I remember right, you were an FMG/IMG, which means you cant depend on your school for support.... which means you need to apply to a lot of programs and make sure they take your profile.

 

[roja]

I concur. It is something that can be done. EM has a number of people who have done this. While funding has become more complicated, Winged gives a great explaination.

Good luck

 

[DrDre311]

There's a guy who matched at UC-Irvine a couple years ago for integrated plastics who had done an entire ophtho residency, followed by an oculoplastics fellowship, and decided that he needed to do another 6-year residency.

 

[marsupial]

Are you sure that wasn't the guy who did ENT at USC then went to plastics at that UC? What was the person's name?

 

[DrDre311]

Are you sure that wasn't the guy who did ENT at USC then went to plastics at that UC? What was the person's name?

I forget the guy's name, it's been awhile since I interviewed. He was from the East Coast though. I'm definitely sure he did ophtho and then an oculoplastics fellowship because I remember him talking about it at UC-Irvine and thinking it was bizarre to take that particular training pathway.

Are you saying someone did an entire ENT residency and then matched into an integrated plastics residency? It's pretty common for people to do ENT and then an independent plastics residency but it would be weird for someone to do all of ENT and then opt for another 6 years of residency when the 2 and 3 year independent residencies are available to people who have completed 5 years of ENT.

 

[marsupial]

You're right I think it was the independent one.

 

[Top Gun]

I forget the guy's name, it's been awhile since I interviewed. He was from the East Coast though. I'm definitely sure he did ophtho and then an oculoplastics fellowship because I remember him talking about it at UC-Irvine and thinking it was bizarre to take that particular training pathway.

Are you saying someone did an entire ENT residency and then matched into an integrated plastics residency? It's pretty common for people to do ENT and then an independent plastics residency but it would be weird for someone to do all of ENT and then opt for another 6 years of residency when the 2 and 3 year independent residencies are available to people who have completed 5 years of ENT.

But doesn't ENT already offer a fellowship in plastics? The guy could have done that instead, unless he wanted to do more than facial plastic surgery.

 

[secretwave101]

Sounds like a reeealy difficult road to me. I'm feeling for you that you have the urge to do this. FM must have done you wrong. I suppose you'll get there if you stick with it.

 

[DrDre311]

But doesn't ENT already offer a fellowship in plastics? The guy could have done that instead, unless he wanted to do more than facial plastic surgery.

Oto's can do a fellowship in facial plastic surgery, which is different than a general plastics "fellowship."

What you will find commonly referred to as a plastics "fellowship" is actually what the ACGME, the RRC, and the AACPS refer to as an independent plastic surgery residency. Independent plastic surgery residencies are 2-3 years (all are soon to be shifted to 3 years per AACPS) and it varies by institution, but independent residencies accept applications (through the SF Match) from people who are or will be BC/BE in general surgery, ENT, orthopaedic surgery, urology, and neurosurgery.

To further complicate things, there are also integrated and combined/coordinated PRS residencies that match medical students through ERAS. I will be happy to explain the differences if anyone wants to know.

The most common precursor to an independent PRS residency is general surgery, followed by ENT. I have heard of orthopods doing independent plastics residencies (rarely), urologists even more rarely, and I've only heard of one neurosurgeon doing PRS.

The guy I'm talking about didn't do ENT. I remember this case because it is so strange. He did an entire ophthalmology residency and then an oculoplastics fellowship, during which he realized that he could be operating all over the body instead of just the eyes. Since he wasn't eligible to apply for independent plastics residencies, he went back and applied to integrated (6 year) PRS residencies and matched at UC Irvine.

Another weird story is that there's an attending at Loma Linda who matched into integrated plastics out of medical school, did 3 years of his residency, and realized he wanted to do craniofacial; so he went back to dental school and got his degree, followed by finishing his PRS residency and doing a CF fellowship.