Elective TDY during Residency

[K3l3v]

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I'm trying to do a Wilderness Medicine elective during my third year of FM residency, as part of an AOC in Wilderness Medicine. Although my local GMEC allows for electives outside my state during residency, my program is telling me that I can't.

The reason stated is this - in order to do a rotation outside my state, I have to be on TDY orders (to be covered by TriCare, to establish place of duty, etc). In order to go on the TDY, it has to be funded. In order to get funded, I have to justify the need for the TDY. And, apparently, TDY's that are not required for a resident to graduate are (almost) automatically disapproved by said GMEC.

I am certain that I'm not the first resident to run up against this kind of thing. Has anyone out there found a successful work-around for this? I want this elective enough that I'm willing to pay out of pocket, but apparently that is also not allowed.

Does anyone know a way, or can anyone suggest a way to fund an elective TDY through other means?

V/r,
K3l3v

 

[NavyFP]

I'm trying to do a Wilderness Medicine elective during my third year of FM residency, as part of an AOC in Wilderness Medicine. Although my local GMEC allows for electives outside my state during residency, my program is telling me that I can't.

The reason stated is this - in order to do a rotation outside my state, I have to be on TDY orders (to be covered by TriCare, to establish place of duty, etc). In order to go on the TDY, it has to be funded. In order to get funded, I have to justify the need for the TDY. And, apparently, TDY's that are not required for a resident to graduate are (almost) automatically disapproved by said GMEC.

I am certain that I'm not the first resident to run up against this kind of thing. Has anyone out there found a successful work-around for this? I want this elective enough that I'm willing to pay out of pocket, but apparently that is also not allowed.

Does anyone know a way, or can anyone suggest a way to fund an elective TDY through other means?

V/r,
K3l3v

Huh????

What service are you with? Active or Reserve? If Reserve, what program are you enrolled in?

 

[K3l3v]

Navy FP,

Thanks for the reply. I am AD Army at Tripler AMC (in Hawaii).

 

[colbgw02]

Is permissive TDY not an option? It seems like that would eliminate the funding issue but allow you to remain under orders.

 

[K3l3v]

colbgw02,

Thanks for the reply. That thought had occured to me. It's one of the suggestions that I'll make, but not sure if it will fly.

*Update* My GMEC specifically disallows permissive TDY during residency. I knew there was a reason why I hadn't requested it... */Update*

Does anyone have any other suggestions. Anyone have a similar situation that they successfully navigated?

V/r,

 

[colbgw02]

*Update* My GMEC specifically disallows permissive TDY during residency. I knew there was a reason why I hadn't requested it... */Update*

V/r,

I've taken PTDY at least twice as a resident, so are they saying it's disallowed in general or just for a rotation? If it's the former, then I call BS.

 

[K3l3v]

I've taken PTDY at least twice as a resident, so are they saying it's disallowed in general or just for a rotation? If it's the former, then I call BS.

The issue, as it has been explained to me, is funding for the TDY. Because 'Wilderness Medicine' is not a required rotation for a resident to graduate from a Family Medicine residency, the GMEC won't approve funding for the TDY.

Also, according to my program director, the GMEC won't allow a permissive TDY during the residency (so paying for it out of pocket is out, too). Not sure if I can protest this one. I definitely haven't come close to using my leave accrued during residency, so...

Any ideas?

 

[Gastrapathy]

People do permissive rotations all the time but blazing a new trail is a PITA. If you are going to be treating patients rather than observing, you need a bunch of paperwork completed (MOU and something else) and signed by the hospital CO. It will define who pays for your malpractice (govt vs the site) and cover the program wrt the ACGME. The process can take quite a while.

But, they should allow this. If they don't, its a site-specific lameness.

Alternatively, take leave and do whatever you want. All that would take is your PD looking the other way a little.

 

[colbgw02]

Double post. Oops.

 

[colbgw02]

I have to admit that I'm a little confused about the answer you're getting from your PD. From what you've written, my suspicion is that your PD doesn't want to allow the rotation for whatever reason and he's using GMEC as the reason. I suppose that if you wanted to press the issue, then you could go straight to your head of GME, because nothing you've written explains why they'd deny permissive TDY. Pissing off your PD is a dangerous game to play, however, and you always run the risk that the head of GME will side with your PD anyway. In which case you'd end up with both a mad PD AND no elective rotation.

 

[NavyFP]

Navy FP,

Thanks for the reply. I am AD Army at Tripler AMC (in Hawaii).

Permissive/No-Cost TDY would seem to be your only option. There are occasionally funds at the OTSG/AMEDD level, but they like to use those for operational guys. MedCens have their own CME (which this would be) funds.

An additional hurdle would be supervision. Who would be providing oversight? You will likely need an MOU to make it Kosher with the RRC. These can be a pain to generate because lawyers are typically involved.

I doubt you will be able to make this happen.

 

[K3l3v]

Permissive/No-Cost TDY would seem to be your only option. There are occasionally funds at the OTSG/AMEDD level, but they like to use those for operational guys. MedCens have their own CME (which this would be) funds.

An additional hurdle would be supervision. Who would be providing oversight? You will likely need an MOU to make it Kosher with the RRC. These can be a pain to generate because lawyers are typically involved.

I doubt you will be able to make this happen.

Appreciate the info so far, gents. It's confirming what I thought, but didn't know.

As far as the specifics of applicability/supervision/actual learning involved... There are two sites that I've looked at. The first is at Madigan - its a residency geared elective in Wilderness Med for residents and medical students (not to be confused with the new fellowship in wilderness med that they started, but run by the same people). It might be easiest to make a case for. The other is run by the Wilderness Medical Society through one of the Universities in Tennessee, and it's already been approved for CME. Not sure about the duration of the elective in Madigan (still need to contact their director for information more current than on their website). The TN elective is 4wks long, would be impossible to swing that on a 'regular' rotation.

In either case, I'd not necessarily be treating pts (so issues of malpractice coverage are moot). Actual participation/oversight would also be easy to verify, esp since our associate (soon to be full-on) PD came from Madigan, and still knows a load of people there.

Not sure how to read my PD. It sounds like he's for it, if I can find funding. He's also deployed currently, so getting a good read is difficult. The associate PD (although he'll step into the role soon), is still taking his cues from the current PD.

It is frustrating, because the elective was already approved (at least in theory), when my AOC (requiring the elective) was approved. Making the paperwork look good for GMEC/RRC will not be a problem. I already had to do that for my elective in Dive Med (though that's all on-island). I'll make some discrete inquiries into who would actually be making the moving/shaking at my GMEC. Depending on who's doing what, I might take it up the chain...

Thanks for the info and ideas.

 

[SuperSoccer19]

Just chiming in that I have taken PTDY multiple times as a resident for academic activities--conferences, an elective as an intern, on a ship, probably something else I am forgetting.

You need an MOU as mentioned below and this can take months to get. Some residents in another department were considering this wilderness medicine elective in Colorado and I *think* their program was endorsing it and im not sure if an MOU was needed or not since there was no patient care and was more a training activity, but I am really not sure.

Our PD has said that if we go outside the area then it has to be justified to our CO why these resources cannot be found locally, but I think we've even sent residents quite far away.

Its definitely not against military residency policy. PTDY should not cost the command anything.

 

[bogatyr]

In 2008 I set up a 2-month visiting rotation at a respected civilian institution in my home state (so I could live at my parents' house). MOUs already existed as Army residents had previously had established rotations there. I did this because my program director said, "You set it up and we'll make it happen." I was later denied because my program didn't have the money for me to go TDY, and at least at that time, COL Powers (chief of Army GME at that time) had prohibited permissive TDY for clinical rotations in the army. I doubt that policy has changed. I think their biggest excuse was something to do with malpractice coverage.

Good luck to you, I hope you can make it work. The problem in a bureaucracy is that is always easiest to just say no.

 

[K3l3v]

Thank you to everyone who has posted so far. I have a partial resolution, but I'm not sure how it will pan out in the end...

After contacting my GMEC resident member, the response was that someone, at some point 'might have' skirted the PTDY issue by making an 'anonymous' donation to the pot of $ used for TDYs, conferences, etc, with an earmark towards whatever their pet project was.

At this point, the issue with my program is not been the training itself, but more about how to fund it. My PD's stated hang up is that he doesn't want to let me pay for the cost ($4-6k for Madigan, $2-4 for TN, depending on travel, board, and fees), but he appears to be actively trying to find alternate funding sources. I've rocked the boat as much as I feel comfortable at this point. We'll see what shakes out. Choosing which hill to die on and all that.

Most of the PTDY vs TDY issues disappear with the Madigan wilderness med elective (since it is run by military), but cost is quite a bit higher than through WMS in Tennessee. Dunno.

I'll post again when I get resolution one way or the other.

 

[DoctorDoom]

One of my fellow Residents when I was at Tripler in GS pulled off exactly what you are trying to do, but he was the PD's boy and he managed to finagle a way to pay out of pocket. That was 3 years ago. It took him a long time to pull it off. PM me and let's see if I can give you more info.