EM after pre-lim funding issues?

[costalgroove]

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IMG applying for EM this year. I think I am as competitive as I can be, but I am an IMG so I need a back up. I was thinking of applying to transitional year and prelim medicine as a backup. I had heard there were potential GME funding issues that might make reapplying to EM after a pre-lim harder. Could someone explain this to me?

I do not want to do a pre-lim surgery ( actually I can't think of anything worse).
I do not want to do categorical FM or IM unless it is a last resort I.e. didn't match EM a second time through.
I will be applying broadly.

Thanks in advance for your comments.

 

[Apollyon]

How it was explained to me: if it doesn't lead to board certification, the clock doesn't start. I did an undesignated prelim IM year (not a required prelim with a categorical PGY-2 seamlessly connected), and was told that my DME was intact.

Now, DME vs IME - direct medical education versus indirect medical education. Direct is to what people are referring when they talk about funding. That is paid at 100%, to the hospital during your first training that leads to board eligibility. When that clock runs out (like 3 years for IM, FM, and Peds, 4 years for Ob/Gyn and psych, and 5 years for Gen Surg), then hospitals are reimbursed at the indirect rate, which is 50 or 60 percent. It's not full, but it's not nearly nothing, either. If your clock started and ran for a shorter program, then you switched to something longer, that is the question - like if you did a year of FM, then switched into general surg. You get 3 years for FM, so that's all you get (because it was your first board-eligible training), and 1 year was used. So, you now have 2 years left of DME, but need 5 for GS. That means the GS program eats the last 3 years of the cost, as they only get paid at the IME rate.

And that means that, if someone starts out in a longer path, like psych, and goes as PGY-2 to a shorter program, like FM, then they would never run out of their DME years.

 

[diphenyl]

Excellently explained Apollyon.

In Summary from what I remember from residency and based on my research it is as follows:

-Categorical PGY spot starts the clock which is set at the number of years it takes to complete that specialty. For Example IM/ FM = 3 years, Gen Surg = 5-7 years depending on your program.

-Transitional or preliminary spots (regardless of specialty) do not start the clock. Including PGY 1, 2, 3 or whatever. If it is preliminary, it doesn't count.

 

[gutonc]

Excellently explained Apollyon.

In Summary from what I remember from residency and based on my research it is as follows:

-Categorical PGY spot starts the clock which is set at the number of years it takes to complete that specialty. For Example IM/ FM = 3 years, Gen Surg = 5-7 years depending on your program.

-Transitional or preliminary spots (regardless of specialty) do not start the clock. Including PGY 1, 2, 3 or whatever. If it is preliminary, it doesn't count.

Close but not completely correct. Prelim/TY years don't start the clock, but they do count. So if you do a prelim year and then start a categorical residency afterwards you will have one less year of full funding (100%DME/100%IME). If you do a medicine prelim year and then transition into an advanced program that requires a prelim year (Gas, PMR, Neuro, etc), no harm no foul. If you go into a categorical IM program, also no problem. If you go into EM (or any other categorical specialty), your last year will be funded at 50% DME/100% IME. It's less than the program would normally get but probably not as much as you think and for most programs, not that big of a deal ($25-35K total).

Frankly, if I were a PD looking at your app the 2nd time around (which there hopefully won't be), I'd rather see you doing something useful like a prelim year than dicking around for a year before you re-apply.