Funded VS. Non-funded Residency Spots

GonnaBeAnMD

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    I notice there are 1 or more unfunded residency slots in some residencies. Are these usually easier to get into? Or are they just as hard for a competitive field? This means you're not gonna get paid during residency right? If so, I'd imagine it would be tough to fill a spot that usually pays $40,000 x 5 years ($200,000 loss for the student).
     

    radonc

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      GonnaBeAnMD said:
      I notice there are 1 or more unfunded residency slots in some residencies. Are these usually easier to get into? Or are they just as hard for a competitive field? This means you're not gonna get paid during residency right? If so, I'd imagine it would be tough to fill a spot that usually pays $40,000 x 5 years ($200,000 loss for the student).


      im not sure but would like to hear other people's input on this scenario...
       

      (nicedream)

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        GonnaBeAnMD said:
        I notice there are 1 or more unfunded residency slots in some residencies. Are these usually easier to get into? Or are they just as hard for a competitive field? This means you're not gonna get paid during residency right? If so, I'd imagine it would be tough to fill a spot that usually pays $40,000 x 5 years ($200,000 loss for the student).

        No, it means the hospital does not get paid. For each funded spot, the hospital gets medicare cash. No funding, no cash, no resident.
         
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        GonnaBeAnMD

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          (nicedream) said:
          No, it means the hospital does not get paid. For each funded spot, the hospital gets medicare cash. No funding, no cash, no resident.
          So when we see a program listing with 7 spots: 5 funded, 2 unfunded and there are 7 spots filled - what does that entail?
           

          (nicedream)

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            GonnaBeAnMD said:
            So when we see a program listing with 7 spots: 5 funded, 2 unfunded and there are 7 spots filled - what does that entail?


            I've only seen that with a couple derm programs, where the residents are unpaid. I don't think many programs accept residents into unfunded slots though; I may be wrong.
             

            Winged Scapula

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              Most programs don't offer unfunded positions for the simple reason that a) residents don't want them and b) fear of legal repercussions.

              If they are offered they might have funding sources outside of Medicare (ie, university, hospital, research grant, etc.). Those interested in such positions should contact the individual programs for more information.
               

              biryani86

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                So if they ask for government vs. corporate funding. Government funding seems to be either military, or NIH? The positions I've seen filled, seem to have a lot of Kingdom of Saudi Arabia trainees, so I'm assuming their government forks over the dough required.

                Would corporate be pharmaceuticals, University departments, or private companies/hospital? Would a private practice count?

                Additionally, what would be the approximate per annum required monies. Likely salary, malpractice insurance, and compensation for the program, amounting to the usual MEDICARE allotted amount? or just enough for the residents salary, and malpractice insurance?
                 

                rokshana

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                  So when we see a program listing with 7 spots: 5 funded, 2 unfunded and there are 7 spots filled - what does that entail?
                  the unfunded spots are usually not filled…programs may work to try to get funding for them at some future point though.

                  i have heard of people funding their own spot (usually for something that has the ability to make the option make sense economically- i.e. GI) but its rare and its not just funding the salary….the cost of train gin a resident or a fellow is upward to 100-125K/year (remember its not just the cost of paying the resident's salary) so it can be a pretty expensive proposition.

                  there was a GI fellow where i did residency that had his spot funded by his father's group…with the expectation that he join the group after fellowship…
                   

                  Law2Doc

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                    Thats what I was wondering, if I did request funding, would I probably have to ask 150k per annum?

                    Not worth looking into -- You generally can't do this privately. Was done in the past and got tons of bad press when it looked like someone's family was buying them into a residency. And you probably can't work for free even if you wanted to for many legal reasons.

                    In general there are separate hurdles a program needs to go through to get allocated a residency slot and then to get it actually federally funded, which accounts for the mismatch. So if a Program is allocated up to seven spots, but only five get funded, in general they are only going to take five residents. The two other spots aren't real spots, just potential for future expansion. Basically place holders. For all intents and purposes, unfunded spots aren't available spots -- forget about them.
                     

                    biryani86

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                      Not worth looking into -- You generally can't do this privately. Was done in the past and got tons of bad press when it looked like someone's family was buying them into a residency. And you probably can't work for free even if you wanted to for many legal reasons.

                      In general there are separate hurdles a program needs to go through to get allocated a residency slot and then to get it actually federally funded, which accounts for the mismatch. So if a Program is allocated up to seven spots, but only five get funded, in general they are only going to take five residents. The two other spots aren't real spots, just potential for future expansion. Basically place holders. For all intents and purposes, unfunded spots aren't available spots -- forget about them.

                      Is the legal issue basically that any institutional DIO would reject "Requests for Exception on Resident compensation" if they sniffed any hint of private funds? I just don't understand why, though; especially if the position itself is earned on merit.
                       

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                      gutonc

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                        Is the legal issue basically that any institutional DIO would reject "Requests for Exception on Resident compensation" if they sniffed any hint of private funds? I just don't understand why, though; especially if the position itself is earned on merit.
                        Because those positions are never earned on merit.
                         
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                        Law2Doc

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                          Is the legal issue basically that any institutional DIO would reject "Requests for Exception on Resident compensation" if they sniffed any hint of private funds? I just don't understand why, though; especially if the position itself is earned on merit.

                          The problem is that once hundreds of thousands of dollars are being thrown about, the "earned on merit" part won't usually pass the sniff test. You don't generally need private funds unless you weren't qualified to get a funded spot in the first place. The bad press case a few years back (discussed on SDn at the time) was a parent that funded a California radiology residency spot so his kid could get one. The program made a lot of money but in the end wasn't worth the hit to reputation. If a private source wants to fund a spot and let the residency fill it with a total stranger that might be different but frankly the incentive to make it happen isn't there.
                           
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                          Law2Doc

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                            Those must be D.O. programs. Definitely doesn't happen in the ACGME world.

                            It can happen with certain Non-accredited Allo fellowships. Problem is, given our countries history of slavery and indentured servitude we are extremely wary of arrangements where people are being asked to work long hours for no pay, no benefits, etc. And a program gives up a lot of control over it's resident/fellows if they aren't drawing a salary that can be docked. The threat of firing someone becomes meaningless if it wasn't a real paid job to start with. There's only so much influence you have over someone who is working for you just to say they did, as a means to an end. You get what you pay for. And most places feel the need to line up moonlighting opportunities for unpaid people, so that creates a loss of controllable time and duty hours and adds additional administrative burdens. All if which is why at the resident level, no pay isn't a real option.
                             
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                            IMPD

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                              It can happen with certain Non-accredited Allo fellowships. Problem is, given our countries history of slavery and indentured servitude we are extremely wary of arrangements where people are being asked to work long hours for no pay, no benefits, etc. And a program gives up a lot of control over it's resident/fellows if they aren't drawing a salary that can be docked. The threat of firing someone becomes meaningless if it wasn't a real paid job to start with. There's only so much influence you have over someone who is working for you just to say they did, as a means to an end. You get what you pay for. And most places feel the need to line up moonlighting opportunities for unpaid people, so that creates a loss of controllable time and duty hours and adds additional administrative burdens. All if which is why at the resident level, no pay isn't a real option.


                              We entertained (for a minute) trying a few privately-funded spots, and rejected them for all the usual reasons cited above. Money is tempting.
                               
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