I'm currently a PGY-2 PM&R resident switching into a PGY-2 year anesthesia (CA-1) starting July. I just learned about the CMS funding issues with switching specialties midway. I have some questions that I hope someone will enlighten me with 🙂
1. Does this issue depend on the hospital I'm going to? How do I tell which hospitals don't go through CMS funding for residents? I'm currently at a hospital where as far as I know the residents's salary is being paid by the hospitals we're rotating through, does this mean that it's not through CMS?
It's a complicated issue, and believe it or not some debate about exactly what happens. But, in a nutshell, when you start training in PM&R you get assigned full funding for the length it would take to train in PM&R - 4 years (prelim, plus 3 years of PM&R). Every year "counts", so you'll have used two years at the end of this year. You'll have 3 Anesthesia years to go, but only 2 years of full funding left. So the last year will be reduced funding.
You can read all about it here:
https://members.aamc.org/eweb/upload/Medicare Payments For Graduate Med Ed.pdf
All of the hospitals you work at probably bill CMS. Even if they don't, the time counts anyway (so it doesn't really matter). And it doesn't matter where you are going (although if you somehow go to a program that doesn't bill Medicare at all, then it doesn't matter. But I've never heard of such a thing).
2. What does 1 year less of funding mean for the residency? Does it mean that I won't get paid or the program/faculty gets paid less as well? I'm willing to work a year of residency for less pay if that's what it takes.
See the link above. DME funding is decreased by 50%. IME funding is the full 100%. But, each institution has a maximum cap -- the maximum amount it is allowed to bill Medicare. If your institution is over the cap, then this doesn't matter at all -- you become one of the people they don't bill for.
You cannot be paid less than your colleagues -- that's a violation of labor laws.
3. I already signed the renewal contract for my current specialty for 2013-2014, if I decide to switch, what will be my repercussions?
This could be a big problem, or not a problem at all. You signed a contract. Chances are, it tells you exactly what happens if you don't follow it. What will happen if you violate the contract? Several options:
1. Nothing. Your PD decides not to care, let's you go, end of story.
2. Your program decides to enforce the contract. Whatever damages are in the contract, you have to address -- perhaps you have to pay for your replacement cost, etc.
3. Your contract doesn't state what the repercussions are. In that case, your program would need to take you to court. Chances are, they will not do this. They could give you an unsatisfactory rating in professionalism, and that could void credit for the year (but perhaps not an issue, if you're training in anesthesia).
4. Your program could report you to the NRMP as a match violator. In order to participate in the match, you stipulated that you were free to work in July 2013. If you already signed a contract, you were untruthful about this. This is a match violation. You could lose your match spot, be barred from future matches, and then get fired from your current program also. All of this costs your program zero, since all they have to do is complain to the NRMP to start an investigation. It appears I am incorrect in this point. The match agreement only stipulates that it is a match violation to match to a program when you have a concurrent match elsewhere -- i.e. if you match to a prelim/advanced combination, it would be a match violation to try to match the next year unless your advanced match had been waived. If you have signed a contract for the next year, the NRMP doesn't care.
BUT, I am confused. If you are in the NRMP match for PGY-2/CA-1 positions, you realize that almost all of those are matching for July 2014, right? Any "Advanced" position to which you applied is for 2014. If you applied to Anesthesia Categorical programs, those will start July 2013 but not as a CA-1, you'll be an intern again. Unless you applied to "R" programs which would be PGY-2 positions for July 2013. I'm interested to know whether programs really registered these spots (as this is a new deal for the NRMP).
4. Will going through the NRMP/SOAP again "reset" the clock of CMS funding? How about out-of-the-match positions?
No and No. Funding is fixed, regardless of match or how you get the spot. There is no way to reset your clock.
5. A unrelated question. Why do programs accepting CA-1 applicants require current PD letters? It's not a requirement for the current PD's approval for a resident to switch, is it just an act of courtesy? I haven't told my PD yet that I am leaving, as I am not sure if I will match for sure. But if the PD is unhappy that I am leaving, what are some possible actions they can take against me?
We ask for a letter because I want to make sure that you're not failing out of your current program. I'd like to know that your performance is fine, and that you're switching to truly change fields out of interest, not because you're about to get fired.
Which again confuses me. If you've applied and are awaiting the match, and programs require a PD letter, how could your PD not know? Rhetorical, feel free to answer if you wish.
