How is the number of positions in a residency/fellowship progam regulated?

[donaldtang]

Who is the one that decide how many residents/fellows that a program can take every year? Is that ACGME (I know it is responsible for accrediting programs)?
What will happen if a program takes more people than it is supposed to? And how can a applicant know that?
I am asking this because I noticed several fellowship programs offer different number of positions each year.

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[drcrispmd]

For residency it is ACGME. If a program wants more they have to apply and give reasoning for the extra spot. They may also have to have funding (such as hospital system putting up some money). If the hospital system decided they do not want to fund as many spots then the residency will likely have to take less residents.

I do not know about fellowship.

 

[galactus]

Bottom line: Money/funding.

 

[Raryn]

The RRC for that specialty (a committee under the auspices of the ACGME) determines, on a program by program basis the cap of the number of residents. They are very, very strict about this cap, with programs even having to request for special permission if they are even one resident above cap for a month (i.e. someone delays graduation due to maternity leave). Temporary permissions are routinely granted in those situations, but permanent expansions must be explicitly justified with appropriate amount of patients/cases/whatever.

The funding issue is a completely separate one. There have been times programs have run under their caps due to inability to fund positions, but this is not a normal circumstance.

 

[Law2Doc]

...

The funding issue is a completely separate one. There have been times programs have run under their caps due to inability to fund positions, but this is not a normal circumstance.

I actually think this is a very "normal circumstance". The couple of residencies I have been affiliated with were approved for one or two more residency seats than they have ever asked the hospitals for internal approval to utilize. Money and logistics dictate expanding residency size as much as the actual cap. Literally having more people than you know what to do with is a problem most PDs don't want. You need to be able to give everybody good training and resources are limited and not always scalable. Nor do you want to have to lower standards to find that Xth person if Y will do.

 

[Winged Scapula]

I actually think this is a very "normal circumstance". The couple of residencies I have been affiliated with were approved for one or two more residency seats than they have ever asked the hospitals for internal approval to utilize. Money and logistics dictate expanding residency size as much as the actual cap. Literally having more people than you know what to do with is a problem most PDs don't want. You need to be able to give everybody good training and resources are limited and not always scalable. Nor do you want to have to lower standards to find that Xth person if Y will do.

I would agree that the ratio of accredited positions to offered positions is often greater than one.

 

[NotAProgDirector]

Some of the variation seen in slots is because the cap is based on total positions. So, if I have a three year fellowship and I can take 2 people per year, my cap is 6. Now let's say that one of my F2's decides to leave and not complete their F3. I can now take an extra F1 and still be under my cap. People can leave a fellowship for many reasons -- an LOA, quitting / failing out, getting a waiver job, combined fellowships (i.e. doing ID/Critical Care), research years, etc.

 

[Law2Doc]

Some of the variation seen in slots is because the cap is based on total positions. So, if I have a three year fellowship and I can take 2 people per year, my cap is 6. Now let's say that one of my F2's decides to leave and not complete their F3. I can now take an extra F1 and still be under my cap. People can leave a fellowship for many reasons -- an LOA, quitting / failing out, getting a waiver job, combined fellowships (i.e. doing ID/Critical Care), research years, etc.

The places I've worked were allowed by RRC to take more residents than they ever do -- they were under the cap without anyone leaving and chose to remain so. I'm pretty sure that's not so rare.

 

[Over9000]

. You need to be able to give everybody good training and resources are limited and not always scalable. Nor do you want to have to lower standards to find that Xth person if Y will do.

Unless its a pathology program.

 

[donaldtang]

Thank you for all the answers!
So it seems that there are two factors that determine the number of spots: cap decided by RRC and the financial resource of a program
How does RRC decide on the cap?
What are the financial sources of a program? (Medicare money? NIH fund? or other source of fund)
I noticed that some extremely busy fellowship programs offer less spots than less busy places
And the faculty/fellow ratio can range anywhere from 10:1 to 1:1

 

[donaldtang]

And if a program takes more fellow that it is allowed, how can I find that out? I do not want to complete a fellowship and finally find out that my position is not accredited.

 

[IMPD]

And if a program takes more fellow that it is allowed, how can I find that out? I do not want to complete a fellowship and finally find out that my position is not accredited.

Umm....you can check probation, accreditation status on the ACGME website. If the program is accredited when you begin, you're 99.999% Ok. This number of spots/number approved has *NOTHING* to do with accreditation.

 

[gutonc]

And if a program takes more fellow that it is allowed, how can I find that out? I do not want to complete a fellowship and finally find out that my position is not accredited.

Funding =! accrediting. If you have a spot in an ACGME sponsored fellowship, it's accredited. As an example, over the course of my fellowship and the 3 years since, class size in that fellowship has ranged from 2-6/year. We have approval for a total of 15 fellows (in a 3 year program) but only enough cash for 9...some years we had extra money from NIH funding for research fellows, some years we had bupkus. The total # of fellows never exceeded 13.

You're getting way too worked up over this.

 

[rokshana]

basically the RRC is going to look to see if there is enough work for the resident or fellow to get the proper amount of exposure to achieve the goals of training...