Institution on probation

[LadyGrey]

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Background: my major criterion for ranking a program at all is "would I rather scramble than be here?" While there are programs I'd be less happy to get, I can't say about any one that I'd be happier to scramble than be there.

However... one is on institutional probation for financial issues that they claim are in the past, and claim that the probation is likely to be lifted at the next site visit. Next visit, though, appears to be this April (from the ACGME site). So the question here is more like "is it worth risking that I might have to find a new program this April rather than in the Scramble?"

I am strongly leaning towards not ranking it. Does that sound reasonable?

 

[Miami_med]

It is reasonable if you are likely to find a spot in the scramble in your specialty. If not, the worst thing that would happen from the program shutting down is you being in the same boat without a spot.

 

[Winged Scapula]

Depends on what the "financial reasons" are.

Not all probationary factors directly affect residents.

 

[LadyGrey]

The hospital was bankrupt, but has changed financial leadership and is now in the black, if that helps.

 

[Winged Scapula]

The hospital was bankrupt, but has changed financial leadership and is now in the black, if that helps.

If they are operating at a profit, that rarely affects residency programs (since the majority of the money doesn't come from the hospital) although I can see how it would make you nervous as programs have been known to close because of it (and programs are apparently under no obligation to find you a spot elsewhere).

 

[Miami_med]

If it were me, and this is just me, financial solvency is HUGE. With the exception of some of the essentially non-disposable county hospitals which always operate in the red as if it were some sort of mandate, a hospital losing money would be a concern to me. The reason is that having problems with accreditation over work hours, paperwork, etc... is likely solveable and unlikely to leave you without a spot. There have been numerous reports in the last couple of years of residents having to run around the country looking for spots because the hospital shut down. You can't continue on in that sort of situation.

 

[LadyGrey]

As much as I have a healthy fear of scrambling, even if I ditch this program I'll have 13 places left to rank, which is more than the magical 10. Basically this place is either 14 or not on the list at all.

While maybe the program shutting down is not a super likely occurrence, I think it's in the same neighborhood as having to scramble. I'm comparing two catastrophic events that are both possible but not likely. And if I look at the options, I'd rather be scrambling at the standard time than left without a program at a later date, if that makes sense.

 

[Samoa]

If this were a program you'd rank highly, but for the probation issue, I would urge you to consider ranking them anyway. When programs close, usually those residents are given priority for any residency spots in that field which may open up across the country. And usually there are enough in every field to accommodate the residents involved. At worst you may lose a year of residency, which you may do anyway if you don't match, and there are few spots in the scramble (which occasionally happens even in the moderately competitive fields).

However, if you were on the fence about the rank vs scramble decision already, and this represents the proverbial straw, don't rank it. People get coerced into ranking programs with poor training all the time with the promise that "it's on the verge of being shut down, and when it is, you'll get a really good spot somewhere else." And then the program keeps limping along for their entire residency and they end up graduating from there, unable to get the kind of job they want.

Probation is definitely an important factor. But the reality of the training there is far more important than the last accreditation decision, whatever it was. So don't let that be the deciding factor.

 

[dragonfly99]

I agree with samoa.
It might help us give you better advice also if we knew if this is a competitive specialty vs. not. I mean, if it's derm or urology or even something like radiology, I'd probably tell you to rank it regardless, unless you want to risk not training in that specialty. If it's IM or fp, or even anesthesia, I'd probably say don't rank it if you were already on the fence about ranking vs. not.

 

[LadyGrey]

Thanks for all the smart advice.

It's EM, so moderately competitive. I'm pretty confident that this program would be dead last on my list of 14 anyway even if it had no probation or financial issues, so ditching it and ranking only 13 is still relatively safe. (Though obviously it's never a sure thing, esp as a DO).