Intern year before ER?

[Back34]

---

Members don't see this ad.

My apologies if you've seen this twice; I posted in another forum and didn't get too many responses.

I'm not 100% committed to ER yet, but I am doing an ER elective now and finding that it's the type of work that suits my personality, etc. Given that the only "highlight" on my application is an o.k. step I score (224) and that I'm still somewhat undecided as to what I want to be when I grow up --although ER is looking better by the day -- a preliminary medicine year sounds appealing. My guess is that it would make me more competitive as far as landing my top choice and would make my initial ER year more productive. I just wanted to get any thoughts as to what anybody thought about the practicality, usefulness of doing so. Thanks.

 

[GeneralVeers]

Don't do it. Taking a preliminary year first is a huge gamble, and getting into EM after one year of post-grad is even more difficult than matching straight out of school. Part of the problem is related to salary issues. My advice to you is that if you want to do EM, apply this year to some medium-low competetiveness programs. When you make your rank list, rank the EM programs first. You can always rank Preliminary Medicine programs separately, and you will match into one of those if you don't match into EM.

 

[Back34]

Don't do it. Taking a preliminary year first is a huge gamble, and getting into EM after one year of post-grad is even more difficult than matching straight out of school. Part of the problem is related to salary issues. My advice to you is that if you want to do EM, apply this year to some medium-low competetiveness programs. When you make your rank list, rank the EM programs first. You can always rank Preliminary Medicine programs separately, and you will match into one of those if you don't match into EM.

Are the "salary issues" related to me expecting a PGY2 salary as an EM PGY1?

 

[GeneralVeers]

Are the "salary issues" related to me expecting a PGY2 salary as an EM PGY1?

The issue is that these residencies get government subsidies for training residents. If you enter into preliminary residency the government expects that you will train for 3 years, so you get 3 years of subsidy paid to your residency. If you then enter into residency training, you will then be doing 4 years of residency, but only have funding for 3. That means the program has to shell out the full amount of your salary in your last year. This is what I was told by the chairman at Indiana's Emergency Department.

 

[Apollyon]

Actually, the PM at Mt. Sinai (NY) told me that prelim (ie, non-categorical - not leading to board elegibility) spots do not count against the funding issue.

 

[GeneralVeers]

Actually, the PM at Mt. Sinai (NY) told me that prelim (ie, non-categorical - not leading to board elegibility) spots do not count against the funding issue.

I've had people tell me both. Was considering doing a prelim year instead of going to King/Drew. Does anyone have a definitive answer to this? I was also told that if you started a prelim-surgery year you were okay, as you had 6 years of funding.

 

[DeLaughterDO]

The issue is that these residencies get government subsidies for training residents. If you enter into preliminary residency the government expects that you will train for 3 years, so you get 3 years of subsidy paid to your residency. If you then enter into residency training, you will then be doing 4 years of residency, but only have funding for 3. That means the program has to shell out the full amount of your salary in your last year. This is what I was told by the chairman at Indiana's Emergency Department.

This is not completely true: while there may be some funding issues, I have also heard (and read from the CMS info) that prelim/internship years do not count against the funding issue. Also (and may more importantly) only a portion of the salary is not covered by CMS if you "go over" your training period. CMS breaks funding down into 2 categories (DME and something else - I can't remember, roughly 1/3 and 2/3 portions), which you get 100% if you are considered a full time equivalent resident. If you "go over," you lose 1/2 of the 1/3 portion and the rest stays where it is, so only 1/6 of the funding goes away (if I de-coded the CMS crap correctly).

I may be way off in left field on this, but that is what I understand.

jd

 

[margaritaboy]

While the funding issue has been called into question, I do not think doing a transitional year will help your competitiveness in applying to EM. Also keep in mind that unless you match into a 2-4 EM program with a prelim year, you will be essentially doing two internships, which is something I would not recommend to anyone. Finally, a board score of 224 is nothing to be ashamed of. All things being equal, you can apply anywhere you want without being rejected solely by this parameter.

 

[Mike MacKinnon]

margaritaboy

So u work at the Copa eh? Im a flight nurse for Air Evac. Doing my pre reqs for med school now. Have you spent time with Bruce Horwood or Dan Carusso yet? Both excellent physicians. I know many of them down there. Excellent place to learn!

 

[tonem]

As somebody already mentioned, there are at least 20 emergency medicine residencies that are 4 years. Most of those require a preliminary year in either surgery or medicine. That route is certainly a possibility if you have your heart set on a preliminary year of medicine. It is probably a "safer" way to have your cake and eat it too if you still want to do emergency medicine.

edit: okay I did a quick bit of research....there are 15 programs that require a preliminary intern year.

You can see which 15 here:

http://www.saem.org/rescat/contents.htm

 

[margaritaboy]

margaritaboy

So u work at the Copa eh? Im a flight nurse for Air Evac. Doing my pre reqs for med school now. Have you spent time with Bruce Horwood or Dan Carusso yet? Both excellent physicians. I know many of them down there. Excellent place to learn!

Yes, Horwood and I were on last night. He is our EMS director and full time EM faculty, so he is pretty hard to miss. Carusso is someone I've only worked with peripherally. When I did my trauma month, he was on leave for knee surgery. He is a nice guy though from everything I've seen and heard. If we are not busy when you fly someone in one of these days, feel free to hang out or say hello. Good luck with your pre reqs!

 

[intern1]

hey guys Iam an Internal Medicine Intern and considering to switch to Emergency Medicine----I always wanted to get into er but being an IMG and having scores in early 200s I did not go for it last year-------will having 1 year of US clinical experience, a few months of resaerch exp. at an IVL school, Er rotation and LOR, Bls and acls cert.,certified in lines and intubations etc.--- improve my chances of getting into er residency --realistic?. Please advise

 

[GeneralVeers]

hey guys Iam an Internal Medicine Intern and considering to switch to Emergency Medicine----I always wanted to get into er but being an IMG and having scores in early 200s I did not go for it last year-------will having 1 year of US clinical experience, a few months of resaerch exp. at an IVL school, Er rotation and LOR, Bls and acls cert.,certified in lines and intubations etc.--- improve my chances of getting into er residency --realistic?. Please advise

I don't think it will improve your chances at most programs.

 

[Sessamoid]

hey guys Iam an Internal Medicine Intern and considering to switch to Emergency Medicine----I always wanted to get into er but being an IMG and having scores in early 200s I did not go for it last year-------will having 1 year of US clinical experience, a few months of resaerch exp. at an IVL school, Er rotation and LOR, Bls and acls cert.,certified in lines and intubations etc.--- improve my chances of getting into er residency --realistic?. Please advise

I would say it would depend much on who your letters are written by and what they say.

As far as the funding issues, asking a department to forego the subsidy is an iffy proposition. For those departments that essentially get paid X dollars per year, any amount they have to cover over the subsidy will come out of the department budget (i.e. attending salaries). Understandably, some of these departments will be unwilling to do so, since it will be at the expense of their own bank accounts. Doubly so since there is currently no shortage of qualified candidates.