Intern year credit, am I getting screwed?

[DocRhinor]

I am currently a PGY2.5? At a program that transitioned from AOA to ACGME prior to me entering it. However I did an intern year in an AOA traditional rotating internship program which has since converted to an IM prelim program. In the process of entering general psychiatry program. They gave me "partial advanced standing" and 6 months credit(***edited details out***). They left out 2 months pediatrics, 3 more months of medicine and 1 month emergency medicine.
My dilemma now, is as I am currently doing the work of a 3rd year in general psychiatry, I am looking for child and adolescent fellowships (and have found, interviewed and have an offer at a wonderful program, pending clear up of start date). In pouring over ACGME program requirements, I do not see any hard requirement that says PGY1 in Gen Psych needs to have any psych at all, but clearly spells out "at least 4 months" in primary medicine, and "no more than 8 months" of psychiatry.
My argument is that my entire intern year can, and should be counted towards total of 48 months needed to complete the general psychiatry program, and not just 6 months.
Does anybody else see a reason that this is not the case? Am I being screwed out of 6 months credit towards graduating? It is a big deal as it is currently a barrier to fellowship in a capstone child psych program starting next year for me.
Thanks for any and all feedback
DocRhinor, PGY2.5 General Psychiatry

---

Members don't see this ad.

 

[xavier2000]

Not screwed at all. You went in knowing you would get 6 months credit and accepted it. Add in an AOA TRI into and AOA psychiatry program and now ACGME, be thankful you can go to ACGME fellowship. Few years ago you would have had a tough time. Next time you finish medical school. go directly into an ACGME psychiatry program and your problem will be solved.

 

[24blue8]

Your program allowed you to apply for child and adolescent as a PGYII? From what I understand you did one full year of prelim, one full year of psychiatry and now, since June you are in the 2nd year of your program and applied in July? Or you already did two full years in your psychiatry program? Most people who fast track do two full years of psych, apply in their 3rd year then complete that year (totaling 3 years of psych) before starting. I typed all of that out for mostly myself lol bc I got confused.

Previous transfer residents I've seen always had to make up time. No one got a full year of credit for a nonpsych residency and they graduate off cycle because of this or have to make up psych months during their PGYIV elective time.

 

[clausewitz2]

Your program allowed you to apply for child and adolescent as a PGYII? From what I understand you did one full year of prelim, one full year of psychiatry and now, since June you are in the 2nd year of your program and applied in July? Or you already did two full years in your psychiatry program? Most people who fast track do two full years of psych, apply in their 3rd year then complete that year (totaling 3 years of psych) before starting. I typed all of that out for mostly myself lol bc I got confused.

Previous transfer residents I've seen always had to make up time. No one got a full year of credit for a nonpsych residency and they graduate off cycle because of this or have to make up psych months during their PGYIV elective time.

Plenty of programs fast track PGY-2s into the first year of their child fellowship, and then interdigitate the remaining years in various combination. At our shop for instance PGY-2s doing the Child thing next do first year of child fellowship (mostly inpatient, IOPs, PHPs, higher levels of care basically), then the standard General PGY-3 and 4 years in order, then do their last year of Child fellowship doing outpatient.

If that is how things go at OP's program I can understand being pissed. I will say that people who have transferred as PGY-2s to us generally make up anything they need to make up during elective time and graduate on-cycle. Thankfully our PGYIV year is almost 100% elective so this is not hard.

 

[FlowRate]

I have a friend who is in a similar situation in that their first year was delayed and they only got credit for 8 months of their first year. It turns out that there are multiple layers of requirements regarding time in training and generally you will need a full 60 months (fast track to child) or 72 (traditional to child) of training, regardless of other specific rotation requirements.

Your other months of training probably didn't count toward standing in your program but I would imagine they might count toward total months of training, worth asking relevant peoples.

 

[liquidshadow22]

Yes the entire intern year should definitely count. This is why many psych programs take PGY2 residents from other fields. The only thing is that you need to makeup any of the psych you didn't get in your intern year to eventually meet ACGME requirements. I'm not sure why the AOA designation matters, ,i.e. they are already decided that 6 months of the AOA counted, so how can you selectively choose which months count and do not. It's all or none. When would you start the child fellowship as a PGY3?(they're OK with taking you without finishing psych acgme requirements I guess?)

 

[splik]

your program can do whatever they want. they could count 12 months, they could count 6. This could be based on their own needs (maybe they need a warm body in your shape for 6 more months etc). remember, your program can also stop you from fasttracking at all. really it is a bit late in the game to be thinking about this, you apparently agreed to only get 6 months credit when you started psychiatry residency. I suppose you could appeal to your PD about this, assuming it was the program that gave you 6 months credit. If your internship only gave you 6 months credit, there's nothing you can do.

 

[liquidshadow22]

your program can do whatever they want. they could count 12 months, they could count 6. This could be based on their own needs (maybe they need a warm body in your shape for 6 more months etc). remember, your program can also stop you from fasttracking at all. really it is a bit late in the game to be thinking about this, you apparently agreed to only get 6 months credit when you started psychiatry residency. I suppose you could appeal to your PD about this, assuming it was the program that gave you 6 months credit. If your internship only gave you 6 months credit, there's nothing you can do.

I love how everyone here says he went in knowing that he would get 6 months and accepted it. Sure but how many options did he have? Given how difficult it is to find openings in residency programs, I'm guessing not many.

Bunch of BS. The fact that residency programs can act like an authoritarian regime and make arbitrary decisions at the expense of the resident is absurd. If residencies were like any other employer, this resident would tell the program to go screw and find another program that gave him the credit for his/her training that the resident is justly due. Unfortunately PDs essentially control a resident's ability to switch programs and there is limited freedom to leave for a better program in many situations.

A dream for me would be to see a stronger national resident labor union that would be able to give residents more power and freedom over how and where they train. Residents are indentured servants and have a weak voice. It's sad.

 

[Shufflin]

... A dream for me would be to see a stronger national resident labor union that would be able to give residents more power and freedom over how and where they train. Residents are indentured servants and have a weak voice. It's sad.

CIR/SEIU

strong? hard to tell, but they've been around for a long time.

 

[liquidshadow22]

CIR/SEIU

strong? hard to tell, but they've been around for a long time.

Do they step in and put a program's feet to the fire when they mistreat a resident? I wonder. What leverage do they have?

 

[Shufflin]

Do they step in and put a program's feet to the fire when they mistreat a resident? I wonder. What leverage do they have?

Hard to tell. I do know they were pretty visible at our hospital mingling with residents during lunch hours. So maybe.

 

[deleted736562]

Do they step in and put a program's feet to the fire when they mistreat a resident? I wonder. What leverage do they have?

Yes, they do that. They also make it very hard to terminate/fire a resident, so they're definitely doing a valuable job. Of course the flip side is that not all programs are part of CIR and if I'm not mistaken this is entirely up to the hospital leadership.

But we do need far more activism. It really starts with the match process which is essentially a conspiring of program directors that allows them to come together, set the rules and tweak the whole process in their favor. There was a law suit a few years back arguing the match violates antitrust laws and the AMA had to intervene and lobby for the Congress to add a clause in the law that residency is not a "job" but part of education. Of course it is a bunch of nonsense. In every country that protects workers and has decent unions (almost every developed country besides the US), medical residency is a job like every other job and workers are entitled the full protection of the law.

In that case residents would not to be forced to pay for a job interview, they would be able to step out once their yearly contract is done and find another place and their whole career would not be at the whims of a single person.

 

[Crayola227]

Yes the entire intern year should definitely count. This is why many psych programs take PGY2 residents from other fields. The only thing is that you need to makeup any of the psych you didn't get in your intern year to eventually meet ACGME requirements. I'm not sure why the AOA designation matters, ,i.e. they are already decided that 6 months of the AOA counted, so how can you selectively choose which months count and do not. It's all or none. When would you start the child fellowship as a PGY3?(they're OK with taking you without finishing psych acgme requirements I guess?)

Not true. I know a resident that transferred from IM to psych and only 4 mos counted

 

[psychattending]

While I have no knowledge of the details, I suspect people are confounding training year and the credit one gets for ABPN eligibility. All the ABPN is going to give the person credit for is based on what part of his/her training meets Board requirements. An individual could do 3 years of surgery and then switch to psych. That individual is not going to do just 1 more year in a psych program and then graduate. He or she, if lucky, would get credit for 4 months of internal medicine type of work.

A second but still important issue is proper functioning of the program. As a PD I am responsible for the training environment of all my residents. Thus, while a person could receive Board credit for a full year, I might not be able to bring that resident in at a PGY2 level as it could interfere with the training of my other residents. If that is the case, then I would not be offering a PGY2 slot to the person but would offer a PGY1 slot to the person.

A third issue is that while there are requirements for Board eligibility, each program decides what exactly a person needs to do in order to graduate from a specific program. In the case above I as PD might decide that even if the PGY3 surgery resident was eligible for 4 months of internal medicine credit, that the time he/she spent on a surgery floor is not what I expect/want my residents to learn and need to function in my training program (and after graduation). In such a case I would want the resident to do 4 months of internal medicine training that all my residents receive so that the person is trained the way I believe a psychiatrist should be trained.

 

[DocRhinor]

Mixed feedback, all of which is appreciated. I suppose some clarification would help. My first 12 months all meets requirements towards board eligibility, and my PD during that year worked hard to tailor it for going into psych, including getting me in neurology and a month of psych inpatient in place of surgery etc.
As some have pointed out, sure I knowingly joined a program with 6 months credit. The program had already received ACGME pre accredidation, but the PD at that time was still very entrenched in AOA tradition. And as a response pointed out, I didnt feel like I had realistic options.
Update from today, current PD who took over is on board as is DIO, and they have submitted training to ABPN for the full 12 months. It turns out, that there was some reason for that unsettled feeling.

 

[DocRhinor]

And final update to this, for closure. ABPN approved all 12 months and I an officially back on track! It was entirely an institutional issue where previous PD had a bias that it should not work that way. I suppose if I was struggling to progress in the specialty it would make sense to extend the duration, but I am not. When the new PD looked into it, they were comfortable requesting full year credit from the board.
I hope that if anybody else finds themselves in similar scenario they are able to advocate for themselves. It was a journey, but worth the effort.

 

[MacDonaldTriad]

Be very careful, the ACGME and the ABPN live in different universes and feel no obligation to confab about these issues so that they are on the same page. I have seen people who split training between a PGY-I at one place, do PGY-II and PGY-III at an other and then try and fast track into a C&A fellowship at a third. Then they find out that they are not be allowed to take the adult boards because they didn't have 12 months of continuous outpatient at any one program. No adult boards, no child boards. Splitting training into three programs can be a red flag for ABPN. On the other hand, these decisions are not overly known for consistency and good for you if this works out.