Internship and Residency Years

[ProudMD]

I understand that after USUHS, everyone will start the one year internship, and after the first year, we will either do a GMO or continue through our chosen residency. This part I am clear.

However, is the one year internship counted as part of residency? If I want to do family medicine (which is 3 years residency), do I finish one year of internship plus two additional years of residency, or do I have to finish one year of internship plus three more years of residency?

To my knowledge, the first year of internship is fully integrated into most residency programs outside of surgery.

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[colbgw02]

It depends. Internship is definitely GME, but it's not always part of your "residency".

In many specialties, a first-year resident and intern are synonymous because you would stay with the same program until graduation (or at least you would in the civilian world). This includes things like internal medicine, pediatrics, family medicine, psychiatry, and general surgery.

Then there are specialties where the internship and residency are completely separate programs, like dermatology, ophthalmology, anesthesiology, radiation oncology, and radiology. A first-year resident in these programs is really a PGY-2.

Then there are the tweeners - like some surgical subspecialties - where you are either formerly assigned to general surgery for a year or two (e.g. urology), or you spend so little time with your assigned department as an intern that you are functionally (but not formerly) separate from it (e.g. ortho, ENT).

So, as a radiologist, when I refer to my residency, I'm really talking about my training beginning as a PGY-2. In contradistinction, a family physician would refer to his internship as residency.

The situation is muddied in the military because of being a GMO. If you do a GMO tour or two, whether or not your internship "counts" toward residency will depend on how much your program director is willing and able to accomodate you (he may be unable to accomodate you based upon the ACGME RRC's rules for the specialty's internship). For example, if you completed an FM internship and then are returning to a military FM residency, then there is a very high likelihood you can enter the program as a PGY-2. On the other hand, if you completed a transitional internship and then want to do orthopedics, then you'll be repeating your internship.

All things being equal, I'd say military PDs are more understanding and are more willing to count all or part of your internship, whereas civilian PDs are more likely to have you repeat internship. So, whether or not you stay in the military for residency is also a factor, the latter of which you would almost certainly do as a USUHS graduate.

 

[HighPriest]

In old school GME, internships and residencies were different. That's how you got general practitioners, wheras now you mostly have family medicine-residency-trained docs. The military has just never changed in the same way that most civilian residencies have. If you go straight through (no GMO), then your internship is essentially the first year of your residency in terms of GME training (but not military service, as described in many threads). There are still programs where continuity is not guaranteed (for example, Army general surgery residencies typically take on more interns than they have residency spots), but that is residency-dependent. Many subspecialty residencies now offer a continuous contract, meaning that you're guaranteed a residency spot if you match into an internship spot, though that was not always the case in the past. Again, this is archaic, but this is military medicine - yesterday's medicine today.

 

[Strategy]

Very informative post @colbgw02

I have a followup question: So if one did an internship right after graduation then proceeded to complete GMO tour to complete all of his payback and then joined a civilian residency program, he would have to repeat the internship year to satisfy the civilian requirements?

 

[HighPriest]

Very informative post @colbgw02

I have a followup question: So if one did an internship right after graduation then proceeded to complete GMO tour to complete all of his payback and then joined a civilian residency program, he would have to repeat the internship year to satisfy the civilian requirements?

Usually you would. In general, it can be challening to find a residency that will pick you up at PGY-2. That can occur, as people drop out or change residencies after their internship. It could potentially be challenging as you'd then be 4 years or so out of your first internship, and many programs may want you to repeat an internship simply due to that fact.

So I think the answer is: it is possible, but would be difficult to do.

 

[TurtleDO2012]

Like everything it all depends on the details and is of course program specific. Yes there are programs that may let you slide into the PGY-2 year, programs that require that general intern year. Programs such as Anesthesiology, Radiology, Dermatology, Ophthamology, PMR, preventative medicine. I don't believe these programs can make you repeat the transitional year if your year satisfied the requirements regardless of the time spent in GMO land. The programs may based off their on design only take people at the PGY-1 point because they incorporate some of the required board training into the PGY-1 year.

Some programs above will allow you to apply for advanced spots (start at PGY-2) if they are offer them. Would you be less desirable if their was 4 years between your intern year and starting PGY-2? Likely program and applicant specific, numerous people have been able to start as PGY-2 in those programs and there also likely people who repeated intern year for various reasons.

If applying for advanced spot you would apply for this when you have 2 years left on your ADSO. You could also just apply during the last year of your ADSO and go for a spot that includes the intern year. You could even do both possibly if not picked up for an advanced spot. A few programs also still offer reserved spots (start as PGY-2 but apply last year of your ADSO) but that is decreasing.


In the past some programs would count your entire transitional year so that you could possibly slide into a PGY-2 spot for something like Family Medicine or Internal Medicine, maybe even Peds and OBGYN. However, I believe the most recent ACGME rules cap the number of months that can be applied to a new program when switching is 6 months. At the same time within the possible shorter time frame you still have to hit all of the milestones for your chosen residency, likely not difficult for most programs.

If you did a pre-lim surgery year, then went to GMO year for say 4 years, then civillian General Surgery program was goal. Well it again falls back on the specific program. Some may accept you for that PGY-2 spot and some may make you start at intern year again. This should be determined easily based off of how you apply to that program. If a GS programs is going to take you as a PGY-2 then it is likely because they have an opening and are filling that sport directly and that is of course being communicated to you.

A detail I don't know is would a program accept you at the PGY-2 level of pay yet you would be doing training at the PGY-1 level. Again this minor detail is probably program specific but it is a small amount of more money being considered a PGY-2 for pay in civillian programs.

 

[colbgw02]

A detail I don't know is would a program accept you at the PGY-2 level of pay yet you would be doing training at the PGY-1 level. Again this minor detail is probably program specific but it is a small amount of more money being considered a PGY-2 for pay in civillian programs.

I'm not totally sure, but I want to say there are rules in the civilian world that all residents within a given program and given training level must be paid the same. For that to work, there would have to be some sort of alternate "resitern" designation, at least on paper, I would think.

 

[j4pac]

Agree with Turtle...it is program specific whether or not you can continue where you left off.

In my experience...if you go from primary care to PGY-2 program (Derm, Neurology, etc) then as long as your got your required rotations done...you are fine.

If you go from a primary care to a different primary care program (such as FP to IM, or Surgery to IM)...then you will have to at least make up a portion of your rotations. PGY-2 programs (military and civilian) general have PGY-1 rotation requirements. If you go from Peds to Gen Surg...there is a very good chance that you will have to repeat all of your PGY-1 year under Gen Surg, just because there is so little of overlap between rotations.