Internship choice effects future funding!

Discussion in 'Military Medicine' started by i want out, Dec 18, 2008.

  1. i want out

    i want out Member
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    The internship you choose now, may effect how competitive you are for future residency even if you do a GMO between.

    http://www.aamc.org/advocacy/library/gme/dgmebroc.pdf

    Start reading at #7 on page 3.

    The basics are this;

    Civilian residency is partially funded by Health Care Finance Administration (HCFA). They use a formula to pay hospitals for training residents, that formula uses the first year of your GME to set how many years your eligible for full funding.

    eg. If you do an FP internship, then complete your time in the .mil as a GMO and apply to civilian programs, you will only be eligible for 2 more years at full 1.0 multiplier reimbursement and then any additional years of residency will be at a reduced rate.

    So, if you want to do Ortho for example, but the Navy decides to put you in an FP internship, then send you off to GMO land you may not be as competitive to civilian programs after your GMO time. Since you would only be eligible for 2 years of full HCFA funding and they would get a reduced rate for the remainder of your residency.

    i want out (of IRR)
     
  2. undecided2009

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    What about a transitional internship? I was specifically told that if not deferred a transitional internship would allow me flexibility to change specialties if later desired after doing a GMO and returning to the civ world or reapplying to the Navy match. Any thoughts?
     
  3. Gastrapathy

    Gastrapathy no longer apathetic
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    From the reference listed above:

    9. ​
    I completed a year of clinical training after medical
    school,and now I am fulfilling a military commitment.
    itial residency period limit affect me?

    Many medical students who have military commitments are
    required to complete ​
    ‘I year of post-medical school training
    in an accredited program before entering the military. If you
    are in your first residency program after graduation from medical
    school or have not exceeded the limits of an initial
    residency period in another specialty, you will be counted as
    a ‘1 .O FTE during the required year of training prior to entering
    the military. If you subsequently leave the military and
    enter a residency program, the year of training previously completed
    will count toward that resident’s initial residency
    period. If the residency year completed prior to entering the
    military was in a specific specialty, such as internal medicine,
    your initial residency period will be based on that
    program-even though you left the program to complete a
    military commitment. If the training prior to entering the military
    was in a transitional or preliminary year program, then
    the initial residency period will be based on the specialty in
    which the resident resumes training. Any training in a residency
    program operated by the military that may be counted
    towards board certification also counts toward the initial

    residency period.
     
  4. tweaked17

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    Would anyone like to elaborate on the consequences of this without the jargon (esp. point 9)?
     
  5. notdeadyet

    notdeadyet Still in California
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    Keep in mind that a transitional internship is not a magic key. Whether or not you will have to repeat is going to depend on the rotations done during the transitional internship.

    Also, if you search around the forum, you'll note that if you do an internship and then four years as a GMO, some programs will make you repeat internship. It's happened before. I doubt it's all that common, but it's a risk to keep in mind.
     
  6. i want out

    i want out Member
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    the basics, are that if you do a Family Practice internship, because thats what the .mil has available, then finish your four years as a GMO.

    You may be applying to a civilian residency with an uphill battle to start with.

    If you want to do FP, IM or Peds, and they will accept your internship for full credit, then you will get HCFA funding for the remaining 2 years of your residency at the same rate as somebody fresh out of medical school.

    The problem comes up when you want to do any residency that is longer than 2 more additional years.

    eg, if you want to do Surgery, Anesthesiology, Optho, Ortho, Rads, etc.
    then you will only be fully funded for 2 years of the training, and HCFA will fund you at only half of what they would for someone who started out in your specialty of choice, for the remainder of your residency.

    So for example, you did an FP internship at .mil hospital of choice, finished a 4 year GMO, and are getting out...
    You send an application to several surgery residencies and the program director then needs to choose whether they will take you or a fresh new med school grad.

    If the selection folks know anything about funding, (they might or might not), they will know that they will get full HCFA funding for 2 years, and only half of what they would get for the new grad for 3 of your 5 years in their program.

    This may or may not be a deciding factor depending on how the program makes their selection.

    good luck
    i want out (of IRR)
     
  7. tweaked17

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    I read it over again and understood the consequences - thanks a lot for the explanation and examples.

    It's definitely something to consider for those planning to do a lengthy residency.

    For those, however, interested in something like a subspecialty of IM (gastro, interventional cardiology, etc.), this wouldn't necessarily affect their candidacy if they were to do their internship followed by 4 years GMO. One could get out, do a civ residency, and apply for their respective fellowship - right?
     
  8. Galo

    Galo Senior Member
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    It never ceases to amaze how many more negatives come with signing away your career to the military. IF this is actually true, it probably now seems as the number ONE reason not to join, since in the af/navy, you have at least 25-30% chance of having to do GMO, and now, if you choose to get out you may not be able to complete a residency of your choice because of the year you already spent as a pgy-1??? Is this really correct?? I read the PDF linked above, but I must admit I do not understand how this would affect a GMO leaving the service to start their training. Would a hospital not take you because they are going to be reimbursed less for a period of your training?

    Certainly questions that need to be answered by someone with first hand knowledge.
     
  9. narcusprince

    narcusprince Rough Rider
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    I know plenty of residents in my own program whom are not funded. I think the funding issue may be one for smaller programs with limited capital. I know plenty of people who switched from other residencies or are already board certified in other specialties who were unfunded that picked up residencies. In my opinion the big programs do not care about funding level. Also, think about it this way would you want to go to a residency that would not accept you based on funding. I would infer that the program may have financial issues and may not be the most desirable based upon that. Just my two cents.
     

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