Looking for Prelim Position?

[dreamweaver]

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hey all, there is a possibility i may be leaving my prelim position starting this july for another area i have realized i would like to pursue... however the program i will be beginning in july is pretty decent and i dont want to leave them high and dry because its not fair although i have realized what i really would like to do and would like to pursue it.. please pm me if interested and have your cvs ready in case of this possibility.. thank you very much.. my other option is to do prelim yr and then do my desired route, however that may just prove to be a waste of a year.. i'm willing to hear your opinions.. thanks alot

 

[ariwax]

Same sort of situation here, only I rashly signed to a respectable FP residency in NJ, beginning in July, and I would much prefer a surgical internship, or maybe a prelim medicine year. Anybody interested? PM me, please.

 

[Blade28]

Why didn't you scramble into a surgery prelim spot?

 

[ariwax]

I'm a USIMG, and basically had to make the decision in a vacuum. I didn't know about the issues of Medicare funding, and neither did my PD, who trained in the US but hasn't practiced there for about ten years. I intend to go on to radiology, if the gods smile upon me, and having funding issues would represent a red flag to all but the best-funded academic programs. Now that I've discovered this, I'd like to find an equitable way out, or it looks like I'll have to join the Army Reserves or offer to work at a deep pay cut to compensate for this one ill-informed decision.

 

[jeff2005]

I'm a USIMG, and basically had to make the decision in a vacuum. I didn't know about the issues of Medicare funding, and neither did my PD, who trained in the US but hasn't practiced there for about ten years. I intend to go on to radiology, if the gods smile upon me, and having funding issues would represent a red flag to all but the best-funded academic programs. Now that I've discovered this, I'd like to find an equitable way out, or it looks like I'll have to join the Army Reserves or offer to work at a deep pay cut to compensate for this one ill-informed decision.

What do you mean by this funding issue. Why wouldn't you be financed like the rest of us?

 

[ariwax]

Well, Medicare compensates programs for residents' salaries. The thing is, they only fully compensate for the duration of your first categorical residency. That is to say, if you sign on for a three year residency in, say, IM, and you leave after your PGY-1 year to join another three-year residency as a PGY-1, then your second program only gets compensated fully for the first two years. Your final year, the program has to eat a proportion of the cost, equal to half of the "DME", or direct Medicare expenditures. (This is in contrast to indirect Medicare expenditures, but I won't cloud the issue.) This might be 10 or $15,000, and is calculated using a formula I won't even pretend to understand.

In my case, if I were to match successfully to radiology - a four-year residency - next year, my program would only get funding for two years, and lose money on me for the second two. All other things being equal, a program would more likely choose someone else with identical qualifications but no funding issue. Does that make sense?

 

[Blade28]

What? You lost me.

 

[mysophobe]

Residents' salaries are reimbursed by Medicare. The program pays you, but they get the money back in the form of resident funding. The amount the program is reimbursed to pay you depends on what specialty you FIRST match into.

For example, Joe matches into Family Medicine, a 3-year residency. He is now "funded" for 3 years, meaning any program that takes him will be reimbursed for his salary for 3 years.

If Joe decides he wants to go into Surgery after his first year, he will still only be funded for those 3 years. Because he'd have to start over, the program he transfers to would only be reimbursed for the first 2 years of his residency (since the first year of funding was done in family practice). In other words, they will have to foot the bill for his last 3 years of residency.

All things being equal, programs will be more likely to take someone that is qualified and will not give them this problem.

 

[ariwax]

Couldn't have said it better myself.

 

[jeff2005]

Where I am, many residents have switched residencies without a problem. One did 3 years of peds than did 4 years of Path. Is it the department that loses money or does the hospital absorb the loss?

So how much money are we talking about. Is it 10 to 15k or the whole 100k or so. That would make a big difference.

 

[Blade28]

Yeah, I don't get this either. People switch residencies all the time.

 

[eyestar]

Yeah, i totally don't get it either since i know too many people who switched residencies (specialties) but it brings up a good pt. One of the other threads asked about a break in residency and whether it would affect someone negatively in getting NYS license. And the replies mentioned about this reimbursement pt. too. So now i have a question. If somebody matches for prelim 1st, they are funded for one yr only? Is it first CATEGORICAL match that medicare was always take into account?
Also, this wouldn't make sense for someone like me.
I finished my transitional, didn't match into ophtho 1st time, got in second time, so i would be funded for BOTH my prelim and categorical? If the answer is yes, the medicare has no way of knowing what i did before coming to ophtho (i didn't fill out anything to medicare and the sfmatch application if I remember correctly didn't ask anything about prior residencies. SO if someone finished their Family practice residency and then applied for ophtho and matched, they WOULD BE funded for the entire 3yrs of ophtho. So medicare in this case would pay say, 6yrs?

 

[radonc]

Yeah, i totally don't get it either since i know too many people who switched residencies (specialties) but it brings up a good pt. One of the other threads asked about a break in residency and whether it would affect someone negatively in getting NYS license. And the replies mentioned about this reimbursement pt. too. So now i have a question. If somebody matches for prelim 1st, they are funded for one yr only? Is it first CATEGORICAL match that medicare was always take into account?
Also, this wouldn't make sense for someone like me.
I finished my transitional, didn't match into ophtho 1st time, got in second time, so i would be funded for BOTH my prelim and categorical? If the answer is yes, the medicare has no way of knowing what i did before coming to ophtho (i didn't fill out anything to medicare and the sfmatch application if I remember correctly didn't ask anything about prior residencies. SO if someone finished their Family practice residency and then applied for ophtho and matched, they WOULD BE funded for the entire 3yrs of ophtho. So medicare in this case would pay say, 6yrs?

not sure about the intricacies of medicare funding but this is basically how it goes:

1. if you match into a categorical spot, you get that many years of funding (plus a prelim if applicable). ie. if you match into a 5 year gensurg spot, you get 5 yrs funding. if you match into rads (1+4), you get 5 years funding, if you match into IM, you get 3 years funding.

2. however, if you match into a prelim/transitional position, you get funding for that year alone. however, if you get into something afterwards, you will receive funding for that program.

3. if you finish a categorical residency, you will not get funding for another specialty.

4. if you get into IM, then want to transfer to gen surg, you only get funding for the 3 years you matched into.

5. if you match into gensurg, then transfer to IM after a year, you will have some funding 'leftover'

 

[eyestar]

Thanks, now it makes sense. We have always been told that you can always change specialties, and people do it all the time, but this is news to me.
So somebody pays the residents for the extra yr or no salary? That's rough.

 

[Dunce]

This is good info to get out to everyone. It's a bit confusing and tends to hide in the shadows, but most people probably need to at least be aware of it.

I understood the part about reimbursement/salary for a set number of years based on categorical specialty. However, I just started thinking about this:

If the residency programs are reimbursed, how much is that reimbursement? This seems to make residents go from "cheap labor" to something that sounds eerily like "free labor." (obviously discounting the other costs involved in training a resident....I'm just referring to salary and the reimbursement of salary by the government)

 

[asunta22]

was it for an internal medicine prelim spot? do you know of how to find out of current residency positions? [email protected]