There are three general categories of programs with respect to PGY-1:
1) Guaranteed, and highly encouraged
In these programs (UMinnesota or Mayo for example) a PGY-1 year is assured if you match for PGY2-4. In fact, you ought to have a pretty good reason to do PGY-1 elsewhere. Some places, such as UCSF, have prelim slots guaranteed for the vast majority of residents but let people with compelling reasons do their internships elsewhere.
2) Guaranteed PGY-1 Interview, but NO Guaranteed Spot
These programs will coordinate a guaranteed medicine interview with your neurology interview day, so you only have to come to town once. If you don't match at the neurology program, the medicine program will not rank you. If you do match in neurology, you are highly likely to be ranked in medicine, but you better have a back-up plan just in case.
3) Sorry sucka, you are on your own...
Partners and Hopkins typify this approach (although they are not alone). They don't provide a PGY-1 spot (period). You are welcome to apply for a prelim medicine spot at Hopkins or MGH, but the neuro department doesn't offer much more than encouragement. It is not uncommon for applicants to get interviews with the neurology department and not get interviews at the same institution for their medicine prelim year. Even if you do get an interview, it may be weeks away from your neurology interview, meaning yet another expensive interview trip. In short, you had better send a couple of prelim year applications to non-competitive programs (and your home school), so you don't get left out in the cold.
In the end, you may end up doing your PGY1 year at program X, and PGY2-PGY4 at program Y. There is nothing intrinsically wrong with this, it is just a pain in the neck. As long as you choose a reasonably strong medicine program, you will not be at a disadvantage for the rest of your training.
What Types of PGY1 Years are Acceptable?
From the American Board of Psychiatry and Neurology Website
A full year of ACGME-accredited training in internal medicine, or as an acceptable alternative, a full year in an ACGME-accredited program in which a minimum of six months of training must be in internal medicine, the details of which must be documented by the training director. The composition of these six months may NOT include rotations in neurology, family medicine, or emergency medicine. To ensure that these six months constitute a high quality experience, they should emphasize progressive responsibility for the resident. At least two of the addition six months must be spent in internal medicine, pediatrics, and/or emergency medicine. For candidates entering neurology residency training on or after July 1, 2001, at least two of the additional six months must be spent in internal medicine, pediatrics, family medicine, and/or
emergency medicine. No more than two of the remaining four months may be spent in neurology.
