Off cycle solution

[Heliox]

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Hi, I will be joining a fellowship next July. I am caught in a piquant situation. Being an IMG I joined residency 15 days late. My PD says I will have to finish my residency before I join my fellowship. With visa issues etc, is there no way I can get around this?
From what I hear, the ACGME requires that one complete 33 out of 36 months to be board eligible. Is this true?
Is there anyone else in this situation? Please help!

 

[SoCuteMD]

My guess is that the other 3 months are vacation time. Probably the only way to make it work would be to ask to have your vacation time for those last 15 days. However, I know at some jobs I've worked this is not allowed - you must work your last day.

 

[RTrain]

You could try to schedule an elective your last month - you know, one of those "electives" with a private practice ophthalmologist who doesn't care if you're there or not, and explain the situation to him - he might let you have the last 2 weeks off with no repercussions. Otherwise, agree with above - take your vacation then. I'm sure your chiefs would be understanding of a need to do that, they don't want you to miss out on starting your fellowship on time.

 

[Winged Scapula]

All residencies have Board Eligibility requirements which are several weeks less than the actual length of residency, mostly to accomodate for vacation and other time off. I remember this when one of my former Chiefs threatened to quit late in the year; we all laughed when we realized that she would still be Board Eligible (provided the program signed off on her training...she ended up not quitting).

I know it sounds harsh and the late start wasn't your fault (most likely) but why should your PD allow you to finish on time if you started 2 weeks late? It would be nice if he/she would and most probably would. However, if yours will not, it appears that your only solution is to take vacation the last two weeks of residency and start fellowship on time. The "easy" elective might work but probably only if you don't have to move or have substantial time off to get to your fellowship site.

 

[dragonfly99]

This seems a bit harsh...on the part of the PD.
Did you and he/she not discuss this until just now?
It would have been nice if you could have planned your last and 2nd to last years with 1 less week of vacation or something...so that you could finish on time.
Agree...try to get schedules rearranged, or trade vacations with someone so that you can have "vacation" your last 2 weeks of residency before you move.

 

[NotAProgDirector]

Your PD is not being harsh. The board's are very strict about this -- you must complete a full 36 months of training.

Agree with above that the best way to address it is to take the last two weeks as vacation.

Another option is to simply tell your fellowship that you will be 2 weeks late. They have not made the schedule yet, it will be relatively easy to put you on some "elective" type experience the first block. However, you then miss out on "orientation" with your colleagues.

Do NOT do an easy elective and then leave with the elective docs approval. If a resident did this in my program, I would 1) not certify them for the boards until they made up the two weeks, 2) consider giving them an unsatisfactory (or marginal) professionalism evaluation as part of their final documentation, and 3) not be willing to actually continue their training any further -- hence they'd need to make up the 2 weeks somewhere else. I'd be really pissed off. Then again, I would have seen this coming long before now, and scheduled you for an elective the last block, and told you to take the 2 weeks as vacation, so there wouldn't be this problem. In fact, all PGY-3's going to fellowships get non-call / elective blocks in June, as many need to leave early for orientations, which can start in mid June.

 

[DarthNeurology]

I remember this when one of my former Chiefs threatened to quit late in the year; we all laughed when we realized that she would still be Board Eligible (provided the program signed off on her training...she ended up not quitting).

That is pretty amazing that a chief surgery resident would threaten to quit for whatever the reason. Mostly I believe because her surgery residency was five years I guess and why not just soldier through until the end, but also most surgery chief residents I have seen have much more respect from attendings than say interns and are basically junior faculty in some respects at that level. What would make a chief surgery resident do such a thing? I am guessing that the faculty did something pretty mean to her for her to even consider doing what I would think would be basically shooting herself in the foot. Then again, maybe she was never serious and was using advanced negotiation skills not for the mild of heart.

I guess you couldn't elaborate more Winged? Pretty fascinating though

 

[DarthNeurology]

Hi, I will be joining a fellowship next July. I am caught in a piquant situation. Being an IMG I joined residency 15 days late. My PD says I will have to finish my residency before I join my fellowship. With visa issues etc, is there no way I can get around this?
From what I hear, the ACGME requires that one complete 33 out of 36 months to be board eligible. Is this true?
Is there anyone else in this situation? Please help!

The PD didn't show you how you could modify your schedule to make your fellowship orientation? (I wouldn't miss orientation as who would want to get off on the wrong foot)? I would try to maintain good relations with your PD and perhaps will have to cancel some vacation and use it for an elective. The only solution I would see would be to setup a special research elective where you spend weeks at the end of your residency doing research and perhaps they would give you two weeks credit for writiing up the research over the first month of fellowship, i.e. perhaps you could start fellowship being BE with the understanding that you would be finishing your residency by completing a research project. So your PD would be happy and you would get to start fellowship on time.

Alternatively, what if you spent 5-10 hours each week starting now on research and perhaps that would equal two weeks of research credit at the end of residency. Heck, if you did the work of two weeks research elective you should get that credit although residency credentially may feel otherwise.

I REALLY DOUBT THIS WOULD WORK AS I AM NOT FAMILIAR WITH THE MORE INTIMATE MECHANICS OF RESIDENCY PROGRAMS

However, I do feel that your PD is not doing his/her job by figuring out how to rearrange your schedule and just ordering you to finish residency if that is the case.

I would also ask the fellowship director about help concerning your situation. Maybe you could do if necessary a low hours elective i.e. research or radiology and spend the rest of your time as an "observer" at your fellowship hospital. I wouldn't do an elective where someone would have to lie and say you were there when you weren't as this could upset the PD as APD pointed out. So get creative, but be sure that it is legit by clearing it with your PD.

 

[Winged Scapula]

That is pretty amazing that a chief surgery resident would threaten to quit for whatever the reason. Mostly I believe because her surgery residency was five years I guess and why not just soldier through until the end, but also most surgery chief residents I have seen have much more respect from attendings than say interns and are basically junior faculty in some respects at that level. What would make a chief surgery resident do such a thing? I am guessing that the faculty did something pretty mean to her for her to even consider doing what I would think would be basically shooting herself in the foot. Then again, maybe she was never serious and was using advanced negotiation skills not for the mild of heart.

I guess you couldn't elaborate more Winged? Pretty fascinating though

Many university programs do NOT have the residents functioning at "junior faculty level" but even if they did, there are a myriad of reasons why people would leave residency. I had another Chief who soldiered on, despite being reportedly miserable from internship, only to get an MBA and never spend a single day as a practicing surgeon. This is pretty unusual, but its certainly not rare in that people do finish or quit in their 4th or final year. It happens - people just cannot spend another day doing something they hate. A colleague in fellowship struggled through his surgery residency, finished and the next day started his anesthesia residency at the same hospital. I nearly quit late in my own 4th year.

The reason my former Chief threatened to quit, as I understood it at the time, was that our program was putting pressure on the residents to lie about their work hours. At least one person did not (during the first year of work hour restrictions) and ACGME came for a site visit based on our "rampant" work hour violations and put us on probation. She admitted that she refused to lie (although it could have been others - we had a lot of subspecialty prelims who would have nothing to lose if they reported the GS department) and was disgusted that when it went down, faculty pretended that they had never put pressure on any of the residents to lie about their work hours. So she threatened to quit over it. I never knew whether or not she knew that she had done enough weeks of residency that she could appeal to get credit and be BE, even if she did leave in April of her final year.

 

[KluverB]

I'm in the same situation as the OP; though, I won't be done for a few more years. However, my GME office claims that per ACGME regulations I can't make up the missed time by, for example, using 2 weeks of my vacation time to make up the 2 weeks I missed at the beginning. They also claim this precludes taking vacation at the end of the last year so as to finish on time. I've trying to find the appropriate ACGME regulations that would support or refute this claim, but haven't been able to do so. Any of the PDs on here could possibly point me to the appropriate links/paragraphs? Many thanks in advance.

 

[Heliox]

Thanks all for the replies.
I have explored these option before. Initially I was told that 33 out of 36 months were OK and that I could join on time. Now I am being told that 3 months are mandatory vacations and I cannot use them to make up for lost time since technically I cannot be on vacation at my program and be doing my fellowship at another.
As a related issue, I have heard of residents with prior experience having shorter residencies. Is that still allowed? Is that an option?
I will have to officially finish when I have to, since this involves visa issues too. My visa is being sponsored by my employer.
Thanks again for the replies.

 

[NotAProgDirector]

I've trying to find the appropriate ACGME regulations that would support or refute this claim, but haven't been able to do so. Any of the PDs on here could possibly point me to the appropriate links/paragraphs? Many thanks in advance.

It's from the ABIM:

The 36 calendar months of full-time medical residency education:

Must include at least 30 months of training in general internal medicine, subspecialty internal medicine and emergency medicine. Up to four months of the 30 months may include training in areas related to primary care, such as neurology, dermatology, office gynecology or office orthopedics.
May include up to three months of other electives approved by the internal medicine program director.
Must include three months of leave for vacation time (or for parental or family leave or illness, including pregnancy-related disabilities.) Vacation or other leave cannot be forfeited to reduce training time.

Now I am being told that 3 months are mandatory vacations and I cannot use them to make up for lost time since technically I cannot be on vacation at my program and be doing my fellowship at another.
As a related issue, I have heard of residents with prior experience having shorter residencies. Is that still allowed? Is that an option?
I will have to officially finish when I have to, since this involves visa issues too. My visa is being sponsored by my employer.
Thanks again for the replies.

After I posted my answer above, I realized that I was wrong. If you're finishing a residency and then going to a job, you can leave some vacation at the end and go -- you're welcome to do anything you want with your vacation, including getting another job.

Problem is with fellowships and Medicare funding. If you're on vacation from my residency you're getting paid. Can't work in your felllowship at the same time since it's paid by Medicare also -- that's double dipping in Medicare. You'd be getting paid for two jobs at the same time by the same employer.

Getting advanced credit for prior training is complicated, and you can only get training at the PGY-1 level. You can't use extra PGY-1 credit to graduate early -- you need 12 months at each of the PGY-1,2, and 3 levels.

This is all for IM. If you're in another field, the answer is likely to be similar (but you never know).

 

[Heliox]

Thank You aProgDirector,
Thanks for the ABIM link. If I understand right, does that mean 30 months of IM training and 3 months of vacation suffice to finish my residency and be board eligible?

 

[NotAProgDirector]

Thank You aProgDirector,
Thanks for the ABIM link. If I understand right, does that mean 30 months of IM training and 3 months of vacation suffice to finish my residency and be board eligible?

Nope. 30 months of medicine training + 3 months of "anything" training (i.e. anesthesia, ortho, research, etc) + 3 months of vacation/leave = 36 total months. If your program offers less than 1 month of vacation (i.e. 3 weeks) then you still need to complete 36 full months.

 

[Heliox]

Thank you aProgDirector

 

[dragonfly99]

This doesn't seem to make sense. I did IM and my program had only 2 weeks/yr of vacation for one of the years, and 3 for the other 2 years. So if someone is at a program with 3-4 weeks/yr of vacation, I don't see why they couldn't just plan to forfeit a couple weeks of vacation and work during those 2 weeks. I understand that this reduces the total training time to 35.5 months, but but the person would be WORKING in the hospital the exact same amount of time as if he/she did 36 months with the extra/normal amount of vacation.

I understand what AProgramdirector has written, but it seems like the ACGME rules need to be changed. Lots of people in the world take <3-4 weeks of vacation a year...such as my family members who own a small business. I think that in extreme circumstances like this, the ACGME needs to make an exception so that a resident who is going to be 1-2 weeks short of the required 36 months could give up vacation time in order to finish on time.

Also, it was common in my program that sometimes PGY3 would have a call month as their last month of residency...and those who had to move would leave a week to 10 days early. Nobody really said anything about this...