I have whats maybe an 'interesting' situation and need some advice. I tried to match into a competitive surgical specialty and went unmatched. I backed up my list with a transitional PGY1 spot locally. Does anyone know how the transitional year impacts future reimbursement to programs? Say for instance, I decide that General Surgery is great this year, will a program have problems taking me due to the medicare reimbursement issue? So in anticipation of the question, I chose transitional year, because I liked Emergency Medicine more than GS, but not as much as my Ortho attempt. Now, the last question, does the transitional year ding the ER reimbursement and lessen my chances of matching next year? If I had the option to switch to a PRELIM status instead of Transitional Year, would this be beneficial?? I.E. would a PRELIM surgery designation preserve 5 years of reimbursement and make ER reimbursement a non-issue? OR would the PRELIM surgery designation force a future surgical residency spot to avoid getting no spot in anything? I'm looking for help in untangling this issue. Thanks.