Prelim and Categorical confusion!

[Candoc]

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I need your advice please. A program has offered to rank me very high for a preliminary Internal Medicine position and since I like the program I'll be ranking it high.

Now I heard from a friend that if I want to apply for an Internal Medicine Categorical PGY1 position next year I'll have trouble since most programs don't accept applications from interns - because of some funding issues. Is this true?

I'll be on a J visa. I just have three days to make any changes to my ROL so would appreciate any comments and suggestions. Thanks a lot.

 

[Winged Scapula]

When you start your categorical track the clock starts ticking on length of CMS funding. Therefore, doing a Prelim year does not decrease the amount of funding a program will get for your should you obtain a categorical postion.

If you were switching programs, ie, going from Categorgical IM to Categorical Surgery as a PGY-1 having to repeat his first year, there WOULD be an issue as you would have been CMS funded for 3 years, or the time it takes to become a BE Internist. If a Surgery program were to take you after your first year of the 3 funded years, they would receive 50% of the CMS funding for you during the years after your 3 years of funding ran out.

Some programs use this as an excuse but AFAIK, there isn't any reason to not accept applications from current interns in regards to funding as long as you are in a Prelim position going to a Categorical one.

I do not know if the visa status plays into this.

 

[Candoc]

Thank you so much for your prompt response. You have no clue as to how worried I am. I'm about to breathe a sigh of relief - but still holding it!

As far as I know the J visa is valid for seven years and should be renewed annually. So i'm not worried about that. My only worry was about the whole funding issue. So like you've said, I shouldn't have a problem if I apply to Categorical Internal Med after a prelim year right? My goal was to do Int Med Categorical at a Uni program so that I have better chances for a fellowship later on.

Shall I go ahead and rank this program high enough on my list then? Thanks so much for the help!

 

[Winged Scapula]

Thank you so much for your prompt response. You have no clue as to how worried I am. I'm about to breathe a sigh of relief - but still holding it!

As far as I know the J visa is valid for seven years and should be renewed annually. So i'm not worried about that. My only worry was about the whole funding issue. So like you've said, I shouldn't have a problem if I apply to Categorical Internal Med after a prelim year right? My goal was to do Int Med Categorical at a Uni program so that I have better chances for a fellowship later on.

Shall I go ahead and rank this program high enough on my list then? Thanks so much for the help!

In general I think its a mistake to rank Prelim programs higher than Categoricals. We know that the match rate for physicians is lower the second time around.

If you rank all Categoricals you would be willing to go to first, then this Prelim program X, if they truly do rank you highly (ie, within whatever number of Prelim positions they have), you will still match there if you don't match to any of the other programs higher on your list.

The risk of ranking them highly is that you match there, have to redo the match during your intern year and spend the entire year auditioning. Unless you are absolutely opposed to go to any of the categorical programs, I'd say your plan is a bad one.

 

[Candoc]

Yeah I think you have a point there. I don't want to get stuck with a prelim position with nowhere to go later on. I'll rank some of the categoricals higher than the prelim program. Thanks for the suggestions. Fingers crossed till Match Day!

 

[NotAProgDirector]

When you start your categorical track the clock starts ticking on length of CMS funding. Therefore, doing a Prelim year does not decrease the amount of funding a program will get for your should you obtain a categorical postion.

Sorry to rain on your parade (with only a few hours left), but to my understanding this is not completely correct.

The clock starts ticking the second you start training, regardless of what training you start.

The "alarm" on the clock is set when you start a categorical or advanced program.

So, in the OP's case, when they match into a prelim they begin consuming their available GME funding in their PGY-1. Once completed with their PGY-1, they will need to either obtain a PGY-2 categorical IM spot, or enter the match again for a PGY-1. In either case, once they start the categorical program, the total maximal amount of funding is set at 3 years, the minumum needed to train in IM. If a PGY-2 spot is obtained, no problem. If a new PGY-1 is obtained, the last year of training will be beyond the GME clock -- in this case the DME is funded at 50% and the IME funded at 100%, so the $$ is less but still sizable. All fellowship training is done at this 50% DME level, so GME offices already deal with this on an ongoing basis.

As another example, let's say someone matches into Prelim Medicine and Derm. They decide to drop out of derm before starting it, and instead switch to surgery. Their clock is then set at 5 years (Derm doesn't count, because they never started it), they used one year on the prelim IM so again they'll be a year short of full funding (unless they can get some credit for the IM year).

 

[Winged Scapula]

Thank you aPD...did not know that.

 

[Life goes on]

aPD can you please expand DME and IME. From your post I understand that even though the $$ are less if one were to repeat the PGY1 year, it should not pose a problem and GME offices are able to take care of that. Please correct me if I am wrong. I am in a similar situation like Candoc above. I will start a prelim year in 2008 want to be knowledgable when I apply for categorical position in 2009 match.Thanx