Program expansion question

[massive1]

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Hey, if any program directors or people in the know can answer this:

When a program is allotted additional spots (i.e. expands from 10 residents per class to 12 residents per class), can they add residents immediately to all classes?

In other words, for the first year this goes into effect, they will have PGY-1 12, PGY-2 10, and PGY-3 10.

Could they however do PGY-1 12, PGY-2 12, PGY-3 10, where they have also taken in 2 residents at the PGY-2 level?

If this is allowed, would it benefit or not benefit a program to do this?

A second question:

How can a person or program determine the exact DGME remaining for a resident? Is there a databank or similar?

My training background is "complex." I started with 5 years DGME (surgery), but left that and completed a program not funded by CMS.

I'd like to have a definitive paper that says "you have x amount of DGME left," but cannot find a source.

Thanks so much!

 

[NotAProgDirector]

For your first question, the answer is "in general, yes". If a program has an increased quota from ACGME, they could recruit into any/all of their classes to fill them. For many three year programs, they might fill PGY-2 openings and not the PGY-3's, as it can be very difficult to take a resident whom is unknown as a PGY-3. Getting a quota increase from the ACGME doesn't necessarily generate a funding increase -- so it's also possible that some programs will phase in their cohort increases for financial reasons. Does it benefit the program? Probably - else why would they have requested a program size increase?

There is no way to figure out your IRP.

 

[massive1]

I appreciate that reply!

I know that having DGME is not typically a major deciding factor when bringing on a resident, but some programs do make it a factor. At some point the program will know? Or they just take whatever CMS gives them, without trying to sort through it?

There is also some weirdness regarding a new program's "cap," which is something I also completely don't understand, but is why every new HCA residency will only take someone who hasn't used any of their funding. Just curious really, if you have the time to explain..

 

[NotAProgDirector]

Start here: Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know

If they care, they will look at your past training history to figure it out.

For new programs (which most of the HCA's are), they are building towards their cap. Their cap is set 5 years into their program. If you have 50% funding when that happens, they get capped with that 50% forever.

 

[massive1]

That link explained a lot. Probably more than most program directors know.

To maximize your cap, all residents have to have 1.0 FTE at the 5 year mark. So if it's a 3 year program, the FTE for the first two classes doesn't matter, as they will have graduated before the 5 year mark.

Is that right? Going back to HCA, they lose a few dimes and nickels if classes 1&2 done have enough DGME for the entire program, but there is no long term effect.

For whatever reason though HCA seems to have a blanket policy of not taking anyone with prior residency training, even is they still have enough DGME for the full program. Any ideas why?

 

[LucidSplash]

That link explained a lot. Probably more than most program directors know.

To maximize your cap, all residents have to have 1.0 FTE at the 5 year mark. So if it's a 3 year program, the FTE for the first two classes doesn't matter, as they will have graduated before the 5 year mark.

Is that right? Going back to HCA, they lose a few dimes and nickels if classes 1&2 done have enough DGME for the entire program, but there is no long term effect.

For whatever reason though HCA seems to have a blanket policy of not taking anyone with prior residency training, even is they still have enough DGME for the full program. Any ideas why?

Everything HCA does is motivated by profit, as they are a FOR profit organization.

 

[NotAProgDirector]

That link explained a lot. Probably more than most program directors know.

To maximize your cap, all residents have to have 1.0 FTE at the 5 year mark. So if it's a 3 year program, the FTE for the first two classes doesn't matter, as they will have graduated before the 5 year mark.

Correct

Is that right? Going back to HCA, they lose a few dimes and nickels if classes 1&2 done have enough DGME for the entire program, but there is no long term effect.

Well, it's a bit more than dimes and nickels. Depends upon how much they have budgeted for CMS income to pay for their new residency programs, which is dependent upon very many factors.

For whatever reason though HCA seems to have a blanket policy of not taking anyone with prior residency training, even is they still have enough DGME for the full program. Any ideas why?

Any number of possible reasons, no way to know. Could be they are worried that prior GME = problem resident who was let go, no way to tell if that's really true or not. Could be financial, worried about cap issues, too complicated to change the rules between now and 2 years from now. Could be they are worried that trainees with prior experience might not integrate well into the "HCA way" of doing things. Might be a completely random decision by someone in leadership for no good reason at all.

Bottom line is it's out of your control, move on.