Pyramidal programs don't exist anymore, do they??

[Stillorgan]

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I was under the impression the pyramidal programs are a thing of the past. I'm not wrong about this, am I? Or should I be asking about this on interviews?

 

[Espion]

They do still exist in some Army programs, but as far as I knew, they are otherwise illegal (even for the Army, which is trying to phase them out).

 

[Stillorgan]

Yeah, I know they're illegal. But do they still exist?

 

[MMH Doc]

Yeah, I know they're illegal. But do they still exist?

I can think of a couple off of the top of my head. Do a quick FREIDA search. You will see some programs which have fewer PGY 5 positions than they do PGY 4 or 3 positions.

 

[Stillorgan]

I can think of a couple off of the top of my head. Do a quick FREIDA search. You will see some programs which have fewer PGY 5 positions than they do PGY 4 or 3 positions.

Thanks. I'll take a look at FRIEDA. Any chance you could share which programs you know of off the top of your head?

 

[RichL025]

All of the army programs (except one, I think) have one more PGY-1 slot than PGY-2+.

I haven't heard, however, that they are trying to get away from that.

 

[GMO2003]

All of the army programs (except one, I think) have one more PGY-1 slot than PGY-2+.

I haven't heard, however, that they are trying to get away from that.

this is true...2 gen surg interns during my internship were shipped out as GMOs after the completion of their internship 👎

 

[Stillorgan]

Wow, I considered the armed forces at one stage. Glad I didn't go ahead with it.

Does anyone know of civillian programs that still function this way?

 

[Pilot Doc]

True pyramidal programs do not exist in civilian hospitals. Previously a program took a large group of undifferentiaed interns but did not guarantee that any of them would finish. People were fired, dropped out, etc.

Now we have a caste system where everyone who matches as a CATEGORICAL resident is essentially guaranteed a chief spot unless you are fired for cause. It's somewhat more complicated than that, but the point is that programs do not take more categorical interns than they have chief spots.

Almost all programs have more interns (and sometimes 2's and 3's) than chiefs. These people come in as prelims, however. They might hope to slip into a spot, but it's dependent on a spot opening up, no matter how good a job the person does. (FREIDA will give the appearance of a pyramidal program in this case. Even if a program 10 interns, 8 two's, 5 threes, 4 fours and 4 chiefs, it's not classically pyramidal. 4 categorical interns start, 4 finish. The rest are prelims.)

I've heard of some programs that run stealth pyramidal programs where they will fire categorical residents if they see better options in their prelims. Hard to say which are which.

 

[Ecthgar]

Also, don't forget that some of the prelim spots you may see on FREIDA are reserved for other surgical subs....ENT,ortho, neurosurg. Like Pilot Doc said, TRUE pyramid systems in the civilian world of residency DO NOT exist.

 

[Stillorgan]

I've heard of some programs that run stealth pyramidal programs where they will fire categorical residents if they see better options in their prelims. Hard to say which are which.

Yeah, that's sort of what I'm getting at here. One program in New York that I know of takes in the same number of catagoricals as there are chiefs. But there are regular drop-outs and regular transfers from prelim to catagorical. I not sure how I see that that's so different from a pyramidal structure.

 

[Pilot Doc]

Yeah, that's sort of what I'm getting at here. One program in New York that I know of takes in the same number of catagoricals as there are chiefs. But there are regular drop-outs and regular transfers from prelim to catagorical. I not sure how I see that that's so different from a pyramidal structure.

An important point is that every program takes the same number of categoricals as they have chiefs. But getting to your example, the major difference is that if you get a categorical spot, you have to go out of your way to lose it! In pyramidal programs previously, there was no way to guarantee yourself a spot. If you applied for surgery, wanted to do surgery, excelled at surgery, you could still lose out simply because the faculty preferred other people in your class. You were cut loose to find another program or another career. Not fun.