Pyramidal Programs

[smashermd]

Are there still pyramidal programs out there? (Someone recently told me that it's illegal for residency programs to use a pyramidal promotion tactic - which I personally find difficult to believe).

What does it mean if you know a program takes 8 categoricals and only finishes 5 (even if people are doing research, the program should still be graduating as many as they admit each year - right?)? Do you know of any programs that are certainly pyramidal?

Any input is appreciated - Thanks.

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[Winged Scapula]

The RRC recommended several years ago that programs dispense with the practice of selecting residents in a pyramidal fashion. With the exception of some of the military residencies (which are not governed by the RRC), I am unaware of any openly pyramidal programs. Most programs have either done away with the practice or at least have done so on a routine basis.

If a program starts with 8 Categorical residents in their intern year, most years they should graduate that many as well provided that they have had the same number of intake interns for that period of time, and that all have stayed (whether willingly or not). As people go into the lab, leaving the clinical track for a certain period, others should be coming out of the lab to take their place. If you are sure a program starts with 8 Categoricals (who are not being tracked into other fields) but intends to only graduate 5 Chiefs per year, you need to find out why.

 

[smashermd]

Thanks for the reply Kimberly. That's basically what I had been told, but I just wanted to verify that from another source.

 

[Foxxy Cleopatra]

In theory, programs should not conduct pyramids. But there are some programs out there that accept a few more categoricals than than they usually graduate. The # of chiefs can also look skewed due to the hiring of people in place of the ones that were either fired or quit. Do your research- hard; I cannot tell you how important this is. Talk to as many students as possible from the school, local connections who may be more in the know, etc. When you graduate medical school >$100,000 in debt, you certainly will not want to have inked your name away to a program that is notorious for throwing people out.

 

[BritneySpears]

Another possibility besides lab/pyramidal for having 8 categoricals and 5 chiefs is the issue of plastics residents. The surgery program at my school takes on 8 "categorical" residents and graduates 6, but two of those switch to plastics after their PGY-3 year. Even though the "categoricals" are accepted as gen surg residents, there are truly only 6 gen surgers from the beginning.

 

[Who'sYourDaddy]

I interviewed at a program recently in NY where the fiance of one of the residents told me that the program was pyramidal. There were many IMG prelims hanging around for years and everyone was so unhappy. Forget about it. If you see that scenario at an interview, don't go there unless you have no other options. If it looks suscipicious it probably is what you think it is. This only exists at programs where lower competitive applicants have no other options. They become exploited by the program, working in excess of 80 hours a week, doing non stop scutwork, operate like there's no tomorrow (only benefit), little teaching. It benefits the attendings but makes life miserable for the residents. Ironically, this program was in NY where they have the strictest regulations. I should report this program to RRC but I'd feel bad if the program lost its accreditation because I think the residents there are happier being exploited than not being in a residency at all. Too bad. Moral of the story: don't go to a pyramidal program if you can avoid it.

 

[Winged Scapula]

Originally posted by BritneySpears
Another possibility besides lab/pyramidal for having 8 categoricals and 5 chiefs is the issue of plastics residents. The surgery program at my school takes on 8 "categorical" residents and graduates 6, but two of those switch to plastics after their PGY-3 year. Even though the "categoricals" are accepted as gen surg residents, there are truly only 6 gen surgers from the beginning.

Good point...I forgot about our Integrated PRS residents being included in the PGY1-3 Categorical totals.

 

[droliver]

Originally posted by Who'sYourDaddy
I interviewed at a program recently in NY where the fiance of one of the residents told me that the program was pyramidal.

Most of those programs aren't really pyramid programs technically. What they do is collect a lot of FMG/IMG bodies as preliminary residents & let them scrap it out if a categorical tract opens up. NYC is notorious for these @ the many low tier programs in the city.

The RRC monitors this stuff pretty close. If you're accepted into a categorical spot there is no true pyramid system anymore (outside the armed forces). The prelim spots however, have little protection from this.