question on pgy position allocation

[hyperdense]

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If a resident who is a PGY 3 leaves a residency program at the end of the year, is it legal for the program to fill it with a PGY 2 if they cannot get a PGY 3 or a PGY1?

 

[exPCM]

No. It is a class A felony punishable by life in prison. Now what question are you really asking for help with?

 

[Smurfette]

A program is only allowed to graduate a certain number of people per year, and they must have fulfilled all requirements. You can't put a pgy2 into a pgy3 spot because they will be "skipping" a year, which is not legal. While hiring another resident to the program keeps the total number of residents the same, it is the number graduating per year that is limited...your program would need to get special permission from the ACGME and, if approved, would mandate an RRC site visit to evaluate the program to ensure that it can accommodate an extra resident at that level based on the program's available resources. In other words, it gets rather complicated.

 

[NotAProgDirector]

A program is only allowed to graduate a certain number of people per year, and they must have fulfilled all requirements. You can't put a pgy2 into a pgy3 spot because they will be "skipping" a year, which is not legal. While hiring another resident to the program keeps the total number of residents the same, it is the number graduating per year that is limited...your program would need to get special permission from the ACGME and, if approved, would mandate an RRC site visit to evaluate the program to ensure that it can accommodate an extra resident at that level based on the program's available resources. In other words, it gets rather complicated.

Actually, this is not quite correct. Programs are limited by their ACGME cap, which limits the total number of residents. If I have a cap of 30, I would usually have 10 residents at each of the 3 PGY levels. However, nothing stops me from having 30 PGY-3's if I want to (except for the havoc it would create with the schedule, having no interns).

There is no rule about the maximum number of residents graduating from a program in any year (although if I actially did have 30 PGY-3 residents, I expect my RRC would not be amused).

However, let's say I lose a PGY-3 so now I have 10+10+9=29. I can certainly take you as a PGY-2 -- now I have 10+11+9=30. All is good, right?

Wrong. Next year, when I go to the match for 10 more interns, I end up with 10+10+11=31 residents, and that can't be without special permission. So, if I take a PGY-2 into a slot vacated by a PGY-3, and then no one else leaves the program, I might have to decrease my PGY-1 count the next year to compensate. Then I'm short a PGY-2 the year after, etc.

So, many programs avoid this to avoid the crazy accounting that occurs in future years.

 

[Smurfette]

Ah, my program has been explaining this wrong to us...this scenario has happened to us due to lab residents shuffling in and out of the lab...and have said that we can only graduate "x" number of chiefs without getting RRC approval. Especially making this seem odd to me is the fact that we are short residents in some of the other years which should still make our total add up to the 'right' number...or does it vary by type of training program? Now I'm curious.

 

[NotAProgDirector]

Actually, they are correct. This is a surgical training issue. From their program requirements:

Categorical (C) residents are accepted into the residency program with the expectation of completing the surgery program, assuming satisfactory performance. At the PG1, PG2, PG3, and PG4 levels, the number of categorical residents must not exceed the number of approved chief residency positions.

This is different from the IM requirements, and I was not aware of it. My apologies for any confusion.

 

[Smurfette]

So it does vary by specialty. Interesting.
Thanks aPD.

 

[lomia]

Resurrecting this thread...Is this a common issue? I ran into another student at my school yesterday who explained a similar issue in which a person who took time off to do a year of research, and was not allowed to come back for THREE years, because no one below him wanted to do research. Said resident was a PGY9 when he graduated.

This seems absolutely ridiculous to me. I'm planning on applying to general surgery residencies next fall, but I really, really don't want to run into this. I'll be 30 when I get into residency (hopefully), and I don't want to waste years getting waiting to get back into the program.

Follow up question: is this the same in all general surgery residencies?

 

[Smurfette]

Resurrecting this thread...Is this a common issue? I ran into another student at my school yesterday who explained a similar issue in which a person who took time off to do a year of research, and was not allowed to come back for THREE years, because no one below him wanted to do research. Said resident was a PGY9 when he graduated.

This seems absolutely ridiculous to me. I'm planning on applying to general surgery residencies next fall, but I really, really don't want to run into this. I'll be 30 when I get into residency (hopefully), and I don't want to waste years getting waiting to get back into the program.

Follow up question: is this the same in all general surgery residencies?

Residents going into and out of the lab can cause logistical issues. In general, there are 3 types of gen surg programs regarding lab time:
a. research required (or "highly recommended". May claim to be "optional" on paper though)...everyone goes into the lab for 2 years, then comes back out. Everyone graduates as a PGY 7.
b. no research....(usually community programs)...no one goes into the lab. Everyone graduates as a PGY 5.
c. research optional...some people do research, some don't. So in order to have the 'right' number of residents per year, the same number of people have to go into the lab as come out of the lab. PDs can work this a few ways: mandate someone go into the lab, mandate someone comes out of the lab, mandate somebody to stay in the lab another year or not let someone go into the lab at all. My program sometimes made people do 2 yrs in the lab when they only wanted to do 1, or made them come out after 1 year when they wanted to do 2.

When you apply to programs, you can generally figure out which programs are which. At interviews, you can ask more details about this when you talk to the residents. If you want to avoid years in the lab, don't pick a program that mandates it or where you may end up being the "one" forced into it.

 

[lomia]

Thanks for the prompt reply. I want to do a research year, but I don't want research years.

Do you think that's a reasonable topic to discuss with the PD when interviewing? Do you think I'd get a straight answer if I asked?

 

[gutonc]

Thanks for the prompt reply. I want to do a research year, but I don't want research years.

Do you think that's a reasonable topic to discuss with the PD when interviewing? Do you think I'd get a straight answer if I asked?

It's the sort of thing that's best asked of the senior/chief residents rather than the PD. You're more likely to get a straight answer.

 

[Winged Scapula]

Thanks for the prompt reply. I want to do a research year, but I don't want research years.

Do you think that's a reasonable topic to discuss with the PD when interviewing? Do you think I'd get a straight answer if I asked?

I might ask what your goal is for your research time. Most go into the lab to be competitive for certain fellowships, because they are planning an academic career, etc. One year is generally not long enough to get experience *and* publications out of the time. While it may be possible to do only 1 year, will that help you achieve your goals? There is a reason why most surgical residents spend 2 years in the lab.

 

[lomia]

Good question. Though I'm not fully committed to it, I really like the oncology cases and patient population. I know that it is up there with peds as a competitive fellowship, but do I really need 2 years of time in the lab?

 

[gutonc]

Good question. Though I'm not fully committed to it, I really like the oncology cases and patient population. I know that it is up there with peds as a competitive fellowship, but do I really need 2 years of time in the lab?

To get a decent publication record? Yes.

I'm not a surgeon but I'm in the middle of my 3rd year in the lab. At the end of year 1 I had exactly 0 publications. At the end of year 2 I had 5. I currently have 7 (with a first author primary research paper on the way). If I'd left the lab after 1 year, I probably would have gotten my name on one or two of those papers since I'd done some work on them, but certainly wouldn't have the number I have now.

 

[Smurfette]

Good question. Though I'm not fully committed to it, I really like the oncology cases and patient population. I know that it is up there with peds as a competitive fellowship, but do I really need 2 years of time in the lab?

For surg onc, 2 years in the lab is needed to be competitive. Surg onc is also a 2-3 yr fellowship (depending on research time during fellowship).

Most other subspecialties (obvious exception is peds surg) do not require lab time to be competitive in general, although research can help you get a fellowship spot at the more highly competitive programs. It depends on your ultimate career goals.

 

[Buzz Me]

Good question. Though I'm not fully committed to it, I really like the oncology cases and patient population. I know that it is up there with peds as a competitive fellowship, but do I really need 2 years of time in the lab?

For Surg Onc? Yes, 2 years is usually needed to be productive, write papers, publish, and present at meetings.

As stated above, 2 years is generally what people do for competitive fellowships or competitive programs in less competitive fields.

 

[Picchu127]

For the surgeons out there, if you did a md/phd (and not necessarily a phd in a surgical area but with several first author publications) is the research still necessary for the more competitive fellowships?

The general advice I have gotten is that it may be better to go straight through in 5 years even in programs where most residents do research provided you beef up other parts of the application..i.e. administrative and education opportunities.

 

[Buzz Me]

Depends how productive you were during those PhD years...if you published, presented, networked at conferences, etc. (That's part of the reason for doing research during residency.)

 

[lomia]

Thanks for the info. Is it predominantly bench stuff, or do people do outcomes/chart review stuff too?

 

[gutonc]

Thanks for the info. Is it predominantly bench stuff, or do people do outcomes/chart review stuff too?

Yes. Especially in surgery, a lot of people will do both. Attach themselves to a lab while also doing some chart review type stuff that their attendings want done.