Re: Designated or Undesignated positions

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Program vacancies at this time are hard to come by and when something pops up , you're hit flat on the face that the program is looking for a designated PGY1. I've got a couple of questions...

1. Why would programs looking for PGY1 need to know whether an applicant is designated or not? Is it because they fear that the undesignated prelim would put too much pressure on the other residents because they'd probably be "fighting" for a PGY2 slot.

2. I came across a program looking for a designated PGY1 and one of the requirements is either a "letter of intent" or a signed PGY2 contract. What is a letter of intent? Is it a letter stating that you're planning to apply in another program or specialty that you have no intention of their PGY2 slot.

Thank you very much for all those who will reply.
Goodluck to everyone who's joining the 2008 match.

 

[NotAProgDirector]

Program vacancies at this time are hard to come by and when something pops up , you're hit flat on the face that the program is looking for a designated PGY1. I've got a couple of questions...

1. Why would programs looking for PGY1 need to know whether an applicant is designated or not? Is it because they fear that the undesignated prelim would put too much pressure on the other residents because they'd probably be "fighting" for a PGY2 slot.

2. I came across a program looking for a designated PGY1 and one of the requirements is either a "letter of intent" or a signed PGY2 contract. What is a letter of intent? Is it a letter stating that you're planning to apply in another program or specialty that you have no intention of their PGY2 slot.

Thank you very much for all those who will reply.
Goodluck to everyone who's joining the 2008 match.

The word "designated" is a bit ambiguous. Usually, a designated PGY-1 spot is a spot for one year only with no suggestion of further training. Hence, programs want to see that you have a landing spot for your PGY-2.

Why? If you don't have a PGY-2 spot lined up:

1. You will need interview time for the match, which can be hard to come by as an intern. As a PD, I feel it's my responsibility to help you get a PGY-2 spot, which can be a scheduling nightmare.

2. What happens in January when I have an open PGY-2 spot for next year, but I have a "better" external candidate? You can imagine how uncomfortable that can be.

3. If you are offered a 3 year spot somewhere else, you will leave the program mid year, creating a schedule nightmare.

 

[Winged Scapula]

1. Why would programs looking for PGY1 need to know whether an applicant is designated or not? Is it because they fear that the undesignated prelim would put too much pressure on the other residents because they'd probably be "fighting" for a PGY2 slot.

In addition to the reasons given by APD above, programs may only be able to offer designated positions to those who have matched into an advanced position. Imagine the additional awkwardness if a PD offered the Designated position to someone without a spot for next year, and then the department finds another candidate who wants the Designated position and DOES have an advanced slot. In our general surgery department, we were not "allowed" to offer Designated Prelim positions to those without Advanced positions; these were only offered by the subspecialty even thought the vast majority of the year was spent in the Gen Surg department.

2. I came across a program looking for a designated PGY1 and one of the requirements is either a "letter of intent" or a signed PGY2 contract. What is a letter of intent? Is it a letter stating that you're planning to apply in another program or specialty that you have no intention of their PGY2 slot.

A letter of intent is a letter from a program which says they "intend" to offer you a contract; you may be asked to sign a similar letter in which you say you "intend" to sign the contract and accept the position. It basically tells the PD of the program with the designated prelim position that you have a spot for the following year (if your contract hasn't been signed for the advanced position already).

 

[Faebinder]

I agree with the poster despite of the reasons stated above. A PGY 2 spot is much easier to secure once in a candidate has completed a PGY 1. You know what you are getting into when you take a prelim position (designated or not). The other excuses are just "reduce" our work excuses (of course I am not a program director so I wont see it your way, totally understand). If a program is that much "troubled" by having an extra "prelim" position, then they should give that position back to ACGME for them to give that position to some other program that is dying to grab another catagorical or prelim position and willing to take an undesignated person but are unable to because of the cap.

Of course if the position is privately paid for by the department/hospital without ACGME funding then hey more power to them. I think these positions are a product of too many applicants to positions ratio, such that the programs can afford to be demanding.

PS: By far my favorite encounter was when I spoke with a "designated" PGY1 opening who wanted me to have an "advanced" position secured and 10 minutes later I spoke with an open "advanced" position who wanted me to have a "designated" PGY1 position secured.

 

[NotAProgDirector]

The other excuses are just "reduce" our work excuses (of course I am not a program director so I wont see it your way, totally understand).

This is true. Much depends upon the number involved. If I have one prelim without a PGY-2 set up, it's no problem to arrange the schedule so they have an elective in January (for interviews), and otherwise organize their schedule so they can work on finding a PGY-2. When it's more than one, it can become difficult. Remember that if you're the PGY-1 with a PGY-2 spot set up, and I take a bunch of PGY-1's without PGY-2's arranged, it's your schedule which becomes inflexible. Measuring fair is hard.

... then they should give that position back to ACGME for them to give that position to some other program that is dying to grab another catagorical or prelim position and willing to take an undesignated person but are unable to because of the cap.

Briefly, it simply doesn't work that way. Unfilled slots are not recycled.