"Repeat" internship, will my program lose money?

[Crazy]

I am a DO but I think reimbursement rules are same for DO and MD residencies. I am applying for a DO residency that has a linked internship, In worst case scenario I will not match and I am dead set on this specialty which means I want to apply next year again. Suppose I'll do traditional rotating internship and DO radiologies will consider me year later but will insist on me doing linked internship (they have linked internships in DO radiology). Will program lose medicare reimbursement money for that repeat year? Because if it will lose significant money than it may be a problem, right? Thanks!

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[Castro Viejo]

I am a DO but I think reimbursement rules are same for DO and MD residencies. I am applying for a DO residency that has a linked internship, In worst case scenario I will not match and I am dead set on this specialty which means I want to apply next year again. Suppose I'll do traditional rotating internship and DO radiologies will consider me year later but will insist on me doing linked internship (they have linked internships in DO radiology). Will program lose medicare reimbursement money for that repeat year? Because if it will lose significant money than it may be a problem, right? Thanks!

Yes, I believe you're right.

Repeating a year means that money the second time around is lost. The program will have to pay you out of pocket. That's why re-applicants or older applicants (those who have done one or more years of a particular specialty and then decide they want to switch to something else, e.g., General Surgery to Internal Medicine) to programs aren't all that attractive sometimes. It's why re-applicants to General Surgery, such as preliminary residents PGY2s who apply for a categorical PGY1, will often get the shaft in favor of a graduating medical student to fill a spot. There's no issue with where the money's gonna come from for the med student, but CMS rules may pull money for the repeat internship.

 

[Crazy]

Ok,but my situation is not a repeat internship, actually I am doing rotating (undecided) and then linked internship that is a part of the residency. I heard prelim surgery and then doing prelim IM with IM residency is not a repeat, right?

 

[Blade28]

So you're doing a year of Prelim Medicine, after you've already done a year of Prelim Surgery?

 

[box29]

So you're doing a year of Prelim Medicine, after you've already done a year of Prelim Surgery?

Not exactly...the OP has applied to DO radiology residency where the internship is linked. He/she is not sure if he/she will match and so has also applied for "stand alone" traditional rotating internship just in case he/she doesn't match and then will reapply to the DO radiology residencies next cycle.

 

[Blade28]

Rads or Nuc Med?

I noticed from a previous thread that the OP may be considering Nuc Med instead.

 

[Crazy]

this is for rads. Nuc is a backup. Talked to meded and they think that any second internship is a decrease in reimbursement for hospital

 

[Pir8DeacDoc]

Here's the skinny:


A prelim year is not considered a terminal residency. The meter only starts to run once you start a terminal residency (i.e. IM, GS). Thus, doing a prelim year and then eventually getting into another field doesn't shaft your program on funding. Programs mainly get killed when someone goes from a short residency and then wants to do a longer one (i.e. IM and change to GS).

 

[Crazy]

Here's the skinny:


A prelim year is not considered a terminal residency. The meter only starts to run once you star a terminal residency (i.e. IM, GS). Thus, doing a prelim year and then eventually getting into another field doesn't shaft your program on funding. Programs mainly get killed when someone goes from a short residency and then wants to do a longer one (i.e. IM and change to GS).

This is what I hoped to hear. Pir8DeacDoc, do you know it for sure?

 

[Pir8DeacDoc]

well that is what I have been told and have read in other places. Maybe try and PM aprogdirector over on the IM boards. He'd know for sure.

 

[NotAProgDirector]

Here's the skinny:


A prelim year is not considered a terminal residency. The meter only starts to run once you start a terminal residency (i.e. IM, GS). Thus, doing a prelim year and then eventually getting into another field doesn't shaft your program on funding. Programs mainly get killed when someone goes from a short residency and then wants to do a longer one (i.e. IM and change to GS).

I think the above is not correct. I can't speak for osteopathic programs (? perhaps the rules are different) but here's how it works for allopathic programs:

If you match/scramble into a prelim year alone, you are not in a terminal residency. Hence, the total amount of training time that CMS will pay for your is not yet set.

Let's assume you were to do the same thing in an allo program -- repeat a prelim year, then start rads. When you start your Rad training, CMS would limit your funding to the minimum amount of time it would take to complete a rads residency (5 years total = 4 Rads + 1 prelim). However, you've already used 1 extra year, so when you are in your last year of rads you don't get full funding.

So, getting only a prelim alone doesn't limit your funding in any way, but it does use one year of training time. if you end up repeating a year for any reason, you're short. The meter starts when you start any training, its just that the total time/funding alloted doesn't attach until you start a terminal training program.

However, remember that just because you're beyond the CMS training limit, your program doesn't get zero funding. Funding from medicare for resident education comes as two separate payments, DME and IME. For residents beyond their initial training time, medicare pays 50% DME and 100% IME. The IME is often the larger amount of money, so many programs may not care. All fellowships are funded this way, so programs do it all the time. However, given two similar candidates one with full funding and one without, they could certainly favor the latter.

 

[DOCTORSAIB]

Here's the skinny:


A prelim year is not considered a terminal residency. The meter only starts to run once you start a terminal residency (i.e. IM, GS). Thus, doing a prelim year and then eventually getting into another field doesn't shaft your program on funding. Programs mainly get killed when someone goes from a short residency and then wants to do a longer one (i.e. IM and change to GS).

Agreed.

This is exactly what I've read on SDN and heard too.

 

[bantyran]

i have a question now... you're all deciding whether a prelim year will count for the PGY1... well what if someone does a PGY1 prelim in med and then decides they want to go into a categorical med program as PGY1.. then what... will that prelim be pgy1 and will he loose funding for going into categorical for pgy1? will the hospital have to pay out of pocket for this?

 

[Tired]

Let's assume you were to do the same thing in an allo program -- repeat a prelim year, then start rads. When you start your Rad training, CMS would limit your funding to the minimum amount of time it would take to complete a rads residency (5 years total = 4 Rads + 1 prelim). However, you've already used 1 extra year, so when you are in your last year of rads you don't get full funding.

Suppose I've started in Ortho with 6y of funding (1 + 5), decide after my second year that I want out. Can I then go do Rads (4 additional years) with full funding throughout?

 

[NotAProgDirector]

Suppose I've started in Ortho with 6y of funding (1 + 5), decide after my second year that I want out. Can I then go do Rads (4 additional years) with full funding throughout?

Yep. No problem with that. Once your "medicare funding clock" is set, any change you make in training does not affect it.

i have a question now... you're all deciding whether a prelim year will count for the PGY1... well what if someone does a PGY1 prelim in med and then decides they want to go into a categorical med program as PGY1.. then what... will that prelim be pgy1 and will he loose funding for going into categorical for pgy1? will the hospital have to pay out of pocket for this?

If after completing a prelim PGY-1 you transfer into a categorical PGY-2, you're fine. If you end up repeating your PGY-1 for some reason (which shouldn;t really happen, although sometimes does if you can't secure a PGY-2) then you'll have the funding problem.

 

[Castro Viejo]

Suppose I've started in Ortho with 6y of funding (1 + 5), decide after my second year that I want out. Can I then go do Rads (4 additional years) with full funding throughout?

Hmmm... Thought you could run with the big dogs playa. What's going on?

 

[Tired]

Hmmm... Thought you could run with the big dogs playa. What's going on?

Vagarities of being active duty Navy. Long story, but suffice it to say that successful completion of a Categorical Orthopaedic Surgery PGY-1 year does not promise me a Categorical Orthopaedic Surgery PGY-2 through PGY-5. Probably won't be an issue, I hope, but good to know where you stand in case the unfortunate happens.

 

[Blade28]

What?

That's messed up.

 

[Tired]

What?

That's messed up.

Not messed up; I knew what I was signing up for when I started down this path. But definitely scary.

For the next two years, it looks like I'll go do primary care for a Marine unit, probably in North Carolina. After that I have to reapply to my residency. It is pretty likely I will get back in and finish my training, but nothing is guaranteed.

I have a "promise" that I will finish training in Orthopedics. However, no time frame is attached to that promise. All options, therefore, must remain on the table.

C'est la vie

 

[Blade28]

C'est la vie

Indeed!

Man. Well more power to you for sticking it out through this tough path.

 

[Leukocyte]

http://www.uth.tmc.edu/med/administration/gme/pdf_files/medicare_payments_gme.pdf

 

[Tired]

Man. Well more power to you for sticking it out through this tough path.

If I do end up in Radiology or something non-surgical, I'm going to have to change my user name so that no one knows who I am . . .

 

[Blade28]

If I do end up in Radiology or something non-surgical, I'm going to have to change my user name so that no one knows who I am . . .

Rads, huh?

How about:

Awake
Energized
Pale
Afraid of the light
NOT Tired
Pupils dilated

Etc.