Aug 24, 2014
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Okay it is me again but now I have probably the most important question I never though to consider. For those of you who read my previous thread know my situation; basically was asked to leave after the beginning of PGY 2 year but I did receive my intern year certification.

My question is, now I am applying broadly including more Internal Medicine, Psychiatry, Neurology, Anesthesia PGY2 spots that are IMG friendly and Family Medicine.

It is probably the most confusing thing in the world and everytime I ask someone I get 4 different answers so I first need clarifications on this :

Since I matched categorical IM and completed one year, does that mean that no matter where I go from here I only have 2 years of eligibility or funding; even if I change to a completely different field?

I am going to assume the answer is "yes, you only have 2 full years." If that is the case, my next question that I never thought about was how the hell am I every going to get interviews at programs for ANY of these specialities if they know I am only good for two years. I have heard of many people who switch and there weren't issues like this that I was aware of. For example, If I wanted to start ALL over and start PGY 1 in psych, the PD will likely know that I only have 2 years of funding and they will fork over the next 2 years so they have absolutely no incentive to hire me; period.

Any suggestions about getting around this or are there programs and certain residencies that don't place as much emphasis on funding. If so, which specialties would I likely have a realistic chance of matching into?

Just for completion sake; I never ever do this and its very pretentious, but I want to give you guys my "short CV" just go help with the advice.

1.) Completed on year of residency however resigned in August due to "personal and family reasons" which is what is in my file and there is nothing stating I was terminated; and again I was not I did officially resign.

2) USMLE Step 1: 242 first attempt
Step 2 CK: 241 first attempt
Step 2 CS: Passed first attempt
Step 3: 229 first attempt
3.) Great deans letter and good LoR from attendings but a very underwhelming PD letter which basically just reitterates my evaluations from the ICU only but at the begining and then end it was nice; still not the greatest letter and I would say not neutral.

4.) Graduated from Carib School (BIG 3) with High honors 3.7 GPA

Thanks guy, this is actually a very serious and new concern that I have and I want to get to the bottom of it because the ACGME is worthless and I was on the phone for an hour waiting for someone from medicare to explain resident funding.
 

Winged Scapula

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"Yes you only have 2 full years"

Funding for residencies from CMS (Medicare) comes in two forms: DME and IME.

DME (direct medical expenses) is resident salary, benefits, faculty salary etc. IME (indirect) is funding for the cost of teaching (extra tests, inefficiencies in training).

After the "clock" runs out, you get funded @ 50% rather than 100% for DME...IME is still funded the same. Your hospital would get 1/2 rather than the total amount of your salary + benefits, in addition to the IME.

Many programs already supplement salaries over the CMS amount; all fellowships are paid for this way as the "clock" has run out.

So what it boils down to is that you have to find a program that is willing to take you, with the reduction AND has the funds to pay you. If you are an attractive enough candidate, the loss of funds will not be a big deal especially at large or endowed programs.
 
Feb 18, 2014
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I doubt ACGME would know. You'll have to call individual programs. My only experience with this is that as a med student, I rotated at an outside university pathology program where they had 2 residents who had matched into path after completing IM residencies. Both residents had actually practiced IM for several years and had no eligibility left. They then decided to switch to path, and basically lucked out.

The path department at this university actually paid their resident salaries. For their entire residency. They said they called around a lot and they were just lucky. This was a few years ago so I don't know if it happens anymore. At a lot of places, they have too many resident positions compared to the amount ACGME/government will fund. So While all training spots must be ACGME approved, so that you can take boards, not all spots are government funded. At my hospital, we have over 100 positions including all fellowships and some residencies that are not paid for by the government. But all are ACGME approved, meaning the hospital has shown that the trainee will get x procedures, etc.

Also, not all spots fill each year. At my current place, all fellowships in the entire institution are paid for by the institution. The departments pay the salaries of
all fellows from the chair fund. If they don't take a fellow that year, I guess they have extra money. I'm not sure how this all works, but there are places out there where it is possible. Maybe if they don't take a fellow, or if they take one fellow but are approved for 2 spots, there is extra money to fund an unfunded resident.

The way things work these days, even well-off places are getting tight with cash. Except probably Methodist hospital in Houston. I think their residents still get a $6k cash bonus when they graduate. But places that are still swimming with cash are quite selective in who they will take, so who knows

Maybe this rambling post was helpful...I tried. :)
 
OP
J
Aug 24, 2014
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Well I appreciate the input from ya'll. I figured that was the case but it makes me sick to my stomach that I only have 2 years of funding. I will keep looking for PGY 2 spots and apply for the match and maybe some programs will give me an interview despite this but like you said this is all a numbers game. Why get half price when you can get another resident at 100% for 4 years? The program doesn't benefit on how great you are or how bad you are; in the end the cash they receive is the same.

Sad but true reality.
 

gutonc

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You clearly didn't pay attention to WS's very good posts. The true difference in cost depends on the program but is in the range of 65-80% of full funding once your "clock runs out". It's really not that much money in the long run. Any program who uses that as the excuse to not take a chance on you is trying to let you down easy.

You're damaged goods now. You're likely to get another residency spot (assuming you're smart about how you apply this year which you seem to be) unless the attitude you display here extends to real life. Like it or not, fair or not, you need to (caution...tortured metaphors ahead) put your tail between your legs and go hat in hand to any program that offers you an interview.

I understand that you're upset, and that's fine. But by my calculation, you have exactly 4 days to get over that and move on.

 
Feb 18, 2014
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If you PM me, I can tell you the program where I saw it happen. It might be institution-wide and not just path. The 2 residents were separated by 1-2 years I think. It may depend on the budget the institution gives the chair.

If I were you, I would post your request for such info in the forums of the specialities of interest to you, and hope people will respond with tips. Also make a very succinct form email, and send it to all the program coordinators of the programs you are interested in. That way, you are not bothering the PD, and the coordinator/PA should have the info you need. It will take time to get a response, so start immediately. I wouldn't ask anything like, "Hi I would like some free cash," I would word it like you are leaving your program and need to know about eligibility for additional years of PGY funding.

It can't be that uncommon. I have known surgery residents, IM and FM transfer into path, with various numbers of PGY used up, and I have known 1 path resident transfer into FM.

You may have to scramble, so get ready.
 

Raryn

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Please, for the love of jeebus, ignore the funding issue. I can't say every PD will and WS gave you a more thorough explanation than most people could, but the general gist of it is that even IF you end up in a program that's soley medicare funded and they slot you into a medicare funded slot, the difference between being funded and unfunded is the difference between the program receiving ~$100k for you and receiving ~$75k for you. It's not between 100k and zero. Most institutions have at least somewhat expanded since 1997 and have a number of spots that are funded through alternative pathways (state funding, private funding, even the VA) and they can just (on paper) say you're in one of THOSE slots. It really, really, doesn't matter the majority of the time. Some PDs might think it does, but if you don't match, the funding will not be the issue.
 

BlondeDocteur

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Also given that anesthesia is heavily critical care based, more competitive than IM, and that this was your downfall previously I would scrap applying to it.
 

Law2Doc

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Agree with what's said so far, but would point out that getting enough time in to get a license could be the baseline you must reach. So have as your fall back some prelim (in anything, IM, surgery, whatever) such that you can log enough time to get licensed, if you aren't already. Then you could always make a career out of urgent care/per diem/moonlighting type shifts if the path to an actual specialty doesn't pan out.
 
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mercaptovizadeh

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My advice is to apply broadly and be prepared to deal with uncomfortable questions regarding your resignation. If you state "family issues" or "health" you must be able to discuss this in a convincing manner. What was the nature of the illness? What family situation led to your taking time off to deal with it? If you cannot discuss this at length because the true reason for your resignation was program pressure/threat of termination, I would go more with a "poor fit" explanation, in which case your chance of matching into IM or a more competitive specialty is going to be slim.
 

thesauce

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This is actually not true. Surprisingly, successful anesthesia applicants have lower board scores, less research, fewer are AOA, fewer MD/PhDs, and an overall higher match rate (especially for non-USMD seniors) than IM!

I was also surprised by this:

http://b83c73bcf0e7ca356c80-e8560f466940e4ec38ed51af32994bc6.r6.cf1.rackcdn.com/wp-content/uploads/2013/08/chartingoutcomes2011.pdf
This surprises me. All of that sudoku that they do has to be increasing their brain power!!
 

mercaptovizadeh

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Also given that anesthesia is heavily critical care based, more competitive than IM, and that this was your downfall previously I would scrap applying to it.
Yes, my impression going through the match was the people at my school were getting into more top notch anesthesia programs (with equal or weaker stats) than people applying to IM. I think the CRNA scare is part of it, as well as people trying to shore up a primary care backup in case (sub)specialization doesn't pan out in Obamacare.
 

thesauce

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Yes, my impression going through the match was the people at my school were getting into more top notch anesthesia programs (with equal or weaker stats) than people applying to IM. I think the CRNA scare is part of it, as well as people trying to shore up a primary care backup in case (sub)specialization doesn't pan out in Obamacare.
I don't think it's the latter since it hasn't been competitive for many years now - even before ACA was proposed. Also, PAs/NPs encroachment on PCPs may be even worse than CRNAs encroachment on anesthesia.