Self funded Preliminary year?

[tkayenn]

I have matched into advanced position but I have not found a PGY1 position todate. I have started to inquire if there is anything like self funded PGY1 . Any thoughts?

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[gutonc]

There is no such thing. Sorry.

 

[tkayenn]

Thank you...... Apprecite your input.

 

[ThoracicGuy]

I have matched into advanced position but I have not found a PGY1 position todate. I have started to inquire if there is anything like self funded PGY1 . Any thoughts?

Have you been working with your Advanced program to help you find a position? They should have vested interest in you getting a position.

 

[tkayenn]

Have you been working with your Advanced program to help you find a position? They should have vested interest in you getting a position.

I have been in touch with them as well. Calling programs every day. No luck so far.

 

[OTOSwap]

I have matched into advanced position but I have not found a PGY1 position todate. I have started to inquire if there is anything like self funded PGY1 . Any thoughts?

there are open PGY1 positions being posted. I saw a transitional posted. Also, go to program directors of surgery they have open positions. Contact as many GME departments as you can. Unposted positions

 

[tkayenn]

Appreciate your suggestions. I have applied to the available transition and PGY1 spots. I am calling programs as well.
I hope something comes up. I am open to any PGY1 anywhere.

 

[curiousme23]

I am in same position as you. Matched to AP but have no TX/Prelim and was also thinking about self-funded prelim program at my AP hospital.

 

[sazerac]

If self funding intern year was a thing, we would all have been paying tuition for intern year a looong time ago.

 

[AdmiralChz]

Does no one here see the issue here? Spending an additional 50K for the ABILITY to work? Doesn't ring any exploitation alarms out there??? I know some people are desperate for spots, but cmon, this would be a horrendous plan.

 

[gutonc]

Does no one here see the issue here? Spending an additional 50K for the ABILITY to work? Doesn't ring any exploitation alarms out there??? I know some people are desperate for spots, but cmon, this would be a horrendous plan.

Ummm...everybody sees the issue here. Did you not read the thread?

And ACGME specifically prohibits self-funded residency spots for this (and many other) reason(s).

 

[AdmiralChz]

Sorry, meant the people actually proposing this as a solution!

 

[gutonc]

Sorry, meant the people actually proposing this as a solution!

Yeah...but they're desperate. They get a bit of a pass.

 

[NotAProgDirector]

And ACGME specifically prohibits self-funded residency spots for this (and many other) reason(s).

As far as I can tell, there is no rule against this. The common program requirements are here: http://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRs_07012016.pdf I see nothing about salary or funding there, just that the program has to have the "resources" to educate residents, which is vague.

I am 100% against this. However, which of the following scenarios are OK, if any:

1. A foreign government decides to fund a residency slot in the US. Only their students can match into this slot. After completing training, the resident is rquired to return to their home country and practice for some amount of time.

2. A community in the US has trouble attracting PCP's. They decide to fund a residency slot in that community, with a contract with that person such that after completing training, they must work (and be paid) in the community for some period of time. The contract spells out consequences for not fulfilling, perhaps repaying triple the cost.

3. A program has additional slots they would like to fill but have no funding. Some investors decide to fund the slot fully. The person that matches into this slot agrees to repay the investors later in their career -- either some fixed amount (principle and interest, basically a loan), or some percentage of their salary (a risk for the investors).

4. A program has additional slots they would like to fill but have no funding. The institution, itself, decides to "fund" the slots, but requires those that match to these slots to pay back the costs of their training -- either a fixed payment plan (i.e. loan), or a variable plan (percentage of future salary). Basically the same as #3, but funded by the program. The program says that future income from this program will go towards funding GME.

This is really tough. #1 already happens. The others seem not that different. #1 and #2 are different in that the resident never financially "pays back" the training costs -- the payors simply see this as recruiting costs for future labor. Somehow this seems better to me than #3 and #4 where the resident is expected to financially pay back.

 

[Raryn]

As far as I can tell, there is no rule against this. The common program requirements are here: http://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRs_07012016.pdf I see nothing about salary or funding there, just that the program has to have the "resources" to educate residents, which is vague.

I am 100% against this. However, which of the following scenarios are OK, if any:

1. A foreign government decides to fund a residency slot in the US. Only their students can match into this slot. After completing training, the resident is rquired to return to their home country and practice for some amount of time.

2. A community in the US has trouble attracting PCP's. They decide to fund a residency slot in that community, with a contract with that person such that after completing training, they must work (and be paid) in the community for some period of time. The contract spells out consequences for not fulfilling, perhaps repaying triple the cost.

3. A program has additional slots they would like to fill but have no funding. Some investors decide to fund the slot fully. The person that matches into this slot agrees to repay the investors later in their career -- either some fixed amount (principle and interest, basically a loan), or some percentage of their salary (a risk for the investors).

4. A program has additional slots they would like to fill but have no funding. The institution, itself, decides to "fund" the slots, but requires those that match to these slots to pay back the costs of their training -- either a fixed payment plan (i.e. loan), or a variable plan (percentage of future salary). Basically the same as #3, but funded by the program. The program says that future income from this program will go towards funding GME.

This is really tough. #1 already happens. The others seem not that different. #1 and #2 are different in that the resident never financially "pays back" the training costs -- the payors simply see this as recruiting costs for future labor. Somehow this seems better to me than #3 and #4 where the resident is expected to financially pay back.

Took me a while to find it but I knew I had read it somewhere: Paying residents is absolutely an ACGME mandate, just not at the program level... It's an institutional requirement.

The relevant clause is on page 7:

Resident Salary and Benefits: The Sponsoring Institution, in collaboration with each of its ACGME-accredited programs and participating sites, must provide all residents/fellows with financial support and benefits to ensure that they are able to fulfill the responsibilities of their ACGME-accredited program(s).

Now, I think this does lead to some ambiguous areas that allow things like #1 or 2 above: It doesn't say where the sponsoring institution has to get its money. The VA pays for 1/3 of my salary to the university that employs me and I have to spend 1/3 of my time there. Nothing to stop the government of Saudi Arabia paying my spots salary via the university and in exchange me signing a contract prior to starting that I'd go back to work there. But I think this does put the kibosh on me actually being required to pay for my spot.

 

[gutonc]

Thanks to both @aProgDirector and @Raryn for clarifying and expanding on this.

 

[NotAProgDirector]

Nice find. Didn't think of the institutional recs.

My sense is the same. If there's external funding that attaches some non-financial requirement upon the resident, that's fine. Military service, return of service contracts, etc, all seem OK. A requirement of financial repayment seems wrong. There's lots of grey in between -- a return of service contract with a salary that's lower than you might otherwise be able to get would be essentially financially equivalent to repayment.

Anyway, for the OP, this isn't an option. All of this discussion is theoretical.

 

[FDK1976]

As far as I can tell, there is no rule against this. The common program requirements are here: http://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRs_07012016.pdf I see nothing about salary or funding there, just that the program has to have the "resources" to educate residents, which is vague.

I am 100% against this. However, which of the following scenarios are OK, if any:

1. A foreign government decides to fund a residency slot in the US. Only their students can match into this slot. After completing training, the resident is rquired to return to their home country and practice for some amount of time.

2. A community in the US has trouble attracting PCP's. They decide to fund a residency slot in that community, with a contract with that person such that after completing training, they must work (and be paid) in the community for some period of time. The contract spells out consequences for not fulfilling, perhaps repaying triple the cost.

3. A program has additional slots they would like to fill but have no funding. Some investors decide to fund the slot fully. The person that matches into this slot agrees to repay the investors later in their career -- either some fixed amount (principle and interest, basically a loan), or some percentage of their salary (a risk for the investors).

4. A program has additional slots they would like to fill but have no funding. The institution, itself, decides to "fund" the slots, but requires those that match to these slots to pay back the costs of their training -- either a fixed payment plan (i.e. loan), or a variable plan (percentage of future salary). Basically the same as #3, but funded by the program. The program says that future income from this program will go towards funding GME.

This is really tough. #1 already happens. The others seem not that different. #1 and #2 are different in that the resident never financially "pays back" the training costs -- the payors simply see this as recruiting costs for future labor. Somehow this seems better to me than #3 and #4 where the resident is expected to financially pay back.

Medical Residency Resources is trying to do a combination of #2 and #3. They're lobbying states with shortages to get exemptions to certain rules to
provide positions in shortage areas but at the end the resident has to revenue share in the future or pay some part of it as most rural communities
and states are pretty strapped for cash as well.