switching from FM to ER?

[Monsters Inc]

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Im currently finishing up my FM residency and was thinking of applying to an EM residency afterwards. I know there are some ERs i can work at after graduating with FP without being an EM trained doc, but I want to keep my options open.

I hope working in ERs will be seen as a positive when I apply for EM residency. Also, after doing a search, looks like I might be able to get 6 months credit for finishing FP. Any advice on people that have been or know of similar situations would be much appreciated. Thanks!!

 

[cach]

Funding is an issue but it is not impossible to do a second residency. Apply broadly to EM residencies, some may reject you because you have done a previous residency, but many will welcome the opportunity to have a resident with previous graduate medical education.

The 'Direct Medical Education' payment is cut to 50%. Depending on the patient structure of the hospital, this DME component is typically about 40k (20k after the 'initial residency period' runs out).

The 'Indirect Medical Education' payment is not affected by the length or number of your residencies. Depending on the patient and payor structure of the hospital, this is anywhere between 60k and 120k.

So, bottom line, your funding drops by approx 20k (or 20%) from what it could be if you where fresh out of medschool. This can be a reason for hospitals that have to rely on GME funding NOT to take you. At larger wealthier institutions where GME payments are just a small part of the mix, it makes less of a difference. Total number of funded residency slots is capped at 1997 levels for each hospital. Some places have grown their residencies nevertheless and just funded the extra slots out of patient care and endowment $$s (at one place in my training, 100 'funded' slots paid for 170 residents salaries).

There is a brochure on the AAMC website that explains some of the issues:
https://services.aamc.org/Publications/showfile.cfm?file=version57.pdf&prd_id=153&prv_id=180&pdf_id=57
And here a slightly politically slanted explanation on how the feds arrive at the numbers they pay to the hospitals:
http://www.amsa.org/pdf/Medicare_GME.pdf

Knowledge is power. Some PDs have the impression that there is NO funding for a second residency. I had the info available at the time and managed to convince someone that I was worth it 😉

 

[gutonc]

From my understanding (others may want to chime in)

I will chime in because your understanding is quite poor.

There are numerous threads about "the funding issue" on this and other forums. Residency spots are funded with a combination of direct (DME) and indirect (IME) funding. Primary residency spots are provided with 100% DME and 100% IME. Second residency spots (and all fellowships) are funded at 50% DME and 100% IME. This equates to a 2nd residency (and all fellowships) being federally funded at ~75% (+/-10-15% depending on the way the program is set up). Which is essentially irrelevant to most all programs.

So, if you're getting the "you have funding issues" line from a program, one of 2 things is happening.

1. You're talking to an administrative functionary whose understanding of funding issues is (unbelievably) worse than yours.
2. It's a polite way of saying "Are you high? Have you seen your application? Not even Starbuck's would hire you."

 

[Tiger26]

Yeah, we have a guy in our program who did FM and is now doing an EM residency