Switching from IM to Gen Sx & The DGME; Advice?

[lhurlb]

Medicare Direct Graduate Medical Education (DGME) Payments
Question:

I am a DO resident, PGY1, tracked in Internal Medicine. I decided to change to General Surgery. I was accepted to surgery and I received my contract. I signed it and before it was received by the surgery program, they called me and stated that they didn't realize that I was IM tracked and they could not fund me for my fourth and fifth year. My program director stated that he already has interviews for my PGY2 spot in Internal Medicine and he would allow me to interview for my spot back but he will not change my contract to a Traditional Rotating Intern, even though I meet the requirements. He (& DME) stated that it would be illegal to do so. The Surgery Residency stated that they typically will change the contract for their residents so they can go on to be fully funded. It just needs to be changed before the completion of the first year. I have until Friday before the Surgery position is giving away my position and I already essentially lost my position here in Internal Medicine.

Question: Does anybody know if it is really illegal for my program in Michigan to change my contract title to a Traditional Rotating Intern?

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[Winged Scapula]

I would check the the office of GME at your program, they are usually the last word of policy.

 

[NotAProgDirector]

This is not an easy question to answer. Medicare usually assigns the DME limit at the time of acceptance into your first residency. If you matched into and started an IM categorical residency, then your DGME money will be fully funded for only the first 3 years of training, even if you switch fields. If you matched into a prelim program, then that usually won't count and your GME limit would be set when you start your PGY-2 program.

Interpretation of these guidelines is left up to the Medicare intermediaries, and hence what is "OK" at one program might not be OK at another.

Rewriting your contract after the fact would be fraud, unless it was a clerical error the first time, which by your description it was not.

"The Surgery Residency stated that they typically will change the contract for their residents so they can go on to be fully funded." -- not quite sure what this means. If someone starts in surgery, their GME clock is set to 5 years which is the maximum, so they can switch to anything they want. The Surg residency might change a prelim contract to a categorical contract, which also would set the clock.

As far as funding is concerned, remember that when you are beyond your clock, DME funding is set at 50%, while IME funding remains at 100%. The IME is the much bigger item at most programs. All fellowships (cardilogy, GI, pulm , CT surg etc) are all paid at 50% DME since residents are beyond their initial training period.

Sadly, if they demand full DME, I don't think there is much you can do. I agree that your DIO (the head of GME) will have the final say.

 

[qlin]

What happen if i switch from IM catagorical to pathology? Will there be any funding problems?

 

[gutonc]

Yes...same as above w/ all the caveats that aPD mentioned (which basically boils down to the fact that the out-of-pocket costs to a program for supporting a non-tracked resident after the # of approved years is 20-30% of the total costs (i.e. $20-30K/yr, assuming semi-random salaries of $40-60K/yr and total costs of $100K/yr). So if you are a decent candidate and the program isn't just looking for warm bodies, it shouldn't be a big deal.

 

[Brwnidgrl]

I just scrambled for a D.O traditonal rotating internship program and was offered either a traditional rotating internship track or IM track my first year with only a one year contract. I was told I could change my track, even after I started.....if I am still considering my specialty options......is it a wiser choice to stick with the traditonal rotating track for the sake of future funding?

I am reading it that way.....but just wanted to make sure.

 

[Winged Scapula]

What happen if i switch from IM catagorical to pathology? Will there be any funding problems?

As I understand it, you've already got the position - so surely your path program understands that you have less available years of funding than someone who started PGY-1 as a path resident, and they've decided you're worth it.