Switching residencies and Medicare GME payment of salary.

[greggth]

I was a resident in general surgery for 2 years. Found that it was not a good fit, am switching to family medicine, starting over in 2011 as an intern.

The cost of supporting a resident is defrayed by GME payments from Medicare to the residency program. This can be tens of thousands of dollars per year per resident. As a resident, your GME funding follows you. If you transfer from one program to another, the new program receives your funding. But my understanding is that each resident has a limited number of years of funding. A resident can only receive a lifetime total of funding for the number of years that his or her first residency lasts. So for example if you start in family medicine residency, a 3-year residency, you only get 3 years of GME funding, that's it, you can never get any more. If you start in general surgery residency, which lasts five years, you get 5 years of funding. If this is wrong and anyone can correct me please do so.

My question is this: If you do 2 years of a family medicine residency and decide you want to switch into a general surgery residency, I can see that Medicare will pay the first year of your salary, but who will pay for the remaining 4 years?

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[Entgegen]

If I understand correctly, it's not that you receive ZERO funding once you move past your alloted time, but you receive reduced funding (I think you end up taking a 20-25% paycut on your salary for each year), and the hospital may have to cover the rest. For more affluent hospitals, this may not be much of an issue...but for hospitals strapped for cash, that may be reason enough not to take an otherwise qualified candidate.

I've kinda' wondered though if you could negotiate with the program that you would be fine with receiving the paycut if that would be a deal-breaker for the program accepting you (assuming you would be ok with taking the reduced salary).

 

[Director Don]

As you might imagine this question is more complicated than it appears.

You are right on one key point: the timing of your initial residency choice impacts the amount of reimbursement the hospital can claim for you. In your scenario there would be no negative impact since you are switching from a program with a longer residency period to one with a shorter period, in spite of the fact that you have done 2 years in surgery already. The common FP residency is 3 years while general surgery is 5 years, so you should be in good standing.

If the reverse were true, your time would only be counted at 50% for each year beyond the initial residency period (IRP). That would include fellowships beyond the IRP as well.

As noted, that reduction may or may not impact the actual salary you are paid. We do not reduce resident salary based on claimed reimbursement nor do we consider it when residents come here. We are hardly an affluent hospital but very committed to medical education as part of our mission.

Good luck with the remainder of your residency.