switching residency path

[elep]

If I want to switch from IM to FM after completing 2 years, what are my chances ???

Becasue I heard there is some funding issues with this, has anyone heard of this ?

Please give your oppinion .

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[Winged Scapula]

Just like in the pre-med forums, WAMC ("what are my chances") questions are essentially unanswerable.

No one knows. There are too many variables. Your performance as a resident. Your in-training exam scores. What your letter writers say about you. Where you apply, how many positions are open, etc.

As an IM resident, you are generally given 3 years of funding through CMS (formerly HCFA); any years beyond that are typically funded at 50%. Some programs may balk at taking a resident for 50% of what they can get for someone else. But people do it every year.

I suggest using the search function for "switching residencies"...this is a very common question and I'm sure you'll find some threads which can give you some valuable information.

 

[deleted87716]

You'll probably end up having to do two years of FM, so you could be faced with one unfunded year. This isn't necessarily a problem if the FM program wants you badly enough.

As Kim said, there's no way for any of us to tell you what your chances are. There's nothing conceptually difficult about making a switch like that. Any difficulties you might face would be dependent on your own situation.

 

[Poety2]

You'll probably end up having to do two years of FM, so you could be faced with one unfunded year. This isn't necessarily a problem if the FM program wants you badly enough.

As Kim said, there's no way for any of us to tell you what your chances are. There's nothing conceptually difficult about making a switch like that. Any difficulties you might face would be dependent on your own situation.

whoa whoa whoa, you mean if we switch we aren't FUNDED????

Im a PGY2 psych - switching to FM or IM (international medicine hopeful) - I had NO IDEA I could potentially be a financial issue to a program?!

 

[Winged Scapula]

whoa whoa whoa, you mean if we switch we aren't FUNDED????

Im a PGY2 psych - switching to FM or IM (international medicine hopeful) - I had NO IDEA I could potentially be a financial issue to a program?!

This is not a new problem. You are funded for the number of years that it takes to become BE in your chosen specialty once you enter the categorical track.

Beyond that, CMS (which provides the Medicare funding) is generally around 50% of its previous level. So, fellowships for example, are not fully funded by CMS and the program must either "eat" the difference or find another source. In the past, it used to be pretty common to switch residencies and there was little detriment to doing so; at some point CMS (formerly HCFA) decided that there needed to be some controls on people switching.

The idea was not really to punish those who switch once and in the middle of residency due to a change of heart, but rather to stop those who do residency, after residency, after residency....

In your case, you are funded for 4 years as a Psych resident. You have used 2 years of your funding, leaving 2 years left. If you were to switch fields, you can "transfer" those two years to IM or FM, but would have at least 1 year funded at a lower rate.

As Kent notes, it can be a problem, but in general if you are a good candidate and a program wants you, they will find a way to pay you.

 

[Blade28]

Many times Medicare (or is it Medicaid?) only funds you for your initial allotment of years - so if you do 3 out of 4 years of OB/GYN and decide to switch to G Surg, for example, you may have trouble funding 4 out of the 5 years.

Edit: damn, KC beat me to it...more eloquent response too.

 

[Winged Scapula]

Many times Medicare (or is it Medicaid?)

Medicare is federally funded, whereas Medicaid is a state program (aka Medi-Cal in California). CMS or Centers for Medicare and Medicaid Services administers the payment for GME.

 

[Poety2]

Thanks so much Kimberli, you've been giving great advice here for YEARS!

 

[deleted87716]

Thanks so much Kimberli, you've been giving great advice here for YEARS!

Um...I think he's saying you're old!

J/K.

 

[Winged Scapula]

Um...I think he's saying you're old!

J/K.

HEY! I'm just a prodigy.

No worries...I just beat down some Pre-Allo kid who's worried "life will be all downhill" after he's done with fellowship because he'll be 35!!!

 

[Shalom77]

So if I orginally was in Gen surg and did two general surgery years prior to switching to PMR where I have to do 3 years I should be ok since my initial allotment was 5 years. Or would I be short a year since PMR is only 4 years?

 

[Winged Scapula]

So if I orginally was in Gen surg and did two general surgery years prior to switching to PMR where I have to do 3 years I should be ok since my initial allotment was 5 years. Or would I be short a year since PMR is only 4 years?

Your funding is based on the specialty into which you first matched.

Therefore as a GS resident, you were given 5 years of CMS funding. If you used two years and then switched to PMR and then only had to do 3 years to finish (sounds like they gave you a year of credit for surgery?), then you have used the entire balance of funding.

If they made you do the entire 4 years, then yes...you would be a year short because of the two years used in general surgery.

 

[Poety2]

OMG, 35 is old? I'm retiring

 

[Shalom77]

Your funding is based on the specialty into which you first matched.

Therefore as a GS resident, you were given 5 years of CMS funding. If you used two years and then switched to PMR and then only had to do 3 years to finish (sounds like they gave you a year of credit for surgery?), then you have used the entire balance of funding.

If they made you do the entire 4 years, then yes...you would be a year short because of the two years used in general surgery.

Thanks. Yes, a surgery internship year can fulfill PMR's prelim year requirements.

 

[elep]

I am worried, because I am leaving in the beginning of PGY3 IM program.

so, what are my chances of matching into a FM or some other program ?

Any advice... or should I consider leaving the country.

 

[Winged Scapula]

I am worried, because I am leaving in the beginning of PGY3 IM program.

so, what are my chances of matching into a FM or some other program ?

Any advice... or should I consider leaving the country.

I'm sorry you feel we have not answered your question. As noted in myriad other threads and this one AGAIN, we cannot answer WAMC ("what are my chances") questions. There are too many variables at stake here. We have not answered that question of yours because a: we don't know anything about you or the programs you are applying to; b: we are unlikely to be right about your chances.

However, I am not sure why you would consider leaving a US residency program to train outside of the country. There is no guarantee that your training elsewhere would be acceptable in this country; there are some programs which have reciprocity (ie, if you are a member of the Royal College of Australasian General Practitioners you can apply for membership in the American Board of Fam Med) but many do not. In addition, it is not as easy to transition without losing time and graduate medical training in many countries is much longer than in the US. You will not save time.

As to whether this applies to all programs, the answer is for all intents and purposes, yes. Unless you are able to find an FM program which is privately funded (ie, receives no money from the state or federal government) then the CMS funding rules apply. There are some privately funded fellowships, but it is exceedingly rare in residency.

You have no idea about whether or not you will be successful unless you try. Some programs will not be happy about you not having full funding. But there are lots of FM programs out there which would be happy to look at your application. There is nothing you can do about your situation - if you have decided to leave IM before finishing then you have no choice but to approach FM programs with less than full funding.

 

[Blade28]

HEY! I'm just a prodigy.

No worries...I just beat down some Pre-Allo kid who's worried "life will be all downhill" after he's done with fellowship because he'll be 35!!!

Hey, I posted something similar there as well!