The program I matched to has 4 pgy-1s and only 3 pgy 2-3 yrs and 2 pgy-4s.

[AutomaTron]

What are the chances that they give 4 a pgy-1 spot and get rid of 1 or 2 on purpose? It's a 4 year categorical program with an automatic pgy-1 IM year. There is a 100% pass rate for both the first and 2nd yr board tests.

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[Winged Scapula]

It appears to me that your program has 2 categorical positions per year, with Preliminary positions for years 1-3, or they may have started taking more residents in the program in the junior years, or they may have residents who start but leave for combined Neuro-Psych programs, etc.

I'm not sure if you are questioning whether or not this is a pyramidal program, but unless its a military residency, pyramidal programs are in violation of the RRC. Therefore, my guess is that they aren't "getting rid" of 1 or 2 PGY1s on purpose, but rather that is the design of the program; that not all 4 are categorical, or that some are destined for training in other fields.

best answer: call the program and ask them.

 

[deleted109597]

Or, they have been approved for more spots by the ACGME, and are slowly putting them in.

 

[Bertelman]

...better pass your boards...mwahahahahaha

 

[NinerNiner999]

What are the chances that they give 4 a pgy-1 spot and get rid of 1 or 2 on purpose? It's a 4 year categorical program with an automatic pgy-1 IM year. There is a 100% pass rate for both the first and 2nd yr board tests.

This question would have been much better timed long before the match...

 

[Entei]

It appears to me that your program has 2 categorical positions per year, with Preliminary positions for years 1-3.

I'm not sure if you are questioning whether or not this is a pyramidal program, but unless its a military residency, pyramidal programs are in violation of the RRC. Therefore, my guess is that they aren't "getting rid" of 1 or 2 PGY1s on purpose, but rather that is the design of the program; that not all 4 are categorical, or that some are destined for training in other fields.

I've heard this again and again, that there are no longer any pyramidal programs... But I noticed going over the contracts that programs show you when you interview that they all contain some variation of the following clauses: employment is only guaranteed from year to year and certain vague "minimum standards" must be met in order to be promoted, for example, above a certain percentile on the ABSITE. Maybe this is a dumb question, but how is this arrangement different from a pyramidal program? It seems to me like the difference is in name only, because from the looks of these contracts, it seems like it's relatively easy to get rid of someone and, at least in today's market, where the demand for catagorical surgery positions is high, it's very easy to replace them with someone else.

(Not trying to turn this into a surgery discussion, btw. From discussions with friends going into other fields, this seems pretty much the same everywhere. Just using surgery as an easy example.)

 

[Winged Scapula]

I've heard this again and again, that there are no longer any pyramidal programs... But I noticed going over the contracts that programs show you when you interview that they all contain some variation of the following clauses: employment is only guaranteed from year to year and certain vague "minimum standards" must be met in order to be promoted, for example, above a certain percentile on the ABSITE. Maybe this is a dumb question, but how is this arrangement different from a pyramidal program? It seems to me like the difference is in name only, because from the looks of these contracts, it seems like it's relatively easy to get rid of someone and, at least in today's market, where the demand for catagorical surgery positions is high, it's very easy to replace them with someone else.

(Not trying to turn this into a surgery discussion, btw. From discussions with friends going into other fields, this seems pretty much the same everywhere. Just using surgery as an easy example.)

Perhaps the difference is just in semantics.

In a pyramidal program, it is KNOWN that x number of residents will not be rehired from one year to the next. That is what is a violation of the RRC rules for ACGME accredited residencies.

Obviously, residencies have to have some criteria as to whether or not they promote you. They are not *supposed* to use ABSITE scores, but some here claim they do (but what you want to bet the program has amassed other *points* against the resident?).

And yes, if you are not well-liked, a program can use the vague language to not rehire you but they will have to collect information on your incompetence, put you on probation and then show you failed to improve. Programs have been burned before with large lawsuits so they know they have to document the incompetence and show they followed the procedures to fire you.

But in the end, the above is still pretty uncommon and I would imagine that "the evil you know, is better than the evil you don't" meaning that programs are more likely to want to work with a problem resident than take a chance on bringing in someone new, who might be even worse.

Call it a pyramidal program if you wish, but since it isn't guaranteed that you will be fired at the end of the year, and the fact that its pretty uncommon, its not technically pyramidal, IMHO.