Tox fellowship to ER residency

[drmg456]

I am a Pediatrician who has been selected for a tox fellowship, my ultimate aim is a EM residency after the Tox fellowship, is it possible

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[EctopicFetus]

I think this would depend on you having federal funding left for your training. Are you referring to a Peds-Em fellowship or are you referring to doing straight up EM?

 

[southerndoc]

I am a Pediatrician who has been selected for a tox fellowship, my ultimate aim is a EM residency after the Tox fellowship, is it possible

Can you combine the two?

One of our peds EM attendings combined both tox and peds EM at Boston Children's. I think he was there for 4 years total.

 

[drmg456]

Can you combine the two?

One of our peds EM attendings combined both tox and peds EM at Boston Children's. I think he was there for 4 years total.

I want to do straight up EM rather than Peds EM, what is the story about federal funding, I heard that the federal govt will fund only for seven years total of your residency. Is that true

 

[southerndoc]

I want to do straight up EM rather than Peds EM, what is the story about federal funding, I heard that the federal govt will fund only for seven years total of your residency. Is that true

No, the federal government will only fund your first residency. So if you completed a pediatrics residency, the program will get no federal funds for your emergency medicine residency. The government won't pay for more training than is mandated by their standards (i.e., 4-year EM programs do not get funding for the fourth year).

Most places will still consider you. The smaller programs or community-based programs might be hesitant to train somebody like you IF (and only if) they are already stretched for funds.

I know we take people with previous training. I can think of a couple people now who have completed a residency before EM. Two in internal medicine, another in surgery, and one other that switched to EM from surgery (so many of her years will not be funded). We also have two people who switched from IM to EM mid-residency.

 

[EctopicFetus]

No, the federal government will only fund your first residency. So if you completed a pediatrics residency, the program will get no federal funds for your emergency medicine residency. The government won't pay for more training than is mandated by their standards (i.e., 4-year EM programs do not get funding for the fourth year).

Most places will still consider you. The smaller programs or community-based programs might be hesitant to train somebody like you IF (and only if) they are already stretched for funds.

I know we take people with previous training. I can think of a couple people now who have completed a residency before EM. Two in internal medicine, another in surgery, and one other that switched to EM from surgery (so many of her years will not be funded). We also have two people who switched from IM to EM mid-residency.

There you have it.

 

[drmg456]

No, the federal government will only fund your first residency. So if you completed a pediatrics residency, the program will get no federal funds for your emergency medicine residency. The government won't pay for more training than is mandated by their standards (i.e., 4-year EM programs do not get funding for the fourth year).

Most places will still consider you. The smaller programs or community-based programs might be hesitant to train somebody like you IF (and only if) they are already stretched for funds.

I know we take people with previous training. I can think of a couple people now who have completed a residency before EM. Two in internal medicine, another in surgery, and one other that switched to EM from surgery (so many of her years will not be funded). We also have two people who switched from IM to EM mid-residency.

the federal government funding is limited to residency or does it include the training years in fellowship also,

I KNOW IN cOOKCOUNTY they have lots of EM after they get trained in another specialty, they might be getting the county funding also

so you mean to say that it's not impossible, but improbable

thanks for your valuable insights

 

[southerndoc]

the federal government funding is limited to residency or does it include the training years in fellowship also,

I KNOW IN cOOKCOUNTY they have lots of EM after they get trained in another specialty, they might be getting the county funding also

so you mean to say that it's not impossible, but improbable

thanks for your valuable insights

Fellowship isn't funded by the federal government, except for a few programs. (Some tox programs are funded by the federal government.)

It's neither impossible or improbable to do another residency. People do it all the time. It's improbable to do it at a location that doesn't have enough money to support you. Smaller programs may need the government funding for its residents. Larger programs (i.e., academic medical centers, large tertiary care facilities, etc.) can afford to pay the residents without the funds.

As I mentioned earlier, we have several residents who have completed other residencies, started other residencies and transferred in, etc. that are not funded by the government. They still receive the standard resident salary. I am in a 4-year EM residency, which means that 100% of our residents in their 4th year are not funded.

 

[MM9]

It is a HUGE misconception the programs will recieve "No federal funding" for residents past their intial residency.

Check out: http://www.aamc.org/advocacy/library/gme/gme0001.htm which as some links on this issue including this nice brochure: http://www.aamc.org/advocacy/library/gme/dgmebroc.pdf. Like most PDF files, it will only take about 5 or 6 tries to download. Keep trying though, it is worth it.

In summary, there are 2 types of funding, Direct and Indirect. These amounts vary based on several factors such as the number of Medicare patients, the average stay of these patients, a "hospital specific amount", the position of the sun, and the temperature in Toledo, Ohio (ok, I made the last 2 up). When you match into a field, you are 'locked' into how many years of full Direct funding the government will give your program. For example, if you match into IM you have 3 years of full Direct funding (they count you 1.0 when they do the math). Once you use up those 3 years, since you are obviously completely useless, you count as half a resident. I'm not kidding, when they do the math you are counted as 0.5.

This is only true for the Direct funding; for the Indirect funding you count as a whole person for as many years as it takes. Fellowship is spared from this maddness as well.

The brochure above shows some nice examples of the math. It also mentions that for most hospitals, the Indirect funding "far exceeds" the Direct. It goes on to say, “So as a percentage of the hospital’s total Medicare medical education payment, the financial impact of a resident beyond the initial residency period may be small.”

If anyone has any other information, or can find fault with the above, please let me/us know.

 

[southerndoc]

I learn something new everyday.