Un-paid Residencies?

[Octagonecology]

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This is kind of a technical question for current residents.

I have an uncle that did an FP residency long ago, didn't like it and went back and did an Anesthesiology residency and worked for 12 years in that field.

He recently sustained a back injury that effectively ended his anesthesiology career.

He wants to go back and do a Psych residency. Mind you he made about 3.5 million during his 12 years and spent very little (hes kind of a hippie)and also draws an income from disability insurance he took out during his MDA years. Thus he needs no money.

With regards to funding limits for residents, if he found an open Psych program but limited out his funding could he take the residency just for the training and get no pay/benefits, etc.?

 

[dragonfly99]

Man, I don't know why someone would want to do this. He can go back to practicing fp with a psych emphasis. Won't he lose his disability benefits if he goes back and does residency (proving he can work and doesn't need it?).
I've heard of people doing unpaid, unaccredited derm residencies, but not psych. I would think that there are psych programs so desperate to get residents that they would probably be willing to take someone, even if they only got 1/2 the GME funding. Don't they still get 1/2 even if he has already done a residency?

 

[Octagonecology]

Man, I don't know why someone would want to do this. He can go back to practicing fp with a psych emphasis. Won't he lose his disability benefits if he goes back and does residency (proving he can work and doesn't need it?).
I've heard of people doing unpaid, unaccredited derm residencies, but not psych. I would think that there are psych programs so desperate to get residents that they would probably be willing to take someone, even if they only got 1/2 the GME funding. Don't they still get 1/2 even if he has already done a residency?

Thx for the response. I guess the reason he did the MDA res. in the first place if for not liking FM. Plus, he can barely walk let alone room to room to room all day and up and down, etc. I guess he figures w/ Psych he can pretty much sit all day and have the recptionist show the pt. into the room.

Interestingly enough his DI policy had a clause that he could go back to the pracice of medicine, just not the practice of "anesthesiology" and still maintain his benefits. Which are, ahem...about $10,000 per month. Of course the insurance company tried to stop the benefits, but he sued and won.

I'm not sure about the 1/2 part...kind of rely on fellows and residents like yourself for that info. I'm sure he knows also but i was just curious for my own fund....

 

[SoCuteMD]

The problem I see is not the funding (he should have half the GME funding/yr), it's that there's more physical demand to psychiatry residency than there is once you are in practice. He may be able to have his FP training count towards some of his psych off-service months, but if he can't then he'll have to do months of floor medicine. Most of psych training is on the wards, so we were up and down, going from conference room to locked ward, etc. most of the day.

I don't think he'd have a problem getting into a program, as long as he could withstand the physical demands. It's probably worth a few phone calls to local psych PDs to feel them out as to whether they'd accept his FP training as some of his off-service months and make his interest known.

 

[nancysinatra]

I would think that there are psych programs so desperate to get residents that they would probably be willing to take someone, even if they only got 1/2 the GME funding.

Why do you say this? There was something like 1 real unfilled spot in the match that actually was open in the scramble this year. The rest were all gone. Psych isn't sitting around begging for residents.

Also he would probably have to work in the psych ER, with patients who might be dangerous and need restraints. Wouldn't that be physically demanding?

 

[Law2Doc]

This is kind of a technical question for current residents.

I have an uncle that did an FP residency long ago, didn't like it and went back and did an Anesthesiology residency and worked for 12 years in that field.

He recently sustained a back injury that effectively ended his anesthesiology career.

He wants to go back and do a Psych residency. Mind you he made about 3.5 million during his 12 years and spent very little (hes kind of a hippie)and also draws an income from disability insurance he took out during his MDA years. Thus he needs no money.

With regards to funding limits for residents, if he found an open Psych program but limited out his funding could he take the residency just for the training and get no pay/benefits, etc.?

The amount of money that goes to the resident is the smallest component of the cost. There are many costs associated with training, ranging from insurance to oversight/instruction, to supplies/scrubs etc. Many spots that are funded net the hospital $100k+, and only $40k or so goes to the resident. So even if he worked for free, where would the other $60k+ funding come from? And no, he can't pay it himself, because that sets a bad precedent if the rich folks can pay money to create residencies for their family members, while the poor folks can't -- it's a public policy nightmare. So I don't see this being a viable solution.

 

[NotAProgDirector]

The ACGME forbids "unpaid" residencies.

I guess he figures w/ Psych he can pretty much sit all day and have the recptionist show the pt. into the room

This is completely unrealistic. If he could function in a wheelchair (meaning push it around himself, or have a motorized wheelchair) then perhaps this could work. This assumes he's willing to deal with overnight call at his age. My guess is that the combination of his atypical history, age, and disability will really limit his choices. Using any of those as actual selection criteria is illegal, but it's going to be an uphill battle.

Why doesn;t he simply volunteer his time? If he's willing to do that, I bet there are plenty of community based mental health centers (or commuity based health centers in general) who would love to have him as a volunteer.

 

[Winged Scapula]

Doesn't Psych require a Prelim Medicine year?

He *might* get some credit for a couple of months of FM, but I doubt he'd be able to get through the IM year and Psych residency (which is also physically demanding) without being in a wheelchair if he cannot tolerate standing for long.

As SoCuteMD notes, Psych can actually be physically demanding...and not just being up all night in the ED - having been attacked by more than 1 patient in my limited experience on Psych (and not always having a burly Psych tech nearby), I highly suggest being able to run and/or restrain a patient.

Is he allowed to do Pain Mgt - or nothing Anesthesia related?

 

[dragonfly99]

psych doesn't require a medicine prelim year...it requires some off service months during intern year...I think it is 3 months of medicine and 3 months of neuro. Having gone through both fp and anesthesia residency, he should have more than enough IM months, should a psych program choose to count those. Anesthesia requires a prelim year, so I'm assuming this doc has done at least several months of IM, surely more than a psych residency requires. He might have to go back and do neuro month(s). I think if he is physically able to walk around the hospital, etc. he could likely get a psych residency. If the things he can't do involve lifting, lots of bending over, etc. I don't see why he still couldn't do psych.

As far as psych filling in the match, yes, it does fill, but it's generally very easy for US allopathic grads (or people switching specialties) to get a spot, especially if they are willing to move, etc. I also have known multiple IMG and FMG's who have gotten psych residencies at prestigious academic hospitals, and this is without having psych related research or other amazing stuff on their resumes...of course they were bright, etc. but in general psych is one of the easiest residencies to get. They also get quite a few career changers (folks from other specialties).

I'm assuming this doc has pretty decent board scores, etc. The fact he already has practiced and has a medical license means he has already been vetted by a lot of authorities, had background checks, and proved he can do a residency. Many PD's prefer these types to some graduating med students who may have red flags in their application, or to taking a FMG from a foreign school unknown to them, who may have some difficulties with English. If this doc can physically do the work, would think he'd have a good chance to get in somewhere...depends if he is willing to move, etc.

 

[deleted21609]

Psych has 4 months of medicine and 2 of neuro in the intern year at my institution. Neuro is probably tough from a wheelchair, but has been done before. There are some consult months that could be difficult but not impossible. As far as assault by patients is concerned, he would probably need someone to accompany him for any schizos etc.

An easier thing to do would be to get a job in an anesthesia pre-op clinic. He might loose the disability income, but he would more than replace it and he could stay involved in medicine.

 

[dragonfly99]

I know there was a neuro attending in a wheelchair at one of the hospitals where I trained.

 

[michaelrack]

Psych has 4 months of medicine and 2 of neuro in the intern year at my institution. .

Instead of IM, Family med or pediatrics are perfectly acceptable substitutes for the 4 medicine months.

 

[michaelrack]

I think the OP is a troll. Here is what he posted in another forum:

"I can only speak for my uncle who did a FP residency...hated that then did Anesthesiology at IU. Then had a crippling back injury which prevented him for standing long periods in the OR. He just went back and did a Psych residency so he could sit all day because of his back...So he is board certified in 3 pretty much mutually exclusive specialties that probably don't enhance one another at all."

http://forums.studentdoctor.net/showthread.php?t=629072

 

[Taurus]

I once met someone who completed multiple residencies first in FP, then psych, and finally anesthesiology. Thought she was crazy to do all that.

 

[zinjanthropus]

the bottom line is that there are always residency programs out there that don't care about the funding limitations because they don't get funding for salaries (residency program itself or the hospital pays the salary)- my EM program is an example and we take multiple residents with full backgrounds/training in other fields

 

[deuist]

Why doesn;t he simply volunteer his time? If he's willing to do that, I bet there are plenty of community based mental health centers (or commuity based health centers in general) who would love to have him as a volunteer.

Or become a pain medicine specialist? If he gave up procedures such as epidurals, his anesthesia training would help him a lot in this field. As a pain medicine doc, he'd see lots of psych patients there, too.

 

[medsRus]

I've heard of people doing unpaid, unaccredited derm residencies

What can one do with this?

 

[Winged Scapula]

What can one do with this?

Open your own practice. If you are in a cash only practice and don't admit patients to a hospital or use their operating facilities, you don't have to worry about graduating from an accredited program which may be a requirement for insurance and hospital credentialing.

 

[deuist]

Open your own practice. If you are in a cash only practice and don't admit patients to a hospital or use their operating facilities, you don't have to worry about graduating from an accredited program which may be a requirement for insurance and hospital credentialing.

That's one of the debates I've heard in the psychiatry world right now. If you open a cash-only office where you do therapy and medical management of outpatient issues such as depression and anxiety, do you really need board certification? Training is needed, but is the paper necessary?

 

[core0]

That's one of the debates I've heard in the psychiatry world right now. If you open a cash-only office where you do therapy and medical management of outpatient issues such as depression and anxiety, do you really need board certification? Training is needed, but is the paper necessary?

Around here most of the psychchiatrists refuse to participate in insurance plans. They accept cash and then the patient bills the insurance company. You could probably OK the only issue would be if you would get any referrals without board certification.

David Carpenter, PA-C

 

[Winged Scapula]

As David, notes you don't need BC in those situations, provided things don't change and no one tries to make it a condition of licensing.

In regards to referrals, I think it depends on your environment. Despite all the education we do about BC, the vast majority of patients and referring physicians don't ask about it.

If you are well priced, easy to schedule an appointment with, conveniently located, communicate with referring physicians and treat patients well, you'll likely get more referrals than the BC physician who isn't /doesn't do the above.

 

[NotAProgDirector]

If you're not BC, you will likely be at some increased risk of losing a lawsuit should one arise, I would think. Not that being BC somehow confers some magical ability to be a better physician, but not being BC probably looks bad to the jury.

 

[core0]

If you're not BC, you will likely be at some increased risk of losing a lawsuit should one arise, I would think. Not that being BC somehow confers some magical ability to be a better physician, but not being BC probably looks bad to the jury.

I don't think that it confers any magical ability, its just that reputable BC physician is less likely to want to testify against a member of the club. On the other hand if the other physician is not BE/BC and encroaches into BC territory they descend like rabid pitbulls on qualudes.

David Carpenter, PA-C