Varying numbers in PGY years

[HughOS]

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Hello all, apologies if this seems like an obvious question but this seemed like the best place to ask it.

I'm currently in medical school and interested in applying to general surgery residencies. I've been comparing a few different programs on Freida and the same question has been crossing my mind. The PGY1 years tend to have the most numbers e.g, there might be 9 residents taken in to PGY1 in a given year. But looking at the profile of the later years there are less residents on the list, even as many as half the original number. What is the reason for this? I speculated that it could be programs culling numbers after 2 years but this seems ridiculous just to arbitrarily reduce the numbers. If that is the case, what happens to these residents who have completed 2-3 years of training? But most importantly why would a program take on more PGY1s than they are prepared to fully train to the end of residency?

Thanks in advance.

 

[TraumaLlamaMD]

Are you sure these are all categorical spots? Many programs will take preliminary surgery residents for their PGY1 year only. FREIDA has been known to get details wrong, so go check out the program's actual website and see what's up.

 

[TraumaLlamaMD]

It's also possible the program has recently been permitted to expand, which might account for 1-2 spots, although it's more likely the number you're looking at includes both categorical and preliminary positions for PGY1.

 

[HughOS]

Hi all thanks for your replies. I didn't think of categorical vs preliminary so that could account for some of it, although there are differences between some PGY2 and 3 years. As far as I'm aware preliminary years are just for PGY1?

Here are two examples of the residencies I was looking at

http://www.nymcatmet.org/residents.html

http://www.cornellsurgery.org/pdf/HS14-15.pdf

These are just examples but there are differences in the numbers between years. It's probably just something Im not accounting for, I'm glad to hear that the initial reason I thought of probably isn't the case.

 

[dozitgetchahi]

I think there still are a handful of pyramidal programs around.

 

[NewCanadian]

Hello all, apologies if this seems like an obvious question but this seemed like the best place to ask it.

I'm currently in medical school and interested in applying to general surgery residencies. I've been comparing a few different programs on Freida and the same question has been crossing my mind. The PGY1 years tend to have the most numbers e.g, there might be 9 residents taken in to PGY1 in a given year. But looking at the profile of the later years there are less residents on the list, even as many as half the original number. What is the reason for this? I speculated that it could be programs culling numbers after 2 years but this seems ridiculous just to arbitrarily reduce the numbers. If that is the case, what happens to these residents who have completed 2-3 years of training? But most importantly why would a program take on more PGY1s than they are prepared to fully train to the end of residency?

Thanks in advance.

It is possible programs are testing the residents. surgery is a difficult field to learn and not everyone succeeds. programs take on extra doctors knowing that some will not make it and some will leave on their own. It is also possible that some doctors need the PGY1 in surgery as a pre requisite for something else like anesthesiology.


I don't know why, but Johns Hopkins takes doctors for two years as 'preliminary'. it's on their website. but they don't explain why they do this. Some doctors get help from johns hopkins to find PGY3 to 5 elsewhere, and some stay at Johns Hopkins.

 

[TraumaLlamaMD]

Some Gen Surg programs do offer prelim PGY2 spots - either the same number as or fewer than the preliminary PGY1 spots they offer. Some may also end up filling all, some, or none of their potential preliminary spots from year to year.

I didn't hear of anywhere on the GS trail this year with a pyramidal structure, which is to say, everywhere I looked at plans to graduate every categorical intern they accept. I can't speak for the entire country as to whether every pyramidal style program has converted by now, but it's certainly not the norm at this point.

Edit: just looked at your first link, and if you explore the website a little, you see the program advertises 3 categorical spots per year, and 3 preliminary spots for PGY1 and PGY2. Mystery solved! This is why you should always go to the website itself rather than trust FREIDA.

 

[HughOS]

Thank you all for clearing that up! I was getting worried that there were a load of programs out there that purposefully took on large classes and then made a point of culling the numbers in the upper years. Glad to hear that should not be the case. Also pardon the thread title "PGY years", I only realised after I had posted.

 

[Winged Scapula]

Pyramidal programs are an ACGME violation regardless of specialty. Thus, you will not find any ACGME accredited GS programs with that structure; I cannot speak for osteopathic or military med programs.

The reason for the difference in numbers is exactly as discussed before: preliminary vs categorical residents. Prelims can either be non-designated or designated. The latter are those residents who have an advance match into a subspecialty which requires a GS intern year: this would classically be ENT, Ortho, Neurosurgery, Uro etc. These are typically for 1 year, although there are some "3+3" programs (like plastics) where the residents are listed under general surgery, although they would usually be listed as such, for more than 1 year.

Finally, there are the non-designated prelims who usually have not matched and spend 1 or 2 years trying to do so. The 2 prelim years may simply be a function of the fact that the program is only designated for X number of categoricals per year, so they may simply keep them listed as a Prelim until 3rd year (when they either have to covert to a categorical or let them go) and someone goes into the lab or the resident is still trying to get into a subspeciality, so prefers another GS year over nothing.

This is nothing to worry over.

 

[Winged Scapula]

Awww... making me sad. We're ACGME accredited. If we weren't, I wouldn't have to take that silly survey every year.

But not all are or were (for years only Mil Med programs were allowed to have pyramidal programs). Obviously that may have/has changed; thank you for clarifying that for me.

So this is kind of news to me. Two years as a prelim? I had no idea that such a thing was allowed. Is that common?

Common? Not really but it is allowed. In the last few years, the American Board of Surgery has cracked down on programs "abuse" of the Prelim system but limiting the number of prelim years and programs one can train in one and still be board eligible. Now its become more of a bastion for FMGs who have failed to match; commonly seen as a dead end but I have seen people getting a PGY3 categorical after 2 Prelim years. Ick...

 

[Winged Scapula]

I guess I can see how it might be useful (eg - IMG in a state that requires two years of post-graduate education, though filling out a license application for another state today I noticed that some now require 3 years for IMGs, also fascinating). But man, if someone isn't suitable for a particular specialty, sometimes you just gotta cut the cord and let them go. Keeping these folks an extra year isn't doing them any favors, unless the transition to the PGY3 is something that occurs frequently.

Agreed. As much as I would like to think the best of some faculty and programs, I'd venture that the crux of the matter is that some aren't necessarily invested in whats best for the resident. Surgical programs tend to be small, with lots of work. Keeping prelims on for a few years ensure that you've got warm bodies for the call schedule etc. Getting approved for additional residency positions can take years; my residency program kept adding attendings and cases, so the work load increased and increased, all without increasing the resident compliment. So you can see the attraction for more Prelims.

Some programs are very good about working to get you a spot, albeit perhaps in another program (ahem...Mayo), and others are not so much. This is why we warn about the non-designated Prelim track being a "dead end" in the Surgery forum.

 

[Raryn]

The other thing to keep in mind is attrition- general surgery has approximately a 20% attrition rate over the course of a residency, so a class of 5 categoricals will on average graduate only 4 of them. Usually, the extra slot will be replaced with a prelim from somewhere else, but people have quit or washed out of programs in later years too, so they may be down a person. (Most interestingly, 20% isn't the highest of any specialty... that honor belongs to psychiatry at something like 25%)