Will transitional year prevent me from doing an IM fellowship?

[rodester86]

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So, in short, here's my question: What is the maximum PGY after which a program no long receives funding for having that resident in their program? Here is why I'm asking.

With the match approaching, I've been kinda looking at worst case scenarios and seeing my options. My goal is to do an IM program and eventually do a subspecialty of some kind. Let's say I don't match and I'm forced to scramble into a transitional year for whatever reason. I heard from a PD that if I do a transitional year, whether it is osteopathic or allopathic, and then start an IM residency after that (making me a PGY-4 my last year of residency), programs won't want to take me as a fellow because after a certain number of years being a resident, programs do not get reimbursed.

In other words, the PD told me that if I do a transitional year, then three years of IM, and then a three year fellowship, after the second year of fellowship the program no longer receives funding to have me as a resident. Anybody know if this is true or false?

 

[gutonc]

So, in short, here's my question: What is the maximum PGY after which a program no long receives funding for having that resident in their program? Here is why I'm asking.

With the match approaching, I've been kinda looking at worst case scenarios and seeing my options. My goal is to do an IM program and eventually do a subspecialty of some kind. Let's say I don't match and I'm forced to scramble into a transitional year for whatever reason. I heard from a PD that if I do a transitional year, whether it is osteopathic or allopathic, and then start an IM residency after that (making me a PGY-4 my last year of residency), programs won't want to take me as a fellow because after a certain number of years being a resident, programs do not get reimbursed.

In other words, the PD told me that if I do a transitional year, then three years of IM, and then a three year fellowship, after the second year of fellowship the program no longer receives funding to have me as a resident. Anybody know if this is true or false?

The PD is very slightly right, but mostly wrong. There's about 30 or 40 threads here (in IM and Gen Res) on the topic of the funding limit and it's worth a search as your question has been answered many times over.

 

[doobiedoobah]

So, in short, here's my question: What is the maximum PGY after which a program no long receives funding for having that resident in their program? Here is why I'm asking.

With the match approaching, I've been kinda looking at worst case scenarios and seeing my options. My goal is to do an IM program and eventually do a subspecialty of some kind. Let's say I don't match and I'm forced to scramble into a transitional year for whatever reason. I heard from a PD that if I do a transitional year, whether it is osteopathic or allopathic, and then start an IM residency after that (making me a PGY-4 my last year of residency), programs won't want to take me as a fellow because after a certain number of years being a resident, programs do not get reimbursed.

In other words, the PD told me that if I do a transitional year, then three years of IM, and then a three year fellowship, after the second year of fellowship the program no longer receives funding to have me as a resident. Anybody know if this is true or false?

Wouldn't you be able to accept an open PGY2 spot after your transitional year, rather than having to repeat an intern year?

 

[darkelven29]

You can only do that if you do prelim medicine right?

 

[Textbookversion]

So, in short, here's my question: What is the maximum PGY after which a program no long receives funding for having that resident in their program? Here is why I'm asking.

With the match approaching, I've been kinda looking at worst case scenarios and seeing my options. My goal is to do an IM program and eventually do a subspecialty of some kind. Let's say I don't match and I'm forced to scramble into a transitional year for whatever reason. I heard from a PD that if I do a transitional year, whether it is osteopathic or allopathic, and then start an IM residency after that (making me a PGY-4 my last year of residency), programs won't want to take me as a fellow because after a certain number of years being a resident, programs do not get reimbursed.

In other words, the PD told me that if I do a transitional year, then three years of IM, and then a three year fellowship, after the second year of fellowship the program no longer receives funding to have me as a resident. Anybody know if this is true or false?

SOAP into prelim medicine. Saves a year of your life.

 

[rodester86]

Assuming I do a prelim year and do PGY-2 at a different program, are more programs likely to accept a prelim medicine year vs a transitional year so that I wouldn't have to repeat intern year?

 

[gutonc]

Assuming I do a prelim year and do PGY-2 at a different program, are more programs likely to accept a prelim medicine year vs a transitional year so that I wouldn't have to repeat intern year?

Yes. Although FWIW, it's quite common when switching programs, even having completed a full year in an IM program elsewhere, to be placed on a somewhat probationary status at first and have to spend some time (up to a year) as an intern again. So I wouldn't get too hung up on this.

 

[rodester86]

So I read the AAMC brochure describing medicare payments for GME. I know that if I do a transitional year, they calculate the initial residency period (IRP) by whatever specialty I choose for my PGY-2 year. So if I start IM as a PGY-2, my IRP is going to be 3 years, and therefore I'll be counted as 1.0 FTE for 3 years.

My question is, if I start a 3 year fellowship as a PGY-5, will I be counted as .5 FTE for those three years? If so, there really wouldn't be any difference between me starting a fellowship as a PGY-4 or a PGY-5 because in both situations my IRP will have already been over and I'd be counted .5 FTE anyways?

I hope that isn't confusing. I guess I'm not seeing how it affects a residency's funding if I do a transitional year because from what I can tell, a fellow gets counted as a .5 FTE regardless of transitional year or not, assuming their first residency was IM and not something longer like surgery.

 

[stronghold]

I am not 100% sure, but think the GME funding restriction depends on first residency. Just residency and it has nothing to do with fellowship. In other words, fellowship funding is not related to residency funding.

 

[gutonc]

So I read the AAMC brochure describing medicare payments for GME. I know that if I do a transitional year, they calculate the initial residency period (IRP) by whatever specialty I choose for my PGY-2 year. So if I start IM as a PGY-2, my IRP is going to be 3 years, and therefore I'll be counted as 1.0 FTE for 3 years.

My question is, if I start a 3 year fellowship as a PGY-5, will I be counted as .5 FTE for those three years? If so, there really wouldn't be any difference between me starting a fellowship as a PGY-4 or a PGY-5 because in both situations my IRP will have already been over and I'd be counted .5 FTE anyways?

I hope that isn't confusing. I guess I'm not seeing how it affects a residency's funding if I do a transitional year because from what I can tell, a fellow gets counted as a .5 FTE regardless of transitional year or not, assuming their first residency was IM and not something longer like surgery.

Nobody will care about your funding in the fellowship setting because everybody at that point has the same amount of funding. And you have the numbers wrong but whatever, that's been covered a million other places in this forum and isn't totally germane to your question.

The issue is that, although your funding clock doesn't start until you enter a "terminal" program (categorical or advanced), all of the previous training you did counts against that time. So if you do a TY (I assume you mean TRI, but again...whatever) and then match IM the following year, you will have to complete a 3 year residency but will only have 2 years of funding left. This is not that huge of a deal for most applicants and most programs. But for borderline applicants, it may be a problem.