Is the Intern Year for PMR Going Away?

[Ready 4 Med]

I heard a rumor that PMR is doing away with separate prelim years and going categorical.

Is there any truth to this? Any evidence?

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[Snivellus]

There are categorical programs as well as programs that require a prelim year.

 

[Ready 4 Med]

Indeed I am familiar with such.

I heard a separate rumor that all of the advanced programs were converting to categorical. This is apparently untrue unless this forum is simply not used by anyone who would know.

Thanks.

 

[RangerBob]

I haven't heard anything about this. To my knowledge our program is remaining advanced only. But there does seem to be a slight push (both here and nationally) towards PM&R programs becoming categorical (or linking a prelim year with matching into the advanced program).

 

[Ready 4 Med]

Thank you, RangerBob. I appreciate your feedback.

It seems like neurology is at least trying to move toward tied-in prelim years if not altogether categorical.

Gas is slowly doing away with advanced programs.

Radiology and Derm are clutching to having other specialties train their people for a year.

I wonder if we are eventually going to see a world without prelims except for the surgical ones that are mostly labor-only.

 

[lejeunesage]

I've heard no such thing. That, by itself, means nothing... but it seems very implausible.

 

[runfastnow]

I've heard rumblings from a few programs that they are trying to at least convert to some categorical spots if they are currently a 100% advanced program. The reasoning I've gotten is that a majority of the most competitive applicants, and the applicant pool in general, are looking for categorical spots at programs and the programs have been handicapped on a good number of applicants they want to interview/recruit/match.

I don't know about a complete transformation to categorical by everyone, everywhere any time soon though.

 

[DubVille]

I've never heard anything about this at my program FWIW.

 

[Ready 4 Med]

Thanks for the replies.

In looking at the overall trends, I have a suspicion that the concept of the preliminary year is going to change. Transitional programs have been declining over the years, I suspect partly because the ACGME now requires TY residents to document "milestone" achievements which is lame considering that most of these places are just looking for some free and easy labor for a year.

Furthermore, internal medicine programs--faced with their own evolving patient caps and hour restrictions--have an incentive to concentrate their funds on people actually interested in a career in IM.

I suppose that the surgery prelims will always be out there, but that option for those going into PMR or the ROAD fields sounds terrible.

 

[ED50]

I'm sure it's a lot of work and investment to only get one year of work out of someone. It's already tough for PMR people since we are on average less competitive then the ROAD people.

Regarding PMR places wanting to switch to categorical it's not as simple as that... stanford, harvard, columbia etc are good PMR programs but great IM programs. It's a tough sell to reserve some of those spots for PMR. I personally think stanford for example will never be categorical. No evidence, just thoughts...

 

[j4pac]

I'm sure it's a lot of work and investment to only get one year of work out of someone. It's already tough for PMR people since we are on average less competitive then the ROAD people.

Regarding PMR places wanting to switch to categorical it's not as simple as that... stanford, harvard, columbia etc are good PMR programs but great IM programs. It's a tough sell to reserve some of those spots for PMR. I personally think stanford for example will never be categorical. No evidence, just thoughts...

Very good point. Hopkins is another example. Elite of the elite medicine...average PM&R, from what I hear. It's also a matter of only a limited number of spots. Mayo reserves 2 spots for PGY-1 PM&R residents. It would be difficult to get all 8 because of space availability.

 

[TXPMR]

Keep in mind that "categorical" doesn't necessarily mean "PM&R interns shipped off to that insitution's internal medicine program for a year." For most programs categorical means that interns do a "PM&R transitional year" rotating through orthopaedics, neurology, general surgery, PM&R, among others in addition to rotating through internal medicine. The burden of the extra PM&R categorical spots is on the PM&R departments not the IM departments. It's the PM&R programs that would need to come up with the funding for the new categorical spots. That's why advanced programs like the concept of prelim years to begin with: someone else funds (and trains) your interns for a year so they don't have to.

 

[Ready 4 Med]

Residency programs get the money from CMS via the hospitals, so my view was that they would rather draw the funding in and have better oversight of it.

My understanding of the system is that the money at an institution is generally paid out for resident service to a hospital, so the money would still be ultimately held by the hospital--it would just pay the resident through a different program.

I guess I just fell like actually integrating a clinical year over 4 years might be a little bit more comprehensive.