Unprecedented Residency Situation, Need Advice Please

[Medical Anomaly]

Hello All,

Thanks for reading this post. Any and all advice is appreciated.

I am currently a PGY-2 at an ACGME accredited family medicine residency program.
I graduated several years ago from medical school and did 1.5 years of ACGME accredited family medicine residency at a different program, before leaving for a year due to burn-out.

I had an opportunity to return after a year to a different program and i took it, starting as a PGY-1. After a year at this program, I am feeling as though staying all 3 years in this program would not be particularly useful, as my intention is only to practice outpatient medicine. I did not complete my PGY-2 year at the first program, but I did complete PGY-1 and all of its requirements and I would like to know if it is possible to apply the year of my previous training to my current training. ACGME only states that you need a total of 3 years and I cannot find anything that either confirms or negates the ability to combine total training time.

My situation is a bit unprecedented, as I left one specialty and returned to the same specialty. I have seen people leave one specialty for another, ex. family medicine --> psychiatry, in which case their PGY-1 year was counted.

Does anyone have any advice on this? Is it even possible? If so, how would I go about the process?

Thanks so much in advance!

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[Dave1980]

you are lucky to have that spot. finish the program.

 

[DrMetal]

would not be particularly useful, as my intention is only to practice outpatient medicine.

Uhhh, yes it would be useful. To practice outpatient medicine, you need to complete a residency. FM is a short residency, buckle down and finish it.

 

[Raryn]

Hello All,

Thanks for reading this post. Any and all advice is appreciated.

I am currently a PGY-2 at an ACGME accredited family medicine residency program.
I graduated several years ago from medical school and did 1.5 years of ACGME accredited family medicine residency at a different program, before leaving for a year due to burn-out.

I had an opportunity to return after a year to a different program and i took it, starting as a PGY-1. After a year at this program, I am feeling as though staying all 3 years in this program would not be particularly useful, as my intention is only to practice outpatient medicine. I did not complete my PGY-2 year at the first program, but I did complete PGY-1 and all of its requirements and I would like to know if it is possible to apply the year of my previous training to my current training. ACGME only states that you need a total of 3 years and I cannot find anything that either confirms or negates the ability to combine total training time.

My situation is a bit unprecedented, as I left one specialty and returned to the same specialty. I have seen people leave one specialty for another, ex. family medicine --> psychiatry, in which case their PGY-1 year was counted.

Does anyone have any advice on this? Is it even possible? If so, how would I go about the process?

Thanks so much in advance!

Without completing a full residency program, you will not be board eligible. Per the ABFM, you must have "satisfactory completion of three years of training (defined as a full 36 calendar months with 12 months in each of the PGY-1, PGY-2, and PGY-3 years) in an Accreditation Council for Graduate Medical Education (ACGME)-accredited Family Medicine residency program."

The time to address this was before you started the current program - they could have given you some number of months of credit for your prior training - but this is done at the express request of your new program director and only if they feel it's appropriate. Since they didn't, it's almost certainly too late - if you want to be a board eligible/board certified FM physician, you must finish out through the end of PGY3.

Now, that said - you could theoretically just leave after your current PGY2 year and be eligible to be licensed in every state except I think South Dakota (which requires completion of a full residency). You could then just get a job, as any licensed physician can. But your employment prospects as someone who is not BC/BE would be extremely limited. Most hospitals won't credential you, most insurances won't put you on their panels, and most employers will laugh at you. Might be able to work seeing Medicare only (but not Medicare advantage plans) or work in a very rural area - or just finish your training.

 

[rokshana]

Hello All,

Thanks for reading this post. Any and all advice is appreciated.

I am currently a PGY-2 at an ACGME accredited family medicine residency program.
I graduated several years ago from medical school and did 1.5 years of ACGME accredited family medicine residency at a different program, before leaving for a year due to burn-out.

I had an opportunity to return after a year to a different program and i took it, starting as a PGY-1. After a year at this program, I am feeling as though staying all 3 years in this program would not be particularly useful, as my intention is only to practice outpatient medicine. I did not complete my PGY-2 year at the first program, but I did complete PGY-1 and all of its requirements and I would like to know if it is possible to apply the year of my previous training to my current training. ACGME only states that you need a total of 3 years and I cannot find anything that either confirms or negates the ability to combine total training time.

My situation is a bit unprecedented, as I left one specialty and returned to the same specialty. I have seen people leave one specialty for another, ex. family medicine --> psychiatry, in which case their PGY-1 year was counted.

Does anyone have any advice on this? Is it even possible? If so, how would I go about the process?

Thanks so much in advance!

If you can’t do 3yrs training...what makes you think you can work as an attending/full fledged physician form20-30 years? The real world is actually harder than residency.

 

[GoSpursGo]

The time to address this was before you started the current program - they could have given you some number of months of credit for your prior training - but this is done at the express request of your new program director and only if they feel it's appropriate. Since they didn't, it's almost certainly too late - if you want to be a board eligible/board certified FM physician, you must finish out through the end of PGY3.

Just to be clear, if you scroll down a little further on that site that you linked they spell that out explicitly that you need to do this before starting at your new program:

However, we recognize that circumstances may occur that lead you to change specialty and/or location of residency training. In these cases, your residency program must notify ABFM that you are entering training with advanced placement credit, using the RTM system. This must be done before you start at the new program in order to count toward your minimum requirements for board eligibility. If the necessary information is not submitted before the start of your training at a new program, this could extend the duration of your training.

Furthermore, the last step in becoming board-certified involves your residency verifying that you successfully completed 3 years. They can't say that if you didn't do a PGY-3 year.

I don't know you and your circumstances, so maybe you did need to take time off for burnout. But it's time to recognize that actions have consequences, and in this case that means you're in training for a longer period of time. There is no shortcut here.

 

[Apollyon]

And, if I recall, the last 24 months of FM have to be at the same place. It's not like you can cobble together some time here and there to get 36 months.

 

[smq123]

And, if I recall, the last 24 months of FM have to be at the same place. It's not like you can cobble together some time here and there to get 36 months.

Yes, this is correct. As a big part of FM/primary care is continuity of care, you need your last 2 years to be at the same program.

 

[Medical Anomaly]

For those who took the time to reply with a non-derogatory response, thank you. Was very helpful. A lot of assumptions on the other posts- disregarded.

 

[Mass Effect]

Hello All,

Thanks for reading this post. Any and all advice is appreciated.

I am currently a PGY-2 at an ACGME accredited family medicine residency program.
I graduated several years ago from medical school and did 1.5 years of ACGME accredited family medicine residency at a different program, before leaving for a year due to burn-out.

I had an opportunity to return after a year to a different program and i took it, starting as a PGY-1. After a year at this program, I am feeling as though staying all 3 years in this program would not be particularly useful, as my intention is only to practice outpatient medicine. I did not complete my PGY-2 year at the first program, but I did complete PGY-1 and all of its requirements and I would like to know if it is possible to apply the year of my previous training to my current training. ACGME only states that you need a total of 3 years and I cannot find anything that either confirms or negates the ability to combine total training time.

My situation is a bit unprecedented, as I left one specialty and returned to the same specialty. I have seen people leave one specialty for another, ex. family medicine --> psychiatry, in which case their PGY-1 year was counted.

Does anyone have any advice on this? Is it even possible? If so, how would I go about the process?

Thanks so much in advance!

This isn't unprecedented. You just don't know of a case, but doesn't mean there aren't cases. Obviously, the ABFM has seen such cases which is why they have the rules they do. I'll also add that if you don't recognize the holes in training at two different programs for one year each, you're really not ready to go solo. You don't know what you don't know and in your case, having completed two intern years, but really no actual resident years, this is particularly significant. Stay and finish.

 

[250orbust]

I would say Finish the program dude and Grind through.So many ppl would love to bewhere you are. Muster some testicular fortitude and mine some inner chi, and run to the finish line...

But burnout is real so weigh your options.

 

[Giovanotto]

For those who took the time to reply with a non-derogatory response, thank you. Was very helpful. A lot of assumptions on the other posts- disregarded.

Yeah, I don't know how anyone can stand the general residency portion of this forum. It's the same 2-3 users bandwagoning every thread. Good luck man, finish strong.

 

[deleted480308]

Hello All,

Thanks for reading this post. Any and all advice is appreciated.

I am currently a PGY-2 at an ACGME accredited family medicine residency program.
I graduated several years ago from medical school and did 1.5 years of ACGME accredited family medicine residency at a different program, before leaving for a year due to burn-out.

I had an opportunity to return after a year to a different program and i took it, starting as a PGY-1. After a year at this program, I am feeling as though staying all 3 years in this program would not be particularly useful, as my intention is only to practice outpatient medicine. I did not complete my PGY-2 year at the first program, but I did complete PGY-1 and all of its requirements and I would like to know if it is possible to apply the year of my previous training to my current training. ACGME only states that you need a total of 3 years and I cannot find anything that either confirms or negates the ability to combine total training time.

My situation is a bit unprecedented, as I left one specialty and returned to the same specialty. I have seen people leave one specialty for another, ex. family medicine --> psychiatry, in which case their PGY-1 year was counted.

Does anyone have any advice on this? Is it even possible? If so, how would I go about the process?

Thanks so much in advance!

Intern responsibilities are different than pgy2 responsibilities are different than pgy3 responsibilities. That is true across all specialties

if you haven’t done a year of pgy3 responsibilities (because fm is a 3yr specialty) you aren’t ready to call yourself a fully trained doctor. I get the appeal to Simplify this to years served but this isn’t a prison sentence it’s a progressive training program

you need to Tough it out and get trained so you can take good care of your patients

 

[cirruslife82]

Finish the program. As someone who left their FM program at 21 months due to severe burnout, I wish I had that board certification every day. I took a break from medicine for a while, and now I am licensed and working as doc in a concierge practice doing something extremely focused and I do enjoy it, but every day is a reminder that if this clinic closes down or the economy goes south, I'll be left with very limited options.

 

[Raryn]

Yeah, I don't know how anyone can stand the general residency portion of this forum. It's the same 2-3 users bandwagoning every thread. Good luck man, finish strong.

We can stop giving advice if you want.

 

[gutonc]

Yeah, I don't know how anyone can stand the general residency portion of this forum. It's the same 2-3 users bandwagoning every thread. Good luck man, finish strong.

If you want a place with the blind leading the willfully ignorant, there’s Reddit.

 

[VA Hopeful Dr]

We can stop giving advice if you want.

I seem to recall a thread a few years ago where some of the SDN admin was concerned at the lack of attending participation in much of the forums...

 

[Raryn]

If you want a place with the blind leading the willfully ignorant, there’s Reddit.

The /r/residency subreddit is basically 99.9% posts of people bitching on midlevels. No real advice.

 

[Desired Member]

If you can’t do 3yrs training...what makes you think you can work as an attending/full fledged physician form20-30 years? The real world is actually harder than residency.

While respectfully acknowledging that you appear to be an attending with more experience than me, I question this statement.
As a resident, you have little to no control over how many days per week you work and how many hours you work. You have little to no control over the patient populations you work with. You have little to no control over how patients are managed. You may have matched into a program away from family and friends. While acknowledging that being an attending has its own unique difficulties, residency has unique difficulties that may be very significant for the OP.

 

[BicepsTriceps]

While respectfully acknowledging that you appear to be an attending with more experience than me, I question this statement.
As a resident, you have little to no control over how many days per week you work and how many hours you work. You have little to no control over the patient populations you work with. You have little to no control over how patients are managed. You may have matched into a program away from family and friends. While acknowledging that being an attending has its own unique difficulties, residency has unique difficulties that may be very significant for the OP.

True!
I'm an attending now. Struggled a bit in residency but having a blast now. I enjoy my work and my time off. It's easier to actually do your work and be happy when you're working on your own terms.

 

[rokshana]

While respectfully acknowledging that you appear to be an attending with more experience than me, I question this statement.
As a resident, you have little to no control over how many days per week you work and how many hours you work. You have little to no control over the patient populations you work with. You have little to no control over how patients are managed. You may have matched into a program away from family and friends. While acknowledging that being an attending has its own unique difficulties, residency has unique difficulties that may be very significant for the OP.

Lol...and you think that it’s any different as an attending? Respectfully, you haven’t been a practicing physician...the rigor it takes to go out and practice is no less than being a resident.
The problems are different...there are no caps on you if you are a hospitalist and the push to see more patients, discharge them in the shortest LOS is not something the problem of the resident. If you are outpt, then you aren’t limited to 8 pt in your clinic...you are easily seeing 20-25...
Your salary is not set in many places and so if you don’t keep up with production, you will make less...and sometimes have to give money back.
You will work uncompensated for many things...and you won’t have a choice about it.
Short of doing a dpc or solo practice...you don’t have as much freedom as you would think.
Never said residency doesn’t have its set of unique issues...but they are just the tip of the iceberg...and if you cant handle just 3 years of residency, it’s going to be hard to handle 20-30 years of practice.
And the 3 years of residency is really short...think of the pgy 8 and 9s out there...
Notice it’s the attendings on this forum that agree with me...it’s the resident that think that residency is the hardest thing ever...and it is...until you go out to practice.

 

[Dr.LeoSpaceman]

The /r/residency subreddit is basically 99.9% posts of people bitching on midlevels. No real advice.

Admittedly a tangent, but I don't get this. Things must be different outside the surgical subspecialties because APPs made inpatient services infinitely better. When you're a junior, it means you get the the OR more. When you're a senior, it means there is someone with some level of institutional knowledge to make sure intern-of-the-month covers the minutiae that will otherwise generate nastygrams.

 

[Raryn]

Admittedly a tangent, but I don't get this. Things must be different outside the surgical subspecialties because APPs made inpatient services infinitely better. When you're a junior, it means you get the the OR more. When you're a senior, it means there is someone with some level of institutional knowledge to make sure intern-of-the-month covers the minutiae that will otherwise generate nastygrams.

Echo chambers gotta echo. They're convinced that the midlevels will take all our jerbs and they'll be unemployed after N years of training with massive debt.

Meanwhile the few specialties I know where people have trouble finding work (rad onc, nephrology, etc) aren't exactly overrun with midlevels, and most docs are just fine regardless. Hell, due to weird consults, I probably am *busier* due to the larger variety of independent NPs in my area.

 

[Medstudent9]

As sb247 said, you would have had to do this before starting. You could have argued to get credit for intern months to replace intern requirements at your second residency. Having extra intern months in your belt now doesn’t shorten your residency because they don’t replace second or third year months.

It’s like arguing taking algebra twice should get you out of calculus.

 

[Desired Member]

Lol...and you think that it’s any different as an attending? Respectfully, you haven’t been a practicing physician...the rigor it takes to go out and practice is no less than being a resident.
The problems are different...there are no caps on you if you are a hospitalist and the push to see more patients, discharge them in the shortest LOS is not something the problem of the resident. If you are outpt, then you aren’t limited to 8 pt in your clinic...you are easily seeing 20-25...
Your salary is not set in many places and so if you don’t keep up with production, you will make less...and sometimes have to give money back.
You will work uncompensated for many things...and you won’t have a choice about it.
Short of doing a dpc or solo practice...you don’t have as much freedom as you would think.
Never said residency doesn’t have its set of unique issues...but they are just the tip of the iceberg...and if you cant handle just 3 years of residency, it’s going to be hard to handle 20-30 years of practice.
And the 3 years of residency is really short...think of the pgy 8 and 9s out there...
Notice it’s the attendings on this forum that agree with me...it’s the resident that think that residency is the hardest thing ever...and it is...until you go out to practice.

Thanks for sharing your point of view. I'm not an independent physician yet, and I'm not in primary care. From my own experience, having to live hours away from your significant other and family for several years can be quite sad and negatively impact quality of life. I did not mean to insinuate that attendings have an easy life.

 

[Splenda88]

Just finish the damn thing man... We know residency is a soul sucker but once you start, you have no other choice than to finish.

You will certain get job offers with a full license, but you want to have more doors open.

 

[Splenda88]

Lol...and you think that it’s any different as an attending? Respectfully, you haven’t been a practicing physician...the rigor it takes to go out and practice is no less than being a resident.
The problems are different...there are no caps on you if you are a hospitalist and the push to see more patients, discharge them in the shortest LOS is not something the problem of the resident. If you are outpt, then you aren’t limited to 8 pt in your clinic...you are easily seeing 20-25...
Your salary is not set in many places and so if you don’t keep up with production, you will make less...and sometimes have to give money back.
You will work uncompensated for many things...and you won’t have a choice about it.
Short of doing a dpc or solo practice...you don’t have as much freedom as you would think.
Never said residency doesn’t have its set of unique issues...but they are just the tip of the iceberg...and if you cant handle just 3 years of residency, it’s going to be hard to handle 20-30 years of practice.
And the 3 years of residency is really short...think of the pgy 8 and 9s out there...
Notice it’s the attendings on this forum that agree with me...it’s the resident that think that residency is the hardest thing ever...and it is...until you go out to practice.

I guess the challenges will never end, but one can choose to work 24-30 hrs/wk as an attending. I wonder how people in surgery do. I have been working close 80 hrs/wk in the past 3 months and I am already losing my mind.

 

[Dr.LeoSpaceman]

I wonder how people in surgery do.

It can be done, you just have to make the requisite choices/tradeoffs. Too often I think people entering medicine or in medical school figure "balance" means being in the 95th percentile for salary in the specialty while being in the 5th percentile for hours and living in the most preferred geographic location. Something's usually gotta give.