Why are there so few transitional years available?

[Terpskins99]

Sorry if this has been addressed earlier (did a quick search but didn't a suitable answer).

I mean, what is so difficult about creating additional transitional years to accomodate all the categorical matches? Isn't it essentially a prelim year with a lot of electives? Do most of the elective services simply not require that many interns and hence why so few of them are made available?

Or are all of the US hospitals colluding to force as many categorical folk to man as many medicine floors/call months as possible?

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[Faebinder]

Sorry if this has been addressed earlier (did a quick search but didn't a suitable answer).

I mean, what is so difficult about creating additional transitional years to accomodate all the categorical matches? Isn't it essentially a prelim year with a lot of electives? Do most of the elective services simply not require that many interns and hence why so few of them are made available?

Or are all of the US hospitals colluding to force as many categorical folk to man as many medicine floors/call months as possible?

http://www.i2i.org/main/article.php?article_id=1299

In 1996, Congress passed the Balance Budget Act, establishing caps on the number of physicians in training (residents) that can be paid for by Medicare. These caps seriously discourage teaching hospitals from increasing the number of resident physicians being trained. No new residency programs are being created, and some programs are being closed because Medicare does not pay enough to cover residents and faculty salaries, benefits, and overhead expenses related to training programs.

You can thank misses clinton for proposing that act.

 

[Winged Scapula]

In addition to the above legal restrictions, many of the subspecialty boards have rotation requirements that a TY does not meet.

 

[Terpskins99]

Thanks for the quick reply guys.

In addition to the above legal restrictions, many of the subspecialty boards have rotation requirements that a TY does not meet.

I'm not entirely following this. How do subspeciality boards have anything to do with available transitional years? Do those subspecialty boards require a certain number of on-call medicine months as a PGY-1 that only a prelim year would have access to?

Also, with regard to the Balanced Budget Act... so hospitals have a cap on the total number of PGY-1 years (transitional/prelim/intern) and therefore they would rather have more prelim years available rather than transitional years because prelim people work more medicine floors?

 

[Winged Scapula]

I'm not entirely following this. How do subspeciality boards have anything to do with available transitional years? Do those subspecialty boards require a certain number of on-call medicine months as a PGY-1 that only a prelim year would have access to?

Yes. Residencies have rotation requirements that are clearly specified in order to meet the requirements of the specific board for board eligibility. A residency would be irresponsible if they graduated you without board eligibility.

Obviously, TYs are acceptable to *some* boards, but they would not be for others (surgery is the most obvious example). Therefore, if you are contemplating doing an IM residency, unless you are specifically told that you can complete your first year with a TY, you would be well advised to check the ABIM (or whatever specialty) for their requirements and make sure that your TY contains the appropriate amount of rotations. The boards will very clearly state the number of months of such rotations, where they have to be done (ie, the primary teaching hospital), the number of electives you can do, etc.

Thus, for many specialties, TY does not satisfy the requirements and there is no need to increase the number of positions when there are Prelim positions which do meet the requirements. The boards do not directly influence the number of TY positions but rather there is a recognition that not all boards accept them and that we need more Prelims than TYs.