What Every Dermatology Applicant Should Know: The Perils of PGY1 Preliminary Year in Internal Medicine, Pediatrics, and Family Medicine (If You Don’t Match Concurrently for a PGY2 Advanced Dermatology Residency Position)

Close reading of AAMC’s 2013 “Medicare Payments for Graduate Medical Education:
What Every Medical Student, Resident, and Advisor Needs to Know,” (available at: http://www.uth.tmc.edu/med/administration/edu_programs/Assets/documents/gme/medicare_payments_gme.pdf ) indicates that great care is potentially needed by dermatology residency applicants in selecting their PGY1 year if they fail to match into categorical dermatology (4 year program that includes internship) or advanced dermatology (3 year program that begins in the PGY2 year). Dermatology applicants who fail to initially match into dermatology residency but match for preliminary PGY1 residency positions in any three year residency (internal medicine, family medicine, pediatrics, etc) are determined to have an initial residency period (IRP) of only three years. This cannot be changed. Even if the future dermatology applicant leaves their program following completion of the PGY1 preliminary year and take a nonaccredited clinical dermatology fellowship in an attempt to improve their application competitiveness, they only have 2 years left of Medicare Graduate Medical Education funding available due to the initial IRP determination. This could be a factor when they reapply for a dermatology residency if Medicare residency funding issues are considered. In this type of scenario, it is much better for the PGY1 year to be transitional (IRP not determined until PGY2 program started) or a preliminary PGY1 position in another specialty such as general surgery that has a longer IRP, because the IRP for general surgery is 5 years. A 5 year IRP designation would allow for complete dermatology residency funding should a position be obtained in the future and general surgical training did not extend beyond the PGY2 year.

If a dermatology applicant matches for both the PGY1 and an advanced dermatology position during the same NRMP, it does not matter if the PGY1 year was transitional or preliminary. All three years of dermatology residency will be covered and funding is not an issue.