Off Cycle And Need Funding: Can I Get A Fellowship I Want?

Hello Dr. Julius,

I hope all is well. Thanks very much for creating this site. It shares a lot

of very valuable, helpful information that is difficult to find elsewhere.

I have a few questions I was hoping you could answer for me.

I matched into a categorical Internal Medicine residency last year, during

which I realized I wanted to pursue radiology because it better aligns

with my interests, strengths, and personality. I discussed this with my

program director, who fully supported my decision. I completed my

internship a few months ago and left the program on good terms, receiving

strong references. I am now involved in radiology research at an

academic medical center. I recently became aware of an unexpected PGY-2/R1

residency opening for this year, which would start shortly, as

an off-cycle position.

1. Does completing an off-cycle residency limit fellowship opportunities?

Would fellowship directors be less interested in a candidate if he or

she finishes residency training after July, thus complicating the schedule

for incorporating a new fellow into the schedule at later point?

2. Since I matched into a 3-year Internal Medicine program, do the

remaining two years of my funding follow me to the next residency?

3. Is it possible to have more than one source of funding for a single

resident? For example, could one theoretically have funding remaining from

the first match and then also have partial funding through the military

or a foreign government? I’ve noticed there are positions on ERAS

dedicated for external financing through the military or international

sponsors. I am just curious if sources of funding can be combined.

Thank you very much for your time! I appreciate it.

Best Regards,

The Off-Cycle Resident

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Answers:

You posed some interesting questions about particular issues that residents of mine have encountered in the past. So, I can help you based on my experiences.

Off-Cycle Issues

Let’s start with the problem of being off-cycle. Yes, most program directors would rather have a resident that is on-cycle. But, life happens, and it does not always work. For personal reasons, we had one resident who started residency three months later than the typical July 1 beginning. In his case, we were able to get a dispensation from the ABR to allow him to start his fellowship on time. On the other hand, if you are way off-cycle, you may not be allowed to do so. In that situation, it would make it a bit more challenging to find a fellowship position that can conform to the timing that you need.

That said, since the market for fellowship now favors the applicants, many programs would be willing to create a spot that allows you to start a fellowship soon after finishing. Right now, I know of many 6-month fellowship positions that would be happy to take an off-cycle resident at almost any time. It might be a bit more difficult if you were interested in a more competitive fellowship like interventional radiology.

Funding Issues

In terms of the funding for residency, typically, the government bases it on the amount of time completed in residency, not the expected time in a residency. So, if you only have completed a year or two of a three-year categorical spot, you will still have as many options as those that did a one or two-year preliminary program.

For those that have completed more than two years of a government-funded residency, you can also get foreign or military funding to supplement the rest, if available. And finally, some spots I know are entirely privately funded, so it does not matter how many years have been supported by Medicare.

Most programs, however, will utilize the government Medicare program for funding. So, if you are in a residency and have used up government Medicare resources, the program can rely on other sources of financing afterward, if your residency can find it and if it is available.

Thanks for the great questions,

Barry Julius, MD

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