Transition to Fellowship

Questions

• Does this impact program ACGME accreditation?

  No, ACGME accreditation is based on compliance with ACGME requirements. ACGME mandates a set length of training, but not a particular start date.

• We already let our graduating residents leave a week early which allows them to start fellowship on July 1st. Why should we make a change?

  Many programs have made accommodations to allow senior residents to use the last 2 weeks of their training to do board prep, and for relocation purposes. However, this is not a universal policy and often mandates residents use their own personal time off or unpaid leave time to accommodate. It also decreases their residency experience. This change will allow graduating residents to focus on reviewing for the qualifying exam and the end of their residency program. This change decreases resident concerns about relocation and starting their fellowship.

• Will programs be without fellow presence due to a later start date?

  Perhaps, but only for the 1st year. After that, the graduating fellows will be on a new cycle that will provide similar attendance as before. For example, a fellow who started on July 7 would graduate on July 6 upon completion of their fellowship. Furthermore, as any gap in coverage will be known far in advance, programs will be able to plan for the transition.

• Will there be a gap in pay?

  Perhaps. This gap may be up to 6 weeks depending on the particular pay period cycles of their residency and fellowship sponsoring institutions. However, many residents will receive a final paycheck 2-4 weeks after their last day of employment according to their resident employment contract. Regardless, trainees would be able to plan far in advance. In surveys, graduating residents prefer a brief gap in pay to the gain in time to prepare for fellowship. In fact, most residents entering employment choose to take off more time than this between residency and the start of their new job resulting in an even greater gap in pay.

• What about the resident health Insurance coverage?

  There are options for residents to maintain or obtain health insurance in the gap between their graduation from residency and start of fellowship.

  • Typically, health insurance lasts through the final pay period. If their pay from residency extends past their end date (such as if their final paycheck is a week or two after their last day of work, then their health insurance should continue through that last pay period).
  • Residents also have the option to obtain their own insurance through the Consolidated Omnibus Budget Reconciliation Act (COBRA). Although this is expensive, coverage via Cobra can be obtained retroactively so the costs would only be incurred if needed during the short time period between residency and fellowship.
• What about our orientation and boot camp programs?

  Sponsoring institutions have their own approach to orientation and "boot camps." If fellowships within a single institution have different start dates this may impact the ability to provide a collective simultaneous orientation. However, the onboarding process is becoming more fluid and many institutions are utilizing virtual or remote orientation. With a larger proportion of our senior residents graduating off cycle, there are typically multiple orientation cycles occurring in the same institution to accommodate later-starting fellowships. There are other fellowships (surgical and pediatrics) with similar delayed start dates, so institutions have adjusted to that.

• How will this impact international graduates who are on a visa?

  Each year, many international graduates enter GME programs in the United States. This begins an endeavor to secure and/or maintain an appropriate visa status that will allow for clinical U.S. training. The visa application process may be complex, and it is important to know regulations, requirements, and timelines. Common issues that foreign national physicians may encounter during the visa application process and general solutions are listed on the ECFMG website.

  Since many U.S. surgical fellowship programs now begin on August 1, rather than the traditional July 1 start date, there is an approximately 30-day gap between the completion of a residency and entry into fellowship training. This has a direct impact on ECFMG-sponsored surgical trainees as J-1 regulations require full-time participation in a program of graduate medical education (GME). There is currently no regulatory provision to allow ECFMG to extend sponsorship to cover a 30-day gap between training programs. To address this issue, the U.S. Department of State (DoS) has instructed ECFMG that J-1 surgical trainees can formally seek to maintain J-1 status during the gap between training programs through submission of a formal “sponsorship authorization (SA)” request.

  Each sponsoring institution may have their own approach to visa situations and incoming fellows with visa concerns should proactively reach out to their fellowship programs to learn what they need to do for that sponsoring institution. Some sponsoring institutions have access to immigration lawyers to help incoming fellows if this is needed.

• How do I get answers to other concerns?

  CREOG recognizes that there may be other concerns that have not been addressed or fully vetted. In an effort to promote a universal approach please raise concerns with CREOG leadership through correspondence addressed to Darya Valantsevich, CREOG Program Manager, ACOG, at dvalantsevich@acog.org. In 2020 during the COVID-19 pandemic, many fellowships adjusted to the delayed qualifying exam, and found it to be more feasible than expected.