Blog Post Focus: An Abnormal Start Behind The Rest of the Cohort
This post focus is on a late start to residency. That is, starting later than the typical ACGME schedule. Starting later than normal is a unique situation, but one that has been experienced by other residents. It likely will affect residency completion time. For those planning on fellowships, it can affect fellowship planning, but may not preclude it.
What is a Late Start in Residency?
A late start to residency would be signing a contract with a start date after the regular start of residency. In the US this is July 1 of any year. So, a late start would be signing a contract with start date any time after July 1.
Note, if you signed the contract to start on July 1, but had some issue whereupon you missed some days then that is different from a late start. Your program may record those days at its discretion. Perhaps you will have to put vacation time or personal days or sick days in place of those days you missed, but it is not a late start.
Consequences of a Late Start to Residency
The consequences of a late start to residency depend on how late of a start one had to residency and on the governing body of your specialty. Ultimately, these consequences are determined by your residency program and your governing body.
A contract beginning one week later than the rest of your cohort may essentially be inconsequential if your program and governing body work together from the beginning. On the other hand, signing a contract to begin a month later than usual may be more consequential.
Potential consequences include compromised fellowship planning, finishing residency after your cohort, or sacrificing personal leave.
Examples of Consequences of a Late Start
Slightly Delayed Start, Slightly Delayed Finish
Example 1, starting a week later. If one starts a week later than typical, one may simply finish a week later than typical. One may use all their personal leave in this time. Their training is simply offset.
Delayed Start—Typical Finish
Example 2, starting several weeks later. Perhaps you start several weeks later than your cohort, but you still desire to finish at the same time as your cohort. In this case, after discussion with your governing body, you may be able to sacrifice vacation time to make up for the weeks of lost start.
Fellowship Planning
Example 3: Compromised fellowship planning. If you are not planning on pursuing fellowships, a late start may not matter. However, if you sign a contract starting late then you may have to sacrifice personal leave time to make up for such a late start. If you start several months later than typical, this may require applying for fellowships a year later.
Final Thoughts—What to Do If Starting Later Than Usual
If you sign a contract starting residency later than usual (after July 1), then meet with your program leadership and your specialty’s governing body to determine if there are any consequences to this. If you want to graduate at the same time as the rest of your cohort you may have to sacrifice personal leave time (vacation, personal days, sick days).
If you don’t mind graduating later than the rest of your cohort then there may be no issue. Regardless, any questions should be discussed with a representative of your specialty’s governing body (such as ACGME and American Board of Internal Medicine if one is an internal medicine resident). Additionally, make sure your program and administration are all on the same page. Any aspect of graduate medical education takes time and planning and one should expect poor communication.
Link to ACGME Home Page
Example link to specialty boards: American Board of Internal Medicine