External rotations are a touchy. Some residency programs allow them without issue, i.e. they still cover the resident's salary and benefits while they are away. Some allow their residents to go, but they are not paid during that time. And some don't allow their residents to go at all.  :-( Of course, you can always take vacation...but who wants to do that!?!

Here is a (very) brief overview on the nuts and bolts of CMS/GME funding for external electives.

  • CMS only pays for residents when they are at their provider site. If you are off site your program is supposed to tell CMS and will not get paid for you while you are gone (or else it's techinically Medicare fraud). However, there is a caveat. If you are visiting a "non-provider site" (like a related lab or hospital), that is covered without having to inform CMS. It is wise to confirm where you are going as a provider or non-provider site.
  • In theory, if you are going to another program you are supposed to fill out the paper work at both your program and the program you are visiting to get payment via them...but again, who wants to do that? And who has a program that will put out that much effort.
  • Many places that allow away rotations already have more residents at their institution then CMS pays for, i.e. they fund the extras. In that case, you just have to make sure that your name is not given to CMS for the month you are away and get permission from your program to leave.

Be advised that the CAP RFEC is actively working on this subject, both with a grass-roots effort (getting residents involved) and working through the AMA to address the CMS rules.

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