Interview Tips

Found this on a different website.

INFORMATION YOU NEED TO KNOW ABOUT CHOOSING THE BEST PM&R RESIDENCY PROGRAM FOR YOU (good for other programs too)


1. Why do you want PM&R? If it is lifestyle you may be in for a surprise. Many attendings still put in 70+ hr/week BEFORE research. Do you want in-patient, outpatient, or a mix of the two? Check the journals and websites (like physicianwork.com) for jobs now. Yes, it will change but you still need to know what?s what. If it is money, the average nationwide starting salary is $130k.

2. Check physiatry.com to review a list of ACGME accredited fellowships. You may be surprised to find out how few there are. Do you know the difference between accredited and unaccredited? Best to think about it now. If you are interested in Sports Med, Pain, or Musculoskeletal you may want to head to FP/IM, anesthesiology, or radiology, respectively.

3. In-patient versus outpatient rotations: Outpatient rotations are where most of your learning takes place, so make sure that there is a significant portion of outpatient rotations. Many programs will tell you ?This is a well rounded program.? ?Well rounded? is the classic way of avoiding the question. Get a copy of every program?s current schedule so that you CAN COUNT the number of months and remember that consults and EMG are NOT outpatient months. Also, compare the number of months of GME required rotations to the number that the program has. Beware if the in-patient rotations (general/ortho, TBI, SCI) and consults/equivalent exceed the minimum. Look for a program that has a minimum of 3-4 months of outpatient rotations/yr beginning in the second year. Unfortunately, most hospitals need residents for the scutt-work that has to be done on the wards and will use you, to the detriment of your learning.

4. Check the number of Rehab beds in the city where the program is located. If the number is too great, the competition to fill beds may mean that you will be working with less than optimum Rehab candidates and your education may suffer.

5. Give your business card with e-mail address/phone number to every resident that you meet. One of them may be honest or disenchanted enough to let you know about the shortcomings of various programs. Get the residents? e-mail addresses and ask them a lot of questions. If they don?t answer (too busy or don?t care), you don?t want to go there.

6. Vacation policy? Three weeks is the minimum! You will use it to review for STEP III, board reviews, etc. Some people are afraid to ask about it or if you can get more vacation time because you may look ?lazy.? If so, phrase it in terms of asking for more time off to study, research, board reviews, etc.

7. Location: If you are married, choose a place where your spouse can easily visit relatives, as the stresses on you relationship cannot be underestimated.

8. Three versus four-year programs: There are pluses and minuses to both. For example: in a four year program (If the interns work at the hospital where they will do most of their PGY2-4 work) gives you the benefit of knowing more of the staff, computer, etc. A three-year program will give you a better breadth of knowledge and experience as none of the first year will be usurped by PM&R in-patient rotations that have a low yield for you.

9. Check the journals and websites to see which programs are advertising for attendings. Figure out how long the ad?s have been running. Figure out too why the slots are open. (That is tough to do.) Why can?t they fill the slots? When checking physiatry.org, FREIDA, etc. note if the listings are up-to-date. If not, it means someone left. Where and why did they go? Where are the attendings from? Are they very junior? (Less learning/more scutt-work for you.) Home grown? Elsewhere? How long has the chairman been there? If there is an acting chairman, beware! When the new guy shows up there will be lots of changes (and likely a significant amount of departures). The people you love may leave!

10. Does the program have time arranged exclusively for you with PT, OT, speech and orthotics/prosthetics companies? If they say ?Oh, you can spend as much time with them as you like.? It means ?No.? In reality, if it isn?t set up as a specific rotation, you won?t have time to do it.

11. Many programs have software that handle admit and discharge orders as well as prescriptions. If it doesn?t you will waste a bunch of time writing and rewriting the same info over and over wasting time that could be used for studying. If the software isn?t there now, it won?t be before you graduate!

12. Can you access the x-rays, CTs and MRs via the computer or do you have to hike down, and wait to see them? Ditto for old records! This can be a BIG waste of time. Again, if they tell you it is coming, it probably won?t get there until after you graduate.

13. Chief residents are poorly compensated (if at all) other than by a nice letter of recommendation from the dept chair. This letter is forthcoming only if the CR gets the residents to do what the chairman wants (program to fill, etc.), so carefully evaluate what they tell you. Also, staff tell residents ?if we don?t fill?? implying that the existing residents will have to do the work and therefore should not do or say anything that might discourage an applicant. During your interviews YOU have to listen between the lines and re-ask every question to validate the response.

14. Chief Residents: If the CR isn?t a PGY4, figure out why. It is probably because the program couldn?t find a PGY4 to do it and that is a warning sigh to you. Ask who is going to be the next CR, ditto if it isn?t a PGY4 to be. If they tell you they don?t know who is next, it is a signal to you as the CR is pretty well known a year ahead of time.

15. Ask how the Chief Residents are chosen. Do the residents have input into the choice and if so, how. If the residents don?t have input, then it is likely that the CR?s will be minions for implementing departmental policy and unlikely that the CR?s will be resident advocates. If you ask ?Do the residents have input into the choice of Chief Residents?? The likely answer will be ?Sure.? Unless they specifically define the input (i.e. vote), then the real answer is ?No.?

16. Frieda and ERAS have disclaimers as to the accuracy of information and there is a reason for it. Some websites say 50 hrs/week for years 2-4 when 70+ is routine. A friend was even told that the residents routinely leave around 4:30pm. She later discovered that 8-9pm was the norm. The PM&R lifestyle is more a rumor than reality.

17. Residents area: the RRC mandates that office area be set aside for residents. Take a look at what the various programs offer. Nice office area or broom closet? It tells you a great deal about how the program perceives its residents.

18. In patient vs outpatient: most of your learning will come from outpatient rotations. If there aren?t 4 to 6 months of outpatient rotations in EACH of years 2, 3 and 4, beware. In-patient rotations will be mostly skin management and intern scutt work!

19. Ask for the programs last review (two is better) by the Residency Review Committee. (Can you ask the RRC directly for it??)This will provide you information as to the programs weaknesses as assessed by people who are aware of all residency programs within a chosen specialty. This should be readily available; if you do not receive it BEWARE. If you aren?t willing to ask and receive it, you may graduate from an uncertified program!

CON'T

20. Electives: Ask how many electives you get and if they have to be in PM&R. This will give you an idea if the program is using your electives to fill their deficiencies. Couch the question in terms of filling other requirements as you are contemplating a double specialty (IM or FP) and PM&R, if you are concerned that it will ?look bad? asking about electives.

21. Ratings: There are only about 6 top ?rated? PM&R programs. After that there are probably two tiers without much difference between the programs. Top ratings are based on advertising (publications) and not much else. If someone tells you they are about number 8 or 10, they are only trying to impress you. The advantage to a top program is ONLY that it may open some doors for you downstream. It doesn?t tell you much of the quality of education that you will receive.

22. Ask if there is a formalized feedback process in which residents rate the strengths and weaknesses of their program. If there isn?t one available, it is a clear signal that management is not interested in input from the trenches. If there is one ask for copies of the last two or three, if the same problems keep cropping-up, it is another signal that management is not really interested in improving the program.

23. How much teaching time do residents receive each week and what is the ratio of residents/attendings doing the teaching. Is teaching time protected? Better to ask how teaching time is protected. If pagers are not signed-out to secretaries, attendings, etc. then the teaching time really isn?t protected. Are daily responsibilities adjusted on teaching days? In other words, are you required to attend three hours of teaching, and then expected to complete a twelve + hour day?s responsibilities?

24. Consider doing a transitional year in a state like New York where residents (and patients) are protected by laws restricting work hours. (Effective with the new residency year, the 80-hour work restriction may make this less important.) Even if the program you want is a categorical program they will make changes in order to fill the slave force. Also, with a traditional transition year, if you decide to change then you won?t have to make up time.

25. Beware if there are too many foreigners. Why? They are some great doc?s, but because of a possible loss of a visa, they won?t stand with you on ethical issues. Guaranteed!

26. Give more consideration to states that allow and programs that have strong resident organizations.

27. Pay attention to details! Ask about parking, the cost of the parking, meals (on call and otherwise), book allowances, payment of license and exam fees. This can affect your take-home pay by more than five thousand dollars per year. Also, the parking can put a dent in your daily schedule when you have to park at a remote lot, wait for a shuttle and then waste still more time on a shuttle. Close parking can add 40 minutes to an hour of ?disposable? time to your day. Besides the total time/dollars, you can learn a great deal about a program from their willingness to pay for the ?little things.?

28. Internal Review Board: If you do research you may have difficulty gaining approval or there may be delays because of back-logs.

29. Conferences: Who goes to conferences? Some programs are generous and others are stingy. Best to know before you sign-up.

30. Do call schedules allow moonlighting? Some programs have ?possible? late admits requiring residents to return to the hospital to admit late arrivals. You will never know when this will happen and therefore cannot commit to moonlighting (or dates or sports events or, or, or?). Ask for a specific cut-off time for admits then ask if the resident has ever admitted a patient later than that. For some programs the policy really is ?the cut-off? time is 5pm, unless the patient arrives later. I.e. there isn?t a cutoff time. Also, some programs restrict moonlighting to within their system. Good to know before you go!

31. What sort of work do you want to do? If you are not planning to work in a major teaching hospital, you may receive more appropriate/better training in a community based hospital. Most med-students think that university based training is, by definition better. This is not necessarily true. Take for example organ transplants. Few hospitals do these procedures. You may ?waste? a great deal of time with transplant patients during your residency, never to see this type of patient again. Your time might be better spent learning about the type of work that you will be doing in the future. More prestigious is not necessarily better.

32. Does the hospital have a strong skilled nursing facility and extended care facility within the hospital? If not, Rehab wards often become dumping grounds for patients that are too sick to go home and the other specialists want to have easy access to for daily follow-up. Other specialists don?t want to have to drive to a nursing home to see the patients and will strong-arm your system?s rehab units into accepting the patients.

33. What state laws affect your teaching? This is a tough one to know about. Take traumatic brain injury for example. Some states have strict laws about ?lock down? facilities. If the program doesn?t invest the required money into the facility, your exposure to various patient bases may be limited.

34. Does the spinal cord unit have ventilator patients?? Do you want
exposure to that type of patient?? Does the spinal cord unit get ?true? spinal cord injuries or are run of the mill laminectomies warehoused there as well??

35. Is the hospital financially solvent? This info is crucial and you can get the info pretty easily. Beware of the people who tell you ?Oh, we are really strong? and don?t offer the info. More than 50% of the hospitals are loosing money. Most will weather the storm, but you can bet that there will be significant pressure on the residents and staff. The pressure on the staff means less TEACHING as the attendings spend more and more hours with other responsibilities and more SCUTT work as nurses and aides can only do so much.

36. Moonlighting?does the hospital have an adequate number of moonlighters? If not there is only one reason?they aren?t paying a market rate. The work always is shifted to the residents who work for free.

37. Look at the number of residents in each year of the program and ask why a particular year isn?t/wasn?t full. Ask if anyone has left and why. You probably won?t get a truthful answer, but still ask several people. Better still find out the names of those who left, where they went. Then, call there and talk to the person. Ask people from the affected year how you can get in touch with the people of left. Also, it is important to ask how your schedule is going to change when an individual leaves. People emphasized this with me and I really didn?t realize that they were saying that I would ?loose? elective time when another person leaves. This is truly an advantage of a larger program?when one in ten leaves it is only 10%, but one in five is 20%. Find out if anyone has sued the program. Scan the residentweb to bulletin board and you will be surprised to find out that it isn?t that unusual.

38. PM&R has call just like most other specialties and the number of hours is rapidly increasing. Many attendings work 12 hours a day + call + research. This will get much worse as Medicare, insurance co?s and HealthSouth squeeze the staff and the patient.

39. Listen to residents when they talk about or to attendings, do they call them by their first names? If not, this is likely a program where the resident-attending relationship is more hierarchal than collegial.

40. Most important?remember the programs need YOU! You are ?free? labor and actually represent income directly to the program in the form of governmental funds. Without you they are LOST!


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