Advice for a "non traditional" candidate

[SuperSoccer19]

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I would probably be considered a "non-traditional" candidate at this point and I figured I would post here before contacting program directors. I did search the forums as best I could, but had a difficult time finding concrete answers to some of these.

I am a physician boarded and practicing in psychiatry, but for a lot of reasons I am considering going back to residency, most likely in PM&R if accepted. I did my internship back in 2008 in psychiatry (although closer to a TY then a true psych internship...its complicated). Here are some of the questions I am having difficulty finding answers to:

1. What exactly are the ACGME requirements for the internship year of PM&R? As in, the specific rotations required? I am assuming I have to repeat mine--partial based on time away and/or possibly not meeting requirements, but find conflicting answers. If applying for categorical positions or even programs requiring a separate internship, do they ever waive previously completed rotations?

2. If there is anyone else who is or was in a similar situation and would like to share his/her experiences, that would be great. Going back to residency after being staff is a little intimidating and will be an adjustment, so I would love to hear your advice.

3. In your interviews/applications, did you find programs that were more open to applicants who may not have taken the normal path and if so, which ones? Any to avoid or be more cautious with? Feel free to PM this, as I would rather not slander a program online.

4. I did get some exposure to PM&R in my first internship--did not know it existed until that time--but am looking for additional experiences on my own time to make sure I know what I am getting myself into and to work on improving clinical skills I have not used in a while. There do not seem to be any PM&R physicians at the hospital I currently work at, but I do have some networking opportunities. What type of additional experiences can one get to have more exposure to this field? By this, I mean, should I try to see if any of the orthopedics are open to me hanging out in their clinics? If I can work with our pain management folks would this also assist in my gaining more exposure? Sports clinic? Other ideas?

5. Back when I was in medical school, I *think* certain applicants could apply for positions outside of the match if you were not a US student (IMG, already graduated, applying from an internship, etc.). Is this still allowed or done? I *might* have also made this up...its been awhile.

6. If anyone has any general advice on this, I would also be interested in hearing it. Although I do work with a residency program, I do not really have an "advisor" to go to on this and there seems to be minimal info outside of SDN, so if someone can recommend other resources on this process that would also be outstanding.

Thanks!

 

[RangerBob]

First off--PM&R is a great field, and if you do decide to go back for residency (which is a huge decision in itself, and hopefully you make the decision that will be the right one for you)

I can't answer most of your questions, but I can offer my opinion on a few:

1) I believe the requirements are actually fairly broad--and there were some programs I applied to that I believe a intern year in psych would actually count for PM&R. A few even said OB-Gyn was ok. If your internship was close to a TY and you did at least 6 months of medicine/EM/other general specialties then I don't think the content would be an issue at all. What could be an issue is how long ago it was--you may want to ask specific programs if they require you to re-do internship if you've x years out of it. And it's certainly possible you could get some credit for your prior rotations if you don't get credit for the full year--once again that's something you would need to discuss with your program. But I doubt you'd get that "partial credit" if you end up doing a pre-lim year--I would think a categorical program would be nicer about giving you credit and thus more electives, whereas a pre-lim program doesn't really have any reason to give you credit (unless you start mid-year, in which case they may)

3) The only way to really know if a program is open to a non-grad is to apply. I ran into applicants at multiple interviews that were in or finished their internship. So apply broadly--being out of medical school is usually considered a handicap, so if you are really set on PM&R it may be worth applying to most/all programs. By USMLE scores we're not exactly at the top in terms of competitiveness, but it is getting much harder to match into PM&R. (People say that every year... but it is true)

4) You will absolutely without-a-doubt need a letter of recommendation from a physiatrist. And having experience with one (rather than oath, FM-sports, pain, etc.) is critical. Working with those other disciplines will certainly help you a but in terms of seeing some areas of overlap with PM&R, but you really want to work specifically with a physiatrist--every interviewer is likely to ask why you're leaving behind a field that you are already an attending in, so you will need a compelling story to explain this (wanting to leave psych won't be enough--programs will want to know why you specifically want to go into PM&R)

5) I don't believe there are any PM&R positions available outside the match anymore. I could be wrong though.

6) If you don't have an advisor, then find one. Does your home medical school have a PM&R program? What about where you did your residency? Start networking as much as you can. There's also a list of physiatrists interested in being advisors on the AAPM&R website. It would definitely help you to have a trusted advisor to turn to.

Best of luck!

 

[SuperSoccer19]

First off--PM&R is a great field, and if you do decide to go back for residency (which is a huge decision in itself, and hopefully you make the decision that will be the right one for you)

I can't answer most of your questions, but I can offer my opinion on a few...
---

Best of luck!

Thanks for your assistance, especially with #6. I was going to email the Medical School in the City closest to me to ask about mentorship, but felt weird doing this and know they have their own students to mentor. I did not consider contacting my former medical school since its on the opposite coast and I do not know many of the faculty, but that does seem like a good first step. I will also look closer at the AAPM&R page.

#1 probably is going to be program specific--every site I have looked at has a different answer, even when the ACGME requirements were cited. I personally don't feel like I am ready to just jump right in without some review of basic skills, but I am trying to do more outside my specialty at my home hospital.

#4 is going to be difficult, but if there's a will, there's a way. I do technically had a rotation as an intern that I did well on, but never asked for a letter. I have (at least in my opinion) a decent reason for why I did not do PM&R initially and why I want to change. I actually do enjoy my current job--I just want to do more and I think I can apply psych to another specialty. I sold my soul to the US military and my branch did not offer any PM&R opportunities...there's a little more to it, but I expect that my dedication to the field will be questioned. I still try to stay up to date with a lot of things related to neuro and muscularskeletal complaints and had a *moment* while watching a concussion CME that maybe I could actually do this more formerly.

I would probably be applying this year, so I need to get my stuff together, so thanks for your help.

 

[Louisville04]

Another consideration would be funding. I have heard that the government will only provide funding for one residency. If your psychiatry residency was funded by the military, this may be moot.

 

[SuperSoccer19]

Another consideration would be funding. I have heard that the government will only provide funding for one residency. If your psychiatry residency was funded by the military, this may be moot.

Thanks--yeah, I had heard this and have been trying to figure out if it applies to me or not since I am not sure what pot of money my GME came from. If it does apply, I still have the GI Bill and have confirmed that I can use this to get a stipend (with or without funding). If money is tight I figured I could moonlight if the inistitution allows. Would also allow me to keep up psych specific skills if I wanted.

 

[j4pac]

Thanks--yeah, I had heard this and have been trying to figure out if it applies to me or not since I am not sure what pot of money my GME came from. If it does apply, I still have the GI Bill and have confirmed that I can use this to get a stipend (with or without funding). If money is tight I figured I could moonlight if the inistitution allows. Would also allow me to keep up psych specific skills if I wanted.

The GI Bill for residency is good play money but not money you can survive off of...especially if you have a family and/or bills. You will make $1748/month after buy-in and kicker for the MGIB, or E-5 with dependent BAH for P911GIB. You will be stretched incredibly thin. If you are a boarded military Psychiatrist, you need to be saving up right now in order to make this plan feasible.

You would also be unlikely to get a ton of moonlighting in while in residency...even if the program allows you.