Advice needed; switching to PM&R

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Creed_Bratton

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The first step to switching is to talk to your current PD first. If you don't do that, you will never be able to switch since you will need a letter from your pd saying you are in good standing. Your pd should hopefully be your advocate assuming you are doing well, and can get you connected with pmr so you can discuss your situation. Also consider this is so early into your first year of anesthesia, it might get better as you progress. Then you could go into a pain fellowship just like pmr, because if you successfully switch into pmr, you will lose time. Either way talk to your anesthesia pd early, better now than later. Since you have top notch scores and have never entered the match for pmr, switching will be less of an issue compared to the traditional didn't match because of low scores/red flags, soaped or scrambled and now trying to reapply
 
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Since ERAS hasn't opened yet, talking to your pd now gives both you and the program time to come up with a plan/assess if you're better off in pmr or staying in anesthesia. You don't want to be 5 months in without any plans. Better awkward now than later
 
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Since ERAS hasn't opened yet, talking to your pd now gives both you and the program time to come up with a plan/assess if you're better off in pmr or staying in anesthesia. You don't want to be 5 months in without any plans. Better awkward now than later
Thanks, I appreciate your help! definitely dreading the awkward conversation but better to get it over with fast.
I need to think through a way to eloquently explain my reasoning without sounding offensive towards gas. I also don't want to sound like a basket case telling them how nervous I get in the OR
 
2020 grad from an average MD school. Applied to gas and matched to a good program. Completed intern year and now have a strong desire to switch to PM&R. Finding myself disliking gas and being too stressed out in the OR environment.
I know it is crazy and I should have figured that out before, but it is what it is right now and I can't go back in time to change it.
Home school had no PM&R department, so no rotation. Attempted to get PMR rotation in 4th year and intern year but unable due to covid.
Have exposure and a research publication in chronic pain management.
In my original application had good LORs from 2 chronic pain docs.
Scores mid 260s/mid 270s/mid 260.
No red flags otherwise.
What should I do now? Unsure if I have a chance to transfer in my current institution. Was considering applying broadly for next year's cycle but moving again would be very problematic for family reasons (SO moved with me for my residency and would have to quit a new job). Wondering if I should inform my current PD and attempt to get some involvement with the PMR department vs talk to the PMR first and gauge the possibility of being accepted to a physician only position. Any advice appreciated.
You are 3 weeks into being a CA1. These are the most stressful times of residency because you still know relatively nothing and people's lives are literally on the line depending on you.

Step 1 - Talk to your PD/aPD/advisor/mentor STAT - What is it about anesthesiology that you dislike now that you either didn't know about or dislike when you applied 4th year? What are the things causing you to be too stressed out in the OR?
Step 2 - Talk to your PD - If you decide you really want to switch out of your currently specialty you will need a letter from them for ERAS anyway.
Step 3 - Talk to a CA2/3 - Maybe they can shed some light on the things you dislike / causing you stress.
Step 4 - Talk to PM&R - Realize that it is a competitive specialty because of the nice lifestyle. Check and see how many R positions were offered in the past couple of years. I know there are PM&R programs that offer both C and A positions. If you went for an A position, you are looking at starting in 2 yrs, what would you do in the mean time?
 
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You are 3 weeks into being a CA1. These are the most stressful times of residency because you still know relatively nothing and people's lives are literally on the line depending on you.

Step 1 - Talk to your PD/aPD/advisor/mentor STAT - What is it about anesthesiology that you dislike now that you either didn't know about or dislike when you applied 4th year? What are the things causing you to be too stressed out in the OR?
Step 2 - Talk to your PD - If you decide you really want to switch out of your currently specialty you will need a letter from them for ERAS anyway.
Step 3 - Talk to a CA2/3 - Maybe they can shed some light on the things you dislike / causing you stress.
Step 4 - Talk to PM&R - Realize that it is a competitive specialty because of the nice lifestyle. Check and see how many R positions were offered in the past couple of years. I know there are PM&R programs that offer both C and A positions. If you went for an A position, you are looking at starting in 2 yrs, what would you do in the mean time?
I heard that it is supposed to get better wit time but I am having an extremely hard time dealing with the stress of the OR. Somehow as a med student I didn't feel that way, likely due to a combination of things including no responsibility, great residents and attendings and overall good atmosphere. Now as a ca1 I feel completely different. I don't know how to do simplest things in the OR, pressure is on me to not harm the patient, the teaching is sub par, some seniors and attendings get annoyed with my questions, and the environment is way more stressful than in med school. My anxiety levels started going through the roof and I dont think I can deal with it for much longer.
I want to be in a specialty that is less acute and where I can take at least a bit of time to think, double check, discuss things.
I just looked at the R positions though and it doesn't look great lol. I dont know ifmy current institution has any and not sure how to find out short of emailing the PD of that program. I am nervous about talking to my PD because if things don't work out with switching I will be the weird flaky person in his mind forever. Also much embarrassed to say that I can't deal with the stress.
 
I heard that it is supposed to get better wit time but I am having an extremely hard time dealing with the stress of the OR. Somehow as a med student I didn't feel that way, likely due to a combination of things including no responsibility, great residents and attendings and overall good atmosphere. Now as a ca1 I feel completely different. I don't know how to do simplest things in the OR, pressure is on me to not harm the patient, the teaching is sub par, some seniors and attendings get annoyed with my questions, and the environment is way more stressful than in med school. My anxiety levels started going through the roof and I dont think I can deal with it for much longer.
I want to be in a specialty that is less acute and where I can take at least a bit of time to think, double check, discuss things.
I just looked at the R positions though and it doesn't look great lol. I dont know ifmy current institution has any and not sure how to find out short of emailing the PD of that program. I am nervous about talking to my PD because if things don't work out with switching I will be the weird flaky person in his mind forever. Also much embarrassed to say that I can't deal with the stress.
It really does get better! PM me if you want to privately chat about more specific stuff regarding your current OR situations / stresses. Maybe I can offer up some tailored advice to help you in the meantime.
 
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It really does get better! PM me if you want to privately chat about more specific stuff regarding your current OR situations / stresses. Maybe I can offer up some tailored advice to help you in the meantime.
Tbh in the past weeks I have been strongly considering quitting residency altogether, but PM&R seems like a good alternative with some patient care but much more tolerable level of stress. Have been looking through job listings outside of medicine, maybe in the health administration, but several good health admin psotions required a completed residency, so here I am trying lol
 
Tbh in the past weeks I have been strongly considering quitting residency altogether, but PM&R seems like a good alternative with some patient care but much more tolerable level of stress. Have been looking through job listings outside of medicine, maybe in the health administration, but several good health admin psotions required a completed residency, so here I am trying lol

It sounds like your current line of work is the main stressor. I would first figure out the exact triggers and see if those are modifiable. This appears to be the core of the issue. Switching specialties is an arduous decision and inevitably you will need a convincing "Why PM&R?", it does not appear to me that you've had any exposure which suggests your desperation of picking the path of least resistance out of your current situation. As others have stated above, an honest and frank discussion with your Senior residents/Chiefs/PD may be able to guide you on how to manage -- I'm sure you're not the only anesthesia resident to have ever felt this way! Of course, PM&R is generally a laid-back specialty, so we'd love to have you but for the right reasons.
 
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I'd be very careful thinking that PM&R is a stress free specialty. That's actually untrue. We have INSANE levels of burn out. We have HUGE administrative burden, and almost all of our patients are either disabled or have chronic pain. I love PM&R...but the stress can be high...in spite of the reasonable income/work ratio. I'd make sure you know what you are getting yourself into.
 
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I'd be very careful thinking that PM&R is a stress free specialty. That's actually untrue. We have INSANE levels of burn out. We have HUGE administrative burden, and almost all of our patients are either disabled or have chronic pain. I love PM&R...but the stress can be high...in spite of the reasonable income/work ratio. I'd make sure you know what you are getting yourself into.
Totally hear what you are saying, and this gave me food for thought. I don't think of it a stress free specialty, but I do think that I would be better at dealing with those stressors. As I mentioned before, I want to have more time to think than frequently allowed in the OR. I fully understand the responsibility in any kind of patient care, but the levels of acuity differ. In PM&R I won't likely be paralyzing anyone and their life won't immediately depend on me getting the airway; nor will anyone be acutely bleeding out on the table or dropping their MAPS to the toilet and depending on me to fix it within seconds to minutes or they die. I understand that emergencies can happen anywhere, but in some specialties it is an exception while in others it is more of a norm. And my thought was, if I were to go towards chronic pain management, won't it be better for me to get there via the PM&R route?
 
Totally hear what you are saying, and this gave me food for thought. I don't think of it a stress free specialty, but I do think that I would be better at dealing with those stressors. As I mentioned before, I want to have more time to think than frequently allowed in the OR. I fully understand the responsibility in any kind of patient care, but the levels of acuity differ. In PM&R I won't likely be paralyzing anyone and their life won't immediately depend on me getting the airway; nor will anyone be acutely bleeding out on the table or dropping their MAPS to the toilet and depending on me to fix it within seconds to minutes or they die. I understand that emergencies can happen anywhere, but in some specialties it is an exception while in others it is more of a norm. And my thought was, if I were to go towards chronic pain management, won't it be better for me to get there via the PM&R route?
If you’re risk adverse, pain is a little more risk than the other PM&R subspecialties. The two most common routes into pain are anesthesia and PM&R. I’ve known some able to get in through Neuro, though it’s less common. Anesthesia is the most common route.
 
Totally hear what you are saying, and this gave me food for thought. I don't think of it a stress free specialty, but I do think that I would be better at dealing with those stressors. As I mentioned before, I want to have more time to think than frequently allowed in the OR. I fully understand the responsibility in any kind of patient care, but the levels of acuity differ. In PM&R I won't likely be paralyzing anyone and their life won't immediately depend on me getting the airway; nor will anyone be acutely bleeding out on the table or dropping their MAPS to the toilet and depending on me to fix it within seconds to minutes or they die. I understand that emergencies can happen anywhere, but in some specialties it is an exception while in others it is more of a norm. And my thought was, if I were to go towards chronic pain management, won't it be better for me to get there via the PM&R route?
Anesthesia is generally the field that sponsors the majority of pain fellowships, pmr is a close second, so if getting some kind of pain fellowship is your goal, then staying at a great anesthesia program will get you there sooner and more easily. Still, should talk to your PD, figure out if anesthesia vs pmr and see if you could get in touch with pmr pd to learn more. And it's true, some fields have more stat emergencies than others, not for everyone
 
It sounds like your current line of work is the main stressor. I would first figure out the exact triggers and see if those are modifiable. This appears to be the core of the issue. Switching specialties is an arduous decision and inevitably you will need a convincing "Why PM&R?", it does not appear to me that you've had any exposure which suggests your desperation of picking the path of least resistance out of your current situation. As others have stated above, an honest and frank discussion with your Senior residents/Chiefs/PD may be able to guide you on how to manage -- I'm sure you're not the only anesthesia resident to have ever felt this way! Of course, PM&R is generally a laid-back specialty, so we'd love to have you but for the right reasons.
Yes, I am afraid I might come off that way.. but my initial exposure to anesthesia was through pain management clinic and I actually think that I am not bad at dealing with chronic pain patients. In my pre-med school life I did a lot of work with teaching exercise classes to old people, and volunteered in a physical therapy clinic and really enjoyed that work. I know its different, but I think I would be good at it and enjoy it as well. It was a touch choice for me in medschool, I wasn't like one of the people who knew what they want right away. Many things seemed interesting and so is anesthesia. But I also need to think about day to day life and work, and in that realm I think PM&R could be more up my alley.
Anesthesia is generally the field that sponsors the majority of pain fellowships, pmr is a close second, so if getting some kind of pain fellowship is your goal, then staying at a great anesthesia program will get you there sooner and more easily
I know, but I also would like to maintain sanity and enjoy my residency ? I feel like I am asking for too much hahaha
 
Yes, I am afraid I might come off that way.. but my initial exposure to anesthesia was through pain management clinic and I actually think that I am not bad at dealing with chronic pain patients. In my pre-med school life I did a lot of work with teaching exercise classes to old people, and volunteered in a physical therapy clinic and really enjoyed that work. I know its different, but I think I would be good at it and enjoy it as well. It was a touch choice for me in medschool, I wasn't like one of the people who knew what they want right away. Many things seemed interesting and so is anesthesia. But I also need to think about day to day life and work, and in that realm I think PM&R could be more up my alley.

I know, but I also would like to maintain sanity and enjoy my residency ? I feel like I am asking for too much hahaha
Umm chronic pain is pain medicine even if you do a pain fellowship. I did a pain fellowship and thought I’d love it and as I was nearing the end of my fellowship I thought I would go crazy after another patient with fibromyalgia or on 20 years of norco wanted something stronger because they had “high pain tolerance” which clearly they didn’t understand what that meant. So pain is the last thing you should do if you don’t like chronic pain patients. As someone in a directorship position in PM&R while I agree that it’s prob less life or death situation than anesthesia plenty of stresses. In the acute setting sicker and sicker patients are being transferred to acute inpatient. I have quite a bunch of patients that are rather high complexity high risk and get plenty of late nights calls about them. So grass is not always greener.
as someone who switched from a competitive specialty into PM&R I can tell you that I didn’t talk to my PD until literally just prior to the match. I knew they were going to do everything in their power to screw my matxh. Perhaps your PD is nice but it’s problematic to talk to them without any interviews etc already lined up. I had a bunch of interviews and I knew I’d match somewhere. It’s also super early on - like 3 weeks. Too early. My two cents. PM&R is not crazy competitive but it does have plenty of applicants. More than enough to fill the current openings and I think it’s filled in the match 100 percent for the last several years.
 
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In my pre-med school life I did a lot of work with teaching exercise classes to old people, and volunteered in a physical therapy clinic and really enjoyed that work. I know its different
Indeed it is. Different as in night and day.
 
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M3 here wondering if PM&R is right for me? I worked with pain physicians before med school and really like that work. I thought I'd want to do anesthesia, but my surgery clerkship has raised doubts about that: I like the physiology of anesthesia, but I don't like the OR setting and I don't think I want to spend so much time around surgeons.
 
M3 here wondering if PM&R is right for me? I worked with pain physicians before med school and really like that work. I thought I'd want to do anesthesia, but my surgery clerkship has raised doubts about that: I like the physiology of anesthesia, but I don't like the OR setting and I don't think I want to spend so much time around surgeons.
I had exactly the same feelings. I wanted to do pain as a med student, did some anesthesia, recoiled at the OR environment and didn't really like the boredom punctuated by chaos of anesthesiology. You need to ask yourself what you like about anesthesiology and whether that's enough to do 3+ years of it in residency, to ultimately be an outpatient internventionist. I felt the training was too circuitious for my end goal, and PM&R, while not direclty linear either, is much more relevant to what day-to-day pain medicine looks like. Also, you need to ask whether you can tolerate the parts of PM&R that aren't your main interest in order to get what you ultimately want. Nothing is perfect. Every residency has trade-offs.

If you haven't done a PM&R rotation or shadowed yet, I encourage you to do so. The AAPM&R website also has a good overview

If the end goal is pain, many PM&R residents match into pain fellowhsips now, and while anesthesiology still has the upper hand, I don't think the difference is as marked as it once was. And as far as the training goes, depending on the program, you may get much more trianing with spine and peripheral injection procedures than most anesthesiology residents do. And your skills in Neuro-MSK exam and understanding of pathology will be very useful downstream. That's by admittedly biased opinion.
 
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