AMA - PGY-2 PM&R Resident, DO Grad

[Haxx]

Hey Everyone!

I'm Haxx, a PGY-2 resident at Mayo Clinic in Minnesota in the Physical Medicine and Rehabilitation Department. I did my training at Rocky Vista University, CO and my preliminary medicine year here at Mayo in the Internal Medicine Department. Some residents came back and did one of these back when I was applying, and I found it really helpful to get some candid answers about what to expect from medical school, the application process for residency, and what residency will be like.

Ask me about the process of med school, residency, PM&R, or whatever else you like! I will be largely unhelpful at answering questions about the process of applying for medical school and the admissions process, as it's been 6 years now since I went through it and likely everything is entirely different. I'm largely an open book though, so ask away and I'm happy to answer most things, and I'll let you know if I don't feel comfortable answering something. Also, I may not answer you all right away because... you know... patient care, but I'll try to get around to all questions eventually!

---

Members don't see this ad.

 

[bioboy23]

Thanks for doing this! I have an interview at RVU this month and I have always thought highly of the school because I have a family member who went there, as well. What are your thoughts on your education from RVU? How were your rotations?

Also, what made you choose PM&R? What do you love about it?

 

[Haxx]

What are your thoughts on your education from RVU?

I was very happy with my education at RVU. I know a lot has changed since I was there, including adding another campus in Utah, and with that some curriculum changes, but overall I think the school certainly has the needs of the students at its focus and provides a quality education.

How were your rotations?

My experience was very different from others. I opted out of the rotations they had set up and arranged all of my own in Minnesota. I was able to see lots of different health systems, network with physicians, and complete rotations with attendings that were really invested in teaching. I had classmates, especially those who ended up rotating in Colorado Springs, that really enjoyed their rotation experience, though, and felt like they learned what they needed to.

Also, what made you choose PM&R? What do you love about it?

I could go on for a while on this one! I'll break it down into 4 reasons for now.

1) The patients: For the most part, patients on inpatient rehab, which I'm most interested in right now, are incredibly motivated to get better! Part of the criteria for admission is that they're willing to complete 3 hours of therapy per day, and therefore the patients who come are generally very nice, motivated, and a pleasure to work with.

2) The team: PM&R stands alone, in my opinion, as the primary specialty where you work as a member of a larger team towards your patient's goals. You work VERY closely with PT, OT, SLP, Rec Therapy, Nursing, Social Work, etc., so if you like that kind of collaborative atmosphere, PM&R is a great choice.

3) The lifestyle: Physiatry is an amazing specialty if you love your work, but also love having a real life outside of work. Even during my PGY-2 year, which is the busiest one, you'll rarely work over 50-60 hours per week, and have many golden weekends. This means you have time to exercise, relax with family, have hobbies, and take care of yourself.

4) The work: PM&R is a specialty where you can choose your own adventure. You could be an inpatient brain rehab physician working with TBI, stroke, brain tumors, etc. in the hospital, or you could be an outpatient sports med doc, not operative ortho/spine physician, etc. You could do lots and lots of procedures with interventional pain injections or ablations, you can perform EMGs, you can do ultrasound guided joint injections, or you can do EMG/US guided botox (amongst lots of other procedures). These are just a few examples, but there are all kinds of practice settings you can pursue from a single specialty, which in turn allows you to be very employable. The compensation is also really solid, which is an added bonus.

 

[bioboy23]

I was very happy with my education at RVU. I know a lot has changed since I was there, including adding another campus in Utah, and with that some curriculum changes, but overall I think the school certainly has the needs of the students at its focus and provides a quality education.



My experience was very different from others. I opted out of the rotations they had set up and arranged all of my own in Minnesota. I was able to see lots of different health systems, network with physicians, and complete rotations with attendings that were really invested in teaching. I had classmates, especially those who ended up rotating in Colorado Springs, that really enjoyed their rotation experience, though, and felt like they learned what they needed to.



I could go on for a while on this one! I'll break it down into 4 reasons for now.

1) The patients: For the most part, patients on inpatient rehab, which I'm most interested in right now, are incredibly motivated to get better! Part of the criteria for admission is that they're willing to complete 3 hours of therapy per day, and therefore the patients who come are generally very nice, motivated, and a pleasure to work with.

2) The team: PM&R stands alone, in my opinion, as the primary specialty where you work as a member of a larger team towards your patient's goals. You work VERY closely with PT, OT, SLP, Rec Therapy, Nursing, Social Work, etc., so if you like that kind of collaborative atmosphere, PM&R is a great choice.

3) The lifestyle: Physiatry is an amazing specialty if you love your work, but also love having a real life outside of work. Even during my PGY-2 year, which is the busiest one, you'll rarely work over 50-60 hours per week, and have many golden weekends. This means you have time to exercise, relax with family, have hobbies, and take care of yourself.

4) The work: PM&R is a specialty where you can choose your own adventure. You could be an inpatient brain rehab physician working with TBI, stroke, brain tumors, etc. in the hospital, or you could be an outpatient sports med doc, not operative ortho/spine physician, etc. You could do lots and lots of procedures with interventional pain injections or ablations, you can perform EMGs, you can do ultrasound guided joint injections, or you can do EMG/US guided botox (amongst lots of other procedures). These are just a few examples, but there are all kinds of practice settings you can pursue from a single specialty, which in turn allows you to be very employable. The compensation is also really solid, which is an added bonus.

Thank you so much!

 

[Haxx]

Thank you so much!

No problem!

 

[Alkain]

Hey! Thanks for doing this.
I'm kind of torn right now between FM and PM&R.

Can you kind of give a general day to day of what you do?
How often/to what extent is OMM/OMT used?
What was the residency interview process like?

 

[Haxx]

Hey! Thanks for doing this.

You're welcome!

Can you kind of give a general day to day of what you do?

Well currently I'm on the inpatient rehabilitation unit, so my day is generally about 7 AM - 4 or 5 PM. We're a primary service there, meaning that we provide the medical care for our patients, write orders, etc. Each morning, I pre-round on my patients (vitals, issues overnight, I&Os, PRN meds needed), then go see them all. We do bedside rounds with the interdisciplinary team after that, then we do "sit down" rounds with just the physician team to discuss medical management of our patients. We'll usually have some sort of teaching after that, and then we have time to get notes and orders done. Eventually admissions will come sometime around lunch, and we will get anywhere from 0-4 admissions in a day to each inpatient service. We usually have about 10-14 patients on each inpatient team (brain and spine rehab), but it can fluctuate wildly depending on how busy the rest of the hospital is.

Outpatient is largely what you would expect. Seeing patients on a schedule throughout the day, with the content of what you're doing totally depending on which rotation you're on, such as MSK general rehab, spine, sports, procedure clinic (injections), regenerative med, pediatrics, non-operative ortho, pain clinic, interventional pain, spasticity clinic, amongst many others.

How often/to what extent is OMM/OMT used?

This really varies. I know some colleagues who use it often, but I haven't really kept my skills honed enough to use it on a regular basis with patients. I more often use OMM on family/friends at this point. It certainly isn't discouraged, but you will need to feel comfortable with your skill, just like with any other part of medicine.

What was the residency interview process like?

In short, you build an application in a single centralized system called "ERAS", and then apply to as many programs as you could see yourself attending (mid 80s total PM&R programs in the nation), paying a small fee for each additional place you send your application to. Luckily, there aren't any "secondary" applications! Then, programs who like you will extend an interview offer. These tend to occur in the fall/winter of your 4th year of med school. You travel to as many as you're interested in, which is usually about 10-15, and then build a rank list of your favorite programs, and they do the same with applicants. Then in March, a magic computer algorithm "matches" you with a program, choosing the best fit for each with a bias toward the applicant, and that match acts as a binding contract to complete residency there! There is definitely more details and nuances, but that's plenty for the stage of training you're in now!

 

[Osminog]

What did you do in medical school that you feel made you competitive enough to match into such a strong program?

 

[Haxx]

What did you do in medical school that you feel made you competitive enough to match into such a strong program?

Well, to be frank, my scores really sucked so I knew I couldn't rely on my academics. I did several away rotations in my specialty that absolutely helped me match at Mayo, I got really solid letters from mentors in the field that I had great relationships with and knew me personally rather than just generically as a student, and I went out of my way to show how much I loved the field through extracurricular activities like becoming the president of my school's PM&R interest group. Also, there's a real component of luck in capitalizing on connections that you make and networking well.

For those who might be interested:
USMLE Step 1: 215
COMLEX Level 1: 559
COMLEX LEVEL 2: 459
Bottom half of the class

Moral of the story; if you are really strong clinically and connect with attendings and residents while working in the hospital, scores do not need to define you, especially in PM&R. That being said, good scores obviously will provide you with more choices and better odds of matching into the specialty you love.

 

[EvidenceLockup12]

Thanks for taking the time to do this!

I'm sure it varies depending on where a person goes, but how was your day to day during medical school in terms of balancing studying and free time (hobbies, friends/families, etc.)?

 

[Haxx]

Thanks for taking the time to do this!

I'm sure it varies depending on where a person goes, but how was your day to day during medical school in terms of balancing studying and free time (hobbies, friends/families, etc.)?

It definitely varies quite a bit depending on your values, but I guess the best way to think about it for me, was that you can still have time to spend with family, do hobbies, exercise, etc., but you will need to clarify which things are really worth spending time on for you and prioritize them. For instance, that doesn't mean that you need to stop playing video games, watching Netflix, or napping, but you likely won't have time for all three during busy blocks. You'll obviously be working super hard, but you don't need to throw away the things you love! Hopefully that's helpful!

 

[Yxs9919]

It definitely varies quite a bit depending on your values, but I guess the best way to think about it for me, was that you can still have time to spend with family, do hobbies, exercise, etc., but you will need to clarify which things are really worth spending time on for you and prioritize them. For instance, that doesn't mean that you need to stop playing video games, watching Netflix, or napping, but you likely won't have time for all three during busy blocks. You'll obviously be working super hard, but you don't need to throw away the things you love! Hopefully that's helpful!

So you are saying that I don't have to completely give up on video games?? Haha thank you so much for this information, I am also very interested in the field of PM&R and hopefully I have the chance to shadow someone really soon!

 

[Haxx]

So you are saying that I don't have to completely give up on video games?? Haha thank you so much for this information, I am also very interested in the field of PM&R and hopefully I have the chance to shadow someone really soon!

Nah, I still play at least a few nights a week! Even during my intern year I'd play at least once a week, and I'm also married with 2 dogs so there are absolutely other commitments I have. There's hope!

 

[BobbyKoch]

long time listener, first time caller. thanks so much for taking my call!

besides academics, what do you think makes a good PM&R candidate? I understand that you maximized your connections and were able to show clinical skills on aways, but what kind of personality traits are desirable or commonplace in PM&R? When did you know that you wanted to pursue this field and can you shed some light on the process you went through in deciding on PM&R?

I'll take my answer off the air.

 

[Haxx]

long time listener, first time caller. thanks so much for taking my call!

besides academics, what do you think makes a good PM&R candidate? I understand that you maximized your connections and were able to show clinical skills on aways, but what kind of personality traits are desirable or commonplace in PM&R? When did you know that you wanted to pursue this field and can you shed some light on the process you went through in deciding on PM&R?

I'll take my answer off the air.

Hi Bobby, thanks for calling:

Besides what I've already stated above, I think personality traits that are well suited to PM&R include:
- Not being tied up in prestige. PM&R is definitely growing in popularity, but it's still relatively unknown to the public and even many physicians don't understand what we do. If you're looking for fame, this isn't the place to find it.
- Generally laid back and collaborative. As a whole, people who end up in PM&R are relaxed, and like to spend time outside of the hospital, too. You won't often find PM&R docs raising their voice, pimping students/residents, etc, because we work so closely with a big team throughout the day, and if you were fiercely individualistic, you wouldn't do too well.


I found PM&R in between my 1st and 2nd years of med school as I was doing research with some neurologists over the summer. I had worked in a neurology clinic before med school and knew I really liked neuro-pathology, but didn't know anything about PM&R. I ended up meeting my mentor because her office happened to be next to my research desk, and she had me shadow her on the rehab unit for a few days. She was very passionate about what PM&R can offer, and so it was hard not to fall in love with it as a result. The process from that point on was actually ruling out that I liked other things more throughout my rotations in 3rd year, and even though I loved just about everything else, I kept getting drawn back to PM&R. The focus on functional outcomes and recovery is one of my favorite parts, because we as a team can get really excited for a patient when, for instance, they can navigate 3 stairs with PT because that means that they'll be able to get out of their house and into the community once they leave us. It's often a very different focus from what the rest of the hospital cares about, and I love that.