Anyone every switch out of PM&R?

[jt713]

---

Members don't see this ad.

Hey guys,

Just started my PGY-2 year and it is pretty miserable doing inpt rehab. Not learning any MSK medicine but instead I feel like I'm babysitting and doing social work for NS and Ortho patients. Hours are longer than intern year believe it or not, 1-2 admissions a day and discharge summaries are 3 times the length I did in IM . So busy taking care of medicine stuff I have no idea what PT/OT is doing with my patients. Anyone else have this experience?

According to senior residents it gets better but I'm still unsure as my program is inpt heavy. Anyone every switch and regret their choice?

BTW my PM&R rotation was an outpatient clinic and consult service so I had no idea what inpt was like, of course this was my mistake. I learned about the specialty late in the game but loved the MSK and procedures I saw, I was heavily considering Neuro at the time and sometimes wonder if I made the right decision. Any input would be helpful.

 

[Prof Moriarty]

Others have felt your pain. Do a few searches here and you will find some interesting discussions. Here's one: http://forums.studentdoctor.net/showthread.php?t=711050&highlight=inpatient

 

[PMR 4 MSK]

Many of us have felt the same way. When I finished residency, I did 1/2 inpt, 1/2 out pt every day. I felt like I was spinning my wheels every day on the inpt side. eventually I dropped that and went 100% outpt.

You survived 4 years of college, 4 years of medical school and 1 year of intership to get here. You can probably manage to get through another 12-18 months of inpt crap to get where you want.

Think of all the people who spend years in a corporate environment, climbing the ladder for many years. Think of lawyers who spend the first few years working 100+ hour weeks to make partner, doing the crap cases.

If MSK medicine is what you want, stick it out and find a way not to hate your daily schedule. Switching to something else now will only prolong the agony.

 

[Paddington]

You'll get more efficient. Inpatient rehab is a lot harder than it was 5 years ago. I remember when all admissions were guaranteed to come between 11 a.m. and 2 p.m. Then late admissions became more common, then evening and even weekend admissions started to get pushed (not just at the place I was at, but everywhere).

A few years back there were also a lot of orthopedic patients, now there's hardly any. The patients that come are sicker and more complicated. And this isn't the 70's or 80's I'm talking about, I mean literally 4-5 years ago. The expectations for how much stuff you have to document for an inpatient admission, so you can satisfy the Medicare requirements, the hospital requirements, and the billing requirements, have also effectively doubled just in 2-3 years.

Even then, it's still an easier residency than most, even at the large, intense stand alone rehab hospitals.

 

[Fiveoboy11]

Hey guys,

Just started my PGY-2 year and it is pretty miserable doing inpt rehab. Not learning any MSK medicine but instead I feel like I'm babysitting and doing social work for NS and Ortho patients. Hours are longer than intern year believe it or not, 1-2 admissions a day and discharge summaries are 3 times the length I did in IM . So busy taking care of medicine stuff I have no idea what PT/OT is doing with my patients. Anyone else have this experience?

According to senior residents it gets better but I'm still unsure as my program is inpt heavy. Anyone every switch and regret their choice?

BTW my PM&R rotation was an outpatient clinic and consult service so I had no idea what inpt was like, of course this was my mistake. I learned about the specialty late in the game but loved the MSK and procedures I saw, I was heavily considering Neuro at the time and sometimes wonder if I made the right decision. Any input would be helpful.

Perhaps you shouldn't be so concerned about what PT/OT is doing with "your patients." Be concerned with your own job and recognize that PT's/OT's are professionals, not your assistants or helpers to carry out your orders. More specificially, the patient's are getting physical therapy under the supervision of a physical therapist, not you. Physical therapy isn't something you just order, and then people get it.

Maybe this will help you.

 

[Taus]

Perhaps you shouldn't be so concerned about what PT/OT is doing with "your patients." Be concerned with your own job and recognize that PT's/OT's are professionals, not your assistants or helpers to carry out your orders. More specificially, the patient's are getting physical therapy under the supervision of a physical therapist, not you. Physical therapy isn't something you just order, and then people get it.

Maybe this will help you.

woah... you're totally taking the above out of context here and are bringing up an entirely separate and unrelated topic....I really don't think that's what he/she meant..... the above has nothing to do w/ who is supervising who and who "ordered" what.... there's nothing wrong with us wanting to know what kind of things our patients are working on in therapy and how they're doing/progressing.

 

[Fiveoboy11]

woah... you're totally taking the above out of context here and are bringing up an entirely separate and unrelated topic....I really don't think that's what he/she meant..... the above has nothing to do w/ who is supervising who and who "ordered" what.... there's nothing wrong with us wanting to know what kind of things our patients are working on in therapy and how they're doing/progressing.

If that's the case I apologize and I agree that everyone should have a clear picture of what others are doing. Just keep in mind that it's the respective therapists job to make sure a patient is getting the treatment they need as far as PT or OT goes and what exactly they are doing.

 

[Taus]

Hey guys,

Just started my PGY-2 year and it is pretty miserable doing inpt rehab. Not learning any MSK medicine but instead I feel like I'm babysitting and doing social work for NS and Ortho patients. Hours are longer than intern year believe it or not, 1-2 admissions a day and discharge summaries are 3 times the length I did in IM . So busy taking care of medicine stuff I have no idea what PT/OT is doing with my patients. Anyone else have this experience?

According to senior residents it gets better but I'm still unsure as my program is inpt heavy. Anyone every switch and regret their choice?

BTW my PM&R rotation was an outpatient clinic and consult service so I had no idea what inpt was like, of course this was my mistake. I learned about the specialty late in the game but loved the MSK and procedures I saw, I was heavily considering Neuro at the time and sometimes wonder if I made the right decision. Any input would be helpful.

Stick it out.... it does get better. I'm going into pain and have been primarily interested in msk issues from the start, but there really is plenty of good stuff to learn on the inpatient wards while sifting through the bs that needs to get done. You probably won't have dedicated teaching on classic outpatient MSK issues while doing inpatient TBI, SCI, CVA,etc... but that's to be expected- you will have that when you're doing those rotations later in residency.

- You will get more efficient and able to prioritize which medical issues need your attention. See your patients, bang out the notes/dispos/etc and be done with it. I liked things much better when I let me ego go re handling complex medical issues- if things are out of control, but not emergent- no shame in getting a consult. You shouldn't be spending your whole day on diabetes, htn, etc. You should do the basic stuff and initiate proper workups and first line treatment.... but you can't be spending your whole day on that stuff. You're training to be a physiatrist... not an internist. Just get a consultant.

-Once you get the above stuff done... focus on the rehab issues as much as you can. You'll see that there is some relevant stuff that carries over to the outpatient MSK/pain realm.
-You can really hone your neuro/msk physical exam w/ patients who have significant upper and lower motor neuron pathology. You'll pick up all sorts of peripheral nerve injuries, especially on TBI.
-There are also very specific MSK/pain issues that affect the neuro-rehab population- read up on hemiplegic shoulder pain, central pain, CRPS, phantom pain, spasticity, etc.
-Bracing/orthosis for foot drop and other issues- a great time to polish your knowledge of anatomy, biomechanics, gait, etc.
- Learn all of the inpatient rehab-specific stuff really well now so you can later focus entirely on outpatient msk/emg/spine/sports/etc when the time comes. If you really liked the MSK/procedural stuff during med school and want to do that.... then why would you quit and do another residency where won't get well trained in that stuff?

I could ramble on.... but bottom line... sticking it out is worth it if you really enjoyed the MSK stuff as a student. The bulk of graduates have been going into MSK and its related disciplines for a while.... you're not alone

 

[mjakec]

I didn't love my PGY2 year but it gets so much better!

I completely agree with Taus. There is alot of MSK that you can focus on during your PGY2 year. I just finished mine and ended up dragging a portable ultrasound machine with me on rounds and looked at a ton of shoulders, knees, ankles, etc.

Even if you intend on doing outpt MSK when you're all done, you still may want to manage some of the bread and butter outpt general rehab pt's so it's worth putting in the time now so you keep the option open of being a "well rounded physiatrist".

 

[jt713]

Thanks for the advice everyone, it is getting a little better but still rough. The reason I started this thread is because I did an elective in neurology during intern year and a spot just opened up and my buddies in the program want me to take it. I really enjoyed the rotation as it was purely consult service with no inpt service in the entire program, everything is admitted to the hospitalist thus no pages for pain, constipation, social issues. Just write your recommendations and the primary team can worry bout the rest. Also i have an interest in sleep medicine with a fellowship available in the program. So sometimes when I'm dictating a 5 page discharge summary and being paged multiple times during my dictation, I think about that open spot. Why be an "intern"' again when i can be a specialist now.

As for the PT/OT line in my post, what I meant was that I wish had more time to shadow and observe the therapist to see how the patient is progressing. However this is limited by the scut I have to do. It wasn't meant to be disrespectful, I can't count the amount of time I've been amazed by how far along my patients have progressed. I just wish I had more time to participate in their therapy.

 

[PMR 4 MSK]

As for the PT/OT line in my post, what I meant was that I wish had more time to shadow and observe the therapist to see how the patient is progressing. However this is limited by the scut I have to do. It wasn't meant to be disrespectful, I can't count the amount of time I've been amazed by how far along my patients have progressed. I just wish I had more time to participate in their therapy.

I believe that going down to the therapy gym is an integral part of a Physiatrist's training. You have to be able to see what the patients are doing. You have to learn how therapy works, how therapists do what they do. As a doc, your job is to control the medical conditions be the team coordinator.

You should have time to see them in PT, OT and SP. You should be able to go see them have swallow studies. If you have a pt with suspected PE, you should be allowed to go see the VQ scan, spiral CT or whatever is being done, and learn from the radiologist how they read it. At the least, your attendings should review the images with you.

 

[deleted185747]

http://youtu.be/BibYFX-6-Rc

 

[thecgrblue]

http://youtu.be/BibYFX-6-Rc

Hahaha, "Dry your tears, they contain electrolytes."

 

[Jitter Bug]

Holy crap that's funny