anyone here do one of the PM&R/IM programs?

[oreosandsake]

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last i checked there are only a handful of these around. I remember hearing in person as well as reading on SDN that the residents that chose more taxing PGY1 years were grateful for it during their residencies because they felt better prepared to handle medicine issues.

What about outright doing a combined program?

Since physiatrists are often the PCP for people with disabilities, do any of you wish you had gone through a combined PMR/IM program?

also soliciting comments on motivation, training experience, regrets, employment outcome, etc.

thank you.

 

[dc2md]

oreo,
here's my rather uneducated thoughts on PMR/IM programs. the only advantages i see are if you plan on doing inpatient rehab for sure (TBI, SCI, CVA)...especially if working at a standalone rehab hospital. if you're going to do pain or msk i wouldn't waste those years of your life. if you plan on being the PCP for people with disabilities you'll be fine with what you learn in the regular 4 years of PMR.
we used to have a combined program at LSU but not anymore. i think east carolina still offers that as an option. don't know if any other programs do.
i couldn't imagine your income would be any higher though...unless you do some IM or ED moonlighting on the side.

 

[Jumpu]

MCW also used to have a PM&R/IM combined program a few years ago, now discontinued. When I inquired about the possibilty of resurrecting the program while interviewing last year, the administration was not in favor of it.

 

[fozzy40]

Most people who are in dual residencies that I've talked to seem to feel that you kind of get average training/exposure to both versus great training in either. I'm probably one of the weird ones but I absolutely love inpatient medicine. I thought about the dual programs but decided to dedicate my time into one specialty. Medicine is hard enough to learn in 3 years so I wonder how much you can actually absorb in a dual program. My feeling is just make sure to get into a preliminary medicine program or some program exposes you to a lot of medicine and you'll be okay. As a physiatrist, you will have to be able to manage basic medical problems which you can learn in one year and cultivate in the years to follow. Past that, you can always just stay up to date on the latest guidelines. If your patient's medical problems get out of this realm, there should probably be more than one person involved in their care.

 

[oreosandsake]

thanks to all of you for the input.

it's great to get advice like that from residents that have also considered the same thing.

I had noticed that the programs were few, far between, and didn't seem to be very popular so I had to ask.

One more Question:

I've shadowed a number of physiatrists and I've never seen one write a prescription for diabetes, blood pressure, etc.

How true is it that physiatrists end up being the PCP for patients with disabilities? (yes, I understand there are situations that this can occur as stated above. But is it the norm?)

 

[dc2md]

sure, some physiatrist definitely become the PCP of patients they saw on their inpt service. but don't worry about diabetes, HTN, and other basic conditions...you'll learn plenty of that with your training. anything too complicated and you'll just refer to a specialist like other PCPs do.

 

[doctobe2]

One more Question:

I've shadowed a number of physiatrists and I've never seen one write a prescription for diabetes, blood pressure, etc.

How true is it that physiatrists end up being the PCP for patients with disabilities? (yes, I understand there are situations that this can occur as stated above. But is it the norm?)

I also have noticed this trend and since I love inpatient and internal medicine type things I asked one of my attendings and he basically told me that the reason a lot of physiatrist ( himself included) refer patients out for most of their medical needs is twofold:

1) Most of the physiatrist patients come by way of referal especially in private practice and therefore if you want to keep on getting these referals you have to do something for the PCP in return I.e consult the IM docs for medical mangement.

2) Some physiatrist after many years of practice don't keep up with the latest IM type treatment reccomendations and the latest literature on approach to medical management and as a result they tend to consult IM service a lot so as to make sure their patients get the best treatment.

That being said, I would like to get some other view points on this and would appreciate it if some of the attendings on this forum can share their opinions on this topic. Thanks

 

[pirate]

I do not know that any of these officially exist anymore. I last looked a year ago, and the only things listed in FRIEDA were Buffalo and ECU. I heard Buffalo did not have spots last year. I know for a fact that ECU does not have a de-facto program looking for applicants every year. (I went to school here, and am doing residency here as well.) There is one resident (who graduates this year) who is IM-PMR. I have talked with both program directors, who would be supportive if I wanted to do this. But it requires a lot of paperwork petitioning both boards to approve of the curriculum. Granted, it is easier since some groundwork has already been done. But it is a case-by-case basis. Curriculum is 5 yr, 1st year all IM, 2nd is all inpatient rehab, then alternating 3 month blocks of medicine and pmr.

For me, my residency decision came down to medicine and rehab. I really like inpatient, which guided me to a prelim medicine year rather than a categorical pmr spot. I've thought long and hard about this in the past, and still think about it. It's still an option, but I would have to make a decision relatively soon, as I would have to start some paperwork this summer.

I certainly see physiatrists who are PMDs for TBI or SCI patients, and certainly in peds. As far as managing other comorbidities such as DM, HTN, etc, it seems to be based on personal comfort.

The reason I think these programs dont exist anymore is based on how inpatient rehab is structured/reimbursed. If you have somebody on an inpatient service and they have ACS or CVA or GI bleed, it doesn't matter that you know how to manage them- they are going back to the acute hospital because they can't participate in their "intensive inpatient rehabilitation program" and insurance won't reimburse you for that service.

 

[Llenroc]

thanks to all of you for the input.

it's great to get advice like that from residents that have also considered the same thing.

I had noticed that the programs were few, far between, and didn't seem to be very popular so I had to ask.

One more Question:

I've shadowed a number of physiatrists and I've never seen one write a prescription for diabetes, blood pressure, etc.

How true is it that physiatrists end up being the PCP for patients with disabilities? (yes, I understand there are situations that this can occur as stated above. But is it the norm?)

Shadow some physiatrists that work in inpatient units. They spend a lot of time managing diabetes and blood pressure.

I'm not a big fan of combined residencies, but I think IM/PM&R is one that actually makes a lot of sense if you want to do inpatient. The doctors that I've worked with that did IM/PM&R or were IM doctors in their home countries and later trained in PM&R knew a lot more about managing patient's medical issues that the average physiatrist, and inpatient is all about managing medical issues.