Application Advice

[zenmedic]

Hi everyone,

I am a fourth year medical student in a bit of a dilemma. Throughout medical school I always thought I would do PM&R, due to enjoying working with one in my gap year. My entire CV is centered around PM&R related extracurriculars and leadership. I am on my first PM&R sub-I right now, but I find myself not enjoying it as much as I hoped. I loved my psychiatry rotation and keep thinking it may be a better fit for me. My question is, will my PM&R centered CV look strange to program directors and prevent me from getting into a decent program? I have considered the option of omitting my PM&R activities, but I think that may look like I haven't been engaged in extracurriculars throughout medical school. For reference, I am a US DO with a 222 on step 1 and a 259 on step 2. I do have a LOR from my psychiatry rotation that is quite strong.

Thanks for any advice!

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[SubzDoc]

I think you will be fine leaving the PM&R stuff in the app. When you go on interviews, if the amount of PM&R experience on the application comes up, I would just say what mentioned above. I think it's a good and genuine narrative, went in thinking one thing, came out thinking another. If anything, the PM&R experiences will show that you are energetic, involved, willing to go above the minimum. It might look a bit odd if some of the other letters specifically mention they are recommending you for PM&R.

 

[zenmedic]

I think you will be fine leaving the PM&R stuff in the app. When you go on interviews, if the amount of PM&R experience on the application comes up, I would just say what mentioned above. I think it's a good and genuine narrative, went in thinking one thing, came out thinking another. If anything, the PM&R experiences will show that you are energetic, involved, willing to go above the minimum. It might look a bit odd if some of the other letters specifically mention they are recommending you for PM&R.

Ok great. Thanks a bunch, doc!

 

[splik]

You should address this in your personal statement with a compelling story, otherwise people may think you are double applying. You also need to do a psych sub-i to show some commitment to specialty. But many people decide they want to do psych late in the game, you just need to be a competitive applicant and have a good explanation of why.

 

[OldPsychDoc]

I really think that admins, PDs, and students should ditch the stigma over "double applying" in this market.

How the hell is someone supposed to know with absolute certainty what they want to spend their life doing when they're 26 years old and have only basically been "pretending" to do any of those specialties with real people AT BEST for 4-6 weeks??? In a pandemic??? And you're supposed to convince me that you're perfectly suited for this now in a freaking teleconference, in a 20 minute interview???
It's ridiculous.

Look, if you're still waffling between IM and Psych, let's talk about it! Let me hear about what you like about each. Still wondering about ENT? Neuro? That's interesting. What are the pros and cons? But hey, here you are today, applying for psych...why is that? Must be some genuine interest here...

OP at least was pulled toward a specialty that has some obvious commonalities with psych (if they can't tell us what they are, then maybe they really are in trouble...) and as @SubzDoc says, they can make a good story of it, explain their thinking, talk about how they hope to approachnn patients in the future, etc. And BTW, NO WAY should you be thinking about taking out extracurriculars that you've actually participated in. No one emerges from the womb ready to pursue their life calling, and ONLY THAT, single-mindedly! I spent 6 years in ministry. 5 years in a neuroscience lab...could I have been more efficient about getting where I am? (Ya think?)
Be you.

 

[zenmedic]

I really think that admins, PDs, and students should ditch the stigma over "double applying" in this market.

How the hell is someone supposed to know with absolute certainty what they want to spend their life doing when they're 26 years old and have only basically been "pretending" to do any of those specialties with real people AT BEST for 4-6 weeks??? In a pandemic??? And you're supposed to convince me that you're perfectly suited for this now in a freaking teleconference, in a 20 minute interview???
It's ridiculous.

Look, if you're still waffling between IM and Psych, let's talk about it! Let me hear about what you like about each. Still wondering about ENT? Neuro? That's interesting. What are the pros and cons? But hey, here you are today, applying for psych...why is that? Must be some genuine interest here...

OP at least was pulled toward a specialty that has some obvious commonalities with psych (if they can't tell us what they are, then maybe they really are in trouble...) and as @SubzDoc says, they can make a good story of it, explain their thinking, talk about how they hope to approachnn patients in the future, etc. And BTW, NO WAY should you be thinking about taking out extracurriculars that you've actually participated in. No one emerges from the womb ready to pursue their life calling, and ONLY THAT, single-mindedly! I spent 6 years in ministry. 5 years in a neuroscience lab...could I have been more efficient about getting where I am? (Ya think?)
Be you.

My reason for switching has less to do with the actual pathology of PM&R and more of how the specialty was practiced on a day to day basis. On inpatient rehab it really feels like we're glorified social workers a lot of the time. I haven't gotten the feeling that we're really helping our patients. The physical, occupational, and speech therapy seem to be the ones that are really helping them. Additionally, a pain fellowship was always an interest of mine, but on my outpatient pain day the attending dissuaded me from pursuing pain, as every year Medicare tightens up on what pain docs can and can't do. You used to be able to do 6 epidurals per year on a patient, now it's 4. You used to be able to use radiofrequency ablation for post herpetic neuralgia, but now it's phased out completely. And for some reason, the actual literature for pain never seems to support what the physician does.

On psych I loved helping stabilize acutely psychotic and manic patients. It really was the most amazing thing I have ever seen. Seeing patients come in that unstable and over the course of their hospital stay become stable was incredible to me. It has a similar ethos to PM&R as well, instead of rehabbing the body we are rehabbing the mind. The physician-patient relationship on psych felt more intimate and meaningful, which I liked. I also appreciate how psych is less resistant to changes in government regulations, with the option to open a cash only practice.

It's a tough decision, though. Part of me feels like whatever choice I make there will be a part of me that always wonders, what if I had gone the other route. But that's life. Make decisions and adjust accordingly. I hadn't considered dual applying, as psych does seem like the better fit for me at this point.

 

[shoomer]

I really think that admins, PDs, and students should ditch the stigma over "double applying" in this market.

How the hell is someone supposed to know with absolute certainty what they want to spend their life doing when they're 26 years old and have only basically been "pretending" to do any of those specialties with real people AT BEST for 4-6 weeks??? In a pandemic??? And you're supposed to convince me that you're perfectly suited for this now in a freaking teleconference, in a 20 minute interview???
It's ridiculous.

Look, if you're still waffling between IM and Psych, let's talk about it! Let me hear about what you like about each. Still wondering about ENT? Neuro? That's interesting. What are the pros and cons? But hey, here you are today, applying for psych...why is that? Must be some genuine interest here...

OP at least was pulled toward a specialty that has some obvious commonalities with psych (if they can't tell us what they are, then maybe they really are in trouble...) and as @SubzDoc says, they can make a good story of it, explain their thinking, talk about how they hope to approachnn patients in the future, etc. And BTW, NO WAY should you be thinking about taking out extracurriculars that you've actually participated in. No one emerges from the womb ready to pursue their life calling, and ONLY THAT, single-mindedly! I spent 6 years in ministry. 5 years in a neuroscience lab...could I have been more efficient about getting where I am? (Ya think?)
Be you.

Agreed, I decided to apply Psych late in the game and didn't really have an application geared towards it. Yet I'm now applying for a fellowship, so my commitment to Psych is obviously there.

Plenty joke about the parallels between residency interviews and dating, but the need to show "interest" while avoiding desperation is very real. But it's worse since you can only use Bumble and you're contractually prohibited from everything else.

 

[Merovinge]

Just another +1 for changing into psych late. I was able to do Sub-I's but got last pick of them (they ended up absolutely amazing and transformative). Entire application was president of a different specialty interest group, all publications in a completely different field, etc. I was happy to discuss it when it got brought up and I did make it clear I was not dual applying, but if anything it was a positive talking point to help describe where my passion for psychiatry came from.

 

[OldPsychDoc]

My reason for switching has less to do with the actual pathology of PM&R and more of how the specialty was practiced on a day to day basis. On inpatient rehab it really feels like we're glorified social workers a lot of the time. I haven't gotten the feeling that we're really helping our patients. The physical, occupational, and speech therapy seem to be the ones that are really helping them. Additionally, a pain fellowship was always an interest of mine, but on my outpatient pain day the attending dissuaded me from pursuing pain, as every year Medicare tightens up on what pain docs can and can't do. You used to be able to do 6 epidurals per year on a patient, now it's 4. You used to be able to use radiofrequency ablation for post herpetic neuralgia, but now it's phased out completely. And for some reason, the actual literature for pain never seems to support what the physician does.

On psych I loved helping stabilize acutely psychotic and manic patients. It really was the most amazing thing I have ever seen. Seeing patients come in that unstable and over the course of their hospital stay become stable was incredible to me. It has a similar ethos to PM&R as well, instead of rehabbing the body we are rehabbing the mind. The physician-patient relationship on psych felt more intimate and meaningful, which I liked. I also appreciate how psych is less resistant to changes in government regulations, with the option to open a cash only practice.

It's a tough decision, though. Part of me feels like whatever choice I make there will be a part of me that always wonders, what if I had gone the other route. But that's life. Make decisions and adjust accordingly. I hadn't considered dual applying, as psych does seem like the better fit for me at this point.

Well, there's plenty of those feelings ("it's all social work", "I can't do what I really want to do", "the RNs/OTs/SWs/psychologists/etc are the ones really helping", etc.) to be found in psych, or in any specialty these days. I think the nice thing about training in psych is that if you do feel a pull to a "non-standard" (for psych) fellowship--sleep, pain, brain injury, palliative, toxicology--it's still can be open to you if you put in enough work, and your psych training will help a lot. We used to get consulted tons on the acute rehab wards for patients who appeared to be insufficiently motivated to engage in their therapies. Having the experience that the other specialists didn't have with different behavioral disorders will really help you see what is going on more clearly so that you can help them to help the patients.

 

[comp1]

I feel like PM&R won't actually look that odd. I certainly work with PT and OT every day on an inpatient psych unit. It's not a useless knowledge base to be sure. And pain...well, you'll be seeing a heck of a lot of that.

 

[zenmedic]

Thanks for the replies and advice, everyone. I'm trying to set up 2 additional sub-Is to show my commitment to the field. Will try to put a unique spin on my PM&R experiences in my application as well. I'll keep everyone posted on how the match goes...

 

[zenmedic]

Hi all, just wanted to give an update on how everything turned out. I ended up dual applying PMR/psych, ranked psych first, and matched number 1 at my dream program. Most programs liked my background in PMR and thought it was a unique path to end up in psych. I am absolutely thrilled to be a future colleague of everyone and can't wait to start! Also any medical students planning to apply PMR or psych feel free to reach out if you need any help with the process.

 

[OldPsychDoc]

THIS is what this forum used to be.
Thanks, @zenmedic!

 

[zenmedic]

THIS is what this forum used to be.
Thanks, @zenmedic!

Haha no thank you guys for encouraging me to go with my passion!