applying to PM&R and IM?

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pirate

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I've been reading for a while and finally need some help that I can't find a good answer to elsewhere.

Like several folks in the past, I'm trying to decide between IM and PM&R. I've been about 50-50 since 1st year (I'm 4th year now). I know about combined programs, and am still considering that route. Whether they would consider me is another issue 🙂

But my question is about applying for multiple programs. My plan was to get my application out as early as possible, then hopefully after another month of PM&R in Oct, I would be able to make a decision and turn down any interviews in whichever field I ruled out. But unlike someone applying for categorical spots in IM and say radiology, rehab complicates matters by having 3 and 4 year programs. So I would be applying for PM&R spots, as well as prelim and categorical medicine spots. My impression that it is frowned upon, especially if the two disciplines are dissimilar. For me, I want to care for elderly patients in an inpatient setting, so I think they complement each other. But PDs might not. Will they think its fishy if I'm applying for prelim and cat spots even if they don't know about the PMR interest?

Unfortunately, not a lot of people around here that can give me good advice here beyond "you need to figure out which field is best for you". I hate to be forced into a life-altering decision based on 2 weeks of rehab becuase I can't get back there until later in the application process.



If this would be more appropriate in the general residency forum, I apologize in advance.

thanks for your input
 
i doubt applying to IM and PM&R would be frowned upon by rehab folks. generally the applicants going for ortho and trying to use pm&r as a back up is what we watch out for.
 
Not sure how that works applying to both. To reasure you, there are alot of attendings/residents who have done IM then came to PMR. Another option you may consider is to do a geriatrics fellowship. You may have to look into weather or not you can also sit for that board because I think typically its done by FP/IM. An options also is to do the fellowship, it shouldn't mater about board cert, you have the knowledge.
 
i doubt applying to IM and PM&R would be frowned upon by rehab folks.

I'm less worried that rehab folks would frown upon me applying to IM, more worried about what IM folks would say to me applying to both prelim (if I do PMR) and categorical (if I eventually decide medicine) positions.

The other option I see is initally applying to PM&R programs, with the idea that there are fewer spots and I need to be in the game earlier. Then if in a couple of months I decide it's not for me, I could work on a medicine categorical position.

I hate the fact that we don't have 3rd year electives and many of us are making blind decisions because we think we want to do something but don't have enough experience to accurately judge. Of course, I can work on changing the system later. What's important is fixing my problem now 😉
 
pirate i hear you man, the system is too inflexible... the advantage is job security, the dis is the inflexibility if your personal or professional interests change.

you want to take care of elderly inpatients? both areas will let you achieve that desire. but more specifically, what kind of issues do you want to take care of? does it turn you on to help a patient improve functionally, overcome musculoskeletal or neurological limitations, and get back to living on their own as best as possible? Do you work well letting others help you as part of team? If you think 'Hella ya' then go into inpatient PM&R.

Or would you rather help stabilize those who are acutely ill, with severe medical problems through diagnostic testing and pharmacology. These are the different leans of the fields.

I would apply to the prelim positions and not the categorical positions, unless you are firmly decided on IM. Or at least you are right, don't apply to prelim and categorical at the same program or they will be very confused, at least as confused as you hahah... then take the beginning half of fourth year to decide as you do not actually have to rank until 2nd half of 4th year.

anyway, if you get hooked on IM during your prelim, you might even be able to stay on with your program as pgy-2. I am a transitional year now. At my program, the upper level residents keep asking me so did we convert you yet to IM? Actually for my tY year I have chosen mostly IM electives, so it would not be entirely impossible to change the mind and have the electives count towards completion of the 3 year IM residency. Still, it is a **BIG** pain to get out of a match contract if the PM&R prog director does not agree to it. You would have to plea to the NRMP, who could banish you from future matches fellowship or other prog's in the future... for life... sounds ridiculously serious doesn't it?? I know someone (not from pm&r or IM) who had to go through that process and luckily the nrmp accepted her case and released her even though her PD didn't want to let them go. Most likely though, hope that your pm&r prog director won't be unreasonable and let you out if you change your mind during pgy-1... Welcome to the harsh reality of the NRMP system...

Overall, i think it would be easier to find an open pgy-2 in IM than PM&R... so you might want to consider prelim and then PM*R with the idea that it would be easier to get out of pm&r and re-apply to IM than the other way around. Or just finish one residency then apply to another!! I know a bunch of people who change around... hematologist go back to fellowship turned into ID specialist, rheumatologist in another country starting over from square 1 in IM to practice in the USA... another guy who finished IM in India, then did residency in UK for awhile then came to USA... suddenly a 5 year combined IM/PM&R doesn't seem like it's that bad... think long term. businessman turned into psychiatrist... career changes are more and more common these days... even though are still difficult in the field of medicine because of the lengthy training committments

so, go with your gut decision, and realize even if it doesn't work out, there still might be a way to change tracks in the future if you are unhappy.

best of luck
 
there is nothing written in this space <--- sorry how do you delete i only see the button for "edit."
 
IM is a very needed specialty and I respect IM docs. However....

YOU ARE CRAZY IF YOU CHOOSE IM OVER PM&R!

As an internist you can look forward to up to 100 hour weeks with a possible steady decline of income year by year with plenty call the rest of your life. My advice to you is talk to some attending level internists that are not at academic programs to get some good advice.

PM&R is sweet! You can work part time to 100hrs/week (YOUR choice). You can do outpatient musculoskeletal the rest of your life or inpatient spinal cord injury. You do not need to obtain a fellowship to have a nice life (such as the internists fighting for GI or allergy fellowships). You can make pretty good money for the work right out of residency (start at $150,000 or so with little to no call and 40-50 hr weeks). You get to help people in very significant ways.

If you really LOVE LOVE LOVE IM then do it. I can tell you don't LOVE it due to the topic of your post. Therefore I say do PM&R and have a great career, nice lifestyle, good money and the opportunity to really help people.
 
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