California PM&R

[SportsMed09]

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Could anyone tell me about the various strengths and weaknesses of the California programs? Inpt/outpt slant? Overall ranks (especially compared to each other)? I've tried looking, and I haven't found one comprehensive place where people have discussed all this.

 

[deleted185747]

I will reply in more depth later but...

#1 UCLA - outpt emphasis / pain emphasis
#2.51 Loma Linda
#2.49 UC Davis
#4 UCI

There are so many variables that go into the decision as to where you want to train... This is not the official list, just my impression as to which program would train me best to get into a pain fellowship / outpatient / EMG

 

[SportsMed09]

I'm looking for a program with an outpt emphasis. At this point I'm not 100% sure of what outpt practice I want to pursue, but at this time I'm thinking I'll be an outpatient oriented physiatrist. What do the outpt California programs focus more on? What fellowships do they offer?

 

[SCIronMike]

I don't think there really is a central place for this information, nor is there an official ranking of programs. I ranked UCI at the top of my list because I thought I could get the best training here. The training is as close to 50/50 outpatient to inpatient as you can get. We have 5 rotations per year, so 15 total. 8 are inpatient, 7 are outpatient. But we do have outpatient clinics during most inpatient months so it all balances out. We have a brand new, gorgeous $2+ million inpatient rehab unit. It is a great place to work, we have tons of new equipment and resources.

We have rotations at a variety of institutions; VA system at Long Beach VA, private hospital at Long Beach Memorial, university setting at UCI, managed care setting at Kaiser.

The strength of this program is EMGs....... the EMG lectures are really strong and the EMG clinic is very well run. We only start doing EMGs our PGY3 year, and halfway through I have logged 140+ EMG/NCS. In my PGY3 year, I have done over 70 interventional spinal procedures including caudals, interlaminars, transforaminals, pulsed radiofrequency, medial branch nerve blocks, facet injections, radiofrequency ablation. One resident per class in the last 3 classes has matched a pain management fellowship. The remainder of the residents have mostly gone to work for Kaiser or private groups.

Our program director is always trying to make changes to improve the program. This year, we added PGY4 outpatient rotations including clinics at the local Kaiser, more spine interventional experience in our new Comprehensive Spine program, and more EMG experience in the PGY4 year.

But the biggest reason that I chose UCI was that when I was a MS4 at USC, I knew nothing about PM&R since we didn't have a department. My faculty adviser saw that I was a Kinesiology major in undergrad and had a big research interest with publications in biomechanics. He told me to look into PM&R and when I called the local programs, only Dr. Evensen at UCI took the time to meet me in his office and discuss the field with me. At UCI, I feel that the attendings really care about teaching me and they have a personal interest in my learning and development. That may be true too at other programs, but I didn't get that feeling when I did my other outside rotations.

 

[ampaphb]

I will reply in more depth later but...

#1 UCLA - outpt emphasis / pain emphasis
#2.51 Loma Linda
#2.49 UC Davis
#4 UCI

There are so many variables that go into the decision as to where you want to train... This is not the official list, just my impression as to which program would train me best to get into a pain fellowship / outpatient / EMG

1) any reason you left Stanford off the list entirely?

2) what do 51 and 49 mean?

 

[olafa]

1) any reason you left Stanford off the list entirely?

2) what do 51 and 49 mean?

sounds like there is a tie for second and for some know reason the OP blieve Loma Linda is a better match for them. Personally I dodn't think so, but thats just my humble opinion. LL is heavy In-pt from what I recall and weak muskuloskeletal/sports/spine etc...

 

[deleted185747]

1) any reason you left Stanford off the list entirely?

2) what do 51 and 49 mean?

I did not get an invitation to interview at Stanford so I don't know much about the program...

Its hard to rank these programs because they all have good things to offer!!! With the future being unknown (darn it) and with pain projected to be less competetive (anesthesia is now reimbursing more than pain so fewer anes going into pain) I have heard that it is easy to get a fellowship. True or not I don't know. I would not risk my future though.

Here is a new question: If you want a california program does it really matter which one? I mean really, c'mon they are all pretty decent- and you get out what you put into a program right??? I have a feeling that there is no simple answer and that anyone who posts will be biased because he/she went thru a program successfully and did... whatever...

 

[GQPMR]

With the future being unknown (darn it) and with pain projected to be less competetive (anesthesia is now reimbursing more than pain so fewer anes going into pain) I have heard that it is easy to get a fellowship. True or not I don't know. I would not risk my future though.

I have to disagree with the comment that pain is gonna get less competitive since anesthesia is getting paid more or comparably to pain. I have talked to numerous anethesia residents at various residencies that said that more than half of their upcoming classes chose anesthesia to go into pain. That is a significant increase in interest within the anesthesia community and really makes things quite competitive for non-anesthesia candidates. That being said if you have done your homework (its quite alot actually) and are really dedicated to getting a fellowship, I think anyone from any of the other 3 specialties (Neuro, Psych and PM&R) can make it into a pain fellowship somewhere.

 

[SportsMed09]

Well, even though the location for all of them is desirable, it does matter to me where I go, simply because i won't get those 3 years of residency back, so i would like to go to a place that will educate and teach me for what I want to do. I was curious about which places had better outpt/msk/sports. I heard UCDavis was the best for this. Anyone who knows better, please help me out.

 

[melancholy]

I'm not inclined to spend paragraphs talking about my own program unless there are specific questions, but I do feel that UC-Davis has its strengths in msk/sports/emg that are easily comparable to other programs and especially in California. I will state a few points that may be different from the programs mentioned above.

- We spend more of our residency on outpatient rotations than inpatient.
- Each half-day on outpatient is spent in a different clinic.
- We do EMGs throughout our three years (when not on inpatient) with 1-2 clinics every week.
- Inpatient rotations are generally either done at the UCD hospital or Shriners (both on the UCDMC campus in Sacramento) or Mercy General Hospital (community/private inpatient) which is about 10 minutes away.
- Most outpatient clinics are at the ambulatory care center on the UCDMC campus, but other outpatient rotations are at the sports clinic (10 minutes), spine clinic (15 minutes), VA (20 minutes), and various Kaiser hospitals around the area.
- We currently take three residents a year. There is one categorical spot and two advanced/PGY2 spots.

--Somewhat off topic of my program but relevant to your question, size of department and residency can make a difference in your program. UCLA and Stanford are larger programs while UCI, Loma Linda, and UCD tend to be on the smaller size. There are pros/cons of more/less residents as well as the attending/resident ratio.


Send me a PM if you have questions about our strengths/weaknesses in specific areas and need more details to help compare to other programs based on your research.

 

[drvlad2004]

I have to disagree with the comment that pain is gonna get less competitive since anesthesia is getting paid more or comparably to pain. I have talked to numerous anethesia residents at various residencies that said that more than half of their upcoming classes chose anesthesia to go into pain. That is a significant increase in interest within the anesthesia community and really makes things quite competitive for non-anesthesia candidates. That being said if you have done your homework (its quite alot actually) and are really dedicated to getting a fellowship, I think anyone from any of the other 3 specialties (Neuro, Psych and PM&R) can make it into a pain fellowship somewhere.

However, there is some truth to what Spinebound said. Anesthesiologists are earning a higher starting salary straight out of residency rather than going into pain management fellowship. In the long run, pain doctors will earn more since the turnover of patients is much higher. I could only speak of my own friends who are in anesthesia. The vast majority of them would rather go straight to practice than going for a pain fellowship. Still anesthesia will continue to the predeominant specialty in pain.

 

[GQPMR]

However, there is some truth to what Spinebound said. Anesthesiologists are earning a higher starting salary straight out of residency rather than going into pain management fellowship. In the long run, pain doctors will earn more since the turnover of patients is much higher. I could only speak of my own friends who are in anesthesia. The vast majority of them would rather go straight to practice than going for a pain fellowship. Still anesthesia will continue to the predeominant specialty in pain.

I am sure doing general anesthesia makes more starting out, but this statement was made based on why these anesthesia residents (major metropolitan area) chose anesthesia as a specialty. What they will end up doing, I have no idea... Maybe they will end up taking that cush, high paying job wherever instead of pursuing a fellowship. This may be better for us PM&R folk who are interested in pursuing pain as a specialty. Either way, my recommendation is to be prepared from the get go starting internship/residency if you are even slightly considering this as a practice choice.