Confused

[Lostin_space]

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I'm looking for some advice from those of you in our great field. I am feeling blue regarding my situation. I'm in a PMR program that's considered excellent on paper, but in practice doesn't always feel that way. It's extremely rigid in one sense, yet rules seem to constantly change to the point where everything becomes frustrating. Call schedules are set in "stone" yet at other times they change without notice in an instant. Some people get great rotations, others get crap. Theres no consistency from year to year of what rotations are supposed to be done.

Looking for thoughts as to what to do here.

 

[lejeunesage]

1. Sorry about your situation. It sucks feeling like you're stuck in a program you're not necessarily in love with. And it sucks even more feeling that certain unflattering aspects of your program were hidden to you when you were interviewing.

2. That said, beware of grass-is-greener-on-the-other-side syndrome. Every program will have some great and not so great features about it.

3. As I see it, you basically have 3 options:
a. Stay put and try to change the program from within. Apparently, from what you're describing, this is not really a possibility.
b. Stay put, put your head down, graduate, and do a fellowship to compensate for your perceived deficits in procedures or peds exposure or whatever it is that you want more of. It might be a longer road but it's safer than quitting.
c. Quit.
i. Quit and leave clinical medicine. It seems silly but it's been done. You're not board certified so your opportunities, say getting a JD or MBA might not be as great as if you'd been board certified.
ii. Quit and switch programs. Go to residentswap.org, pay the fee to register, and see what programs are open out there. There might be one or 2 programs that might be open elsewhere in PM&R, and you might or might not have to repeat a year. The problem is that there's a reason those spots are open. Maybe they were just silly and overconfident and didn't interview enough people. But maybe they made someone else's miserable, in which case you might take all the risk of leaving your program without incurring any benefit.
iii. Quit and try another specialty, say Occupational Medicine or Preventive Medicine?

To make a long story short, you've always got options; they just might not be the options you want.

 

[Jitter Bug]

How far into residency are you?

 

[lobelsteve]

Keep your head down, mouth shut, and show up. Just do your job. You will be out after 3 years with a piece of paper. Start deciding where and what type of practice you want. Turn to these forums for support and info.

In 2003 I was the resident and the RRC came to town. I did not take my own advice. Almost fired as a chief resident from the program. Almost lost my fellowship. Almost went crazy. More crazy.

 

[RUOkie]

Listen to Steve.

I learned more in my first 3 months of clinical practice than I did in 4 yrs of residency. Even if you don't enjoy clinical medicine, you really want to finish a residency to advance your career in whatever you choose to do.

 

[Lostin_space]

Listen to Steve.

I learned more in my first 3 months of clinical practice than I did in 4 yrs of residency. Even if you don't enjoy clinical medicine, you really want to finish a residency to advance your career in whatever you choose to do.

When you say clinical practice do you mean when you were out as an attending?

 

[RUOkie]

When you say clinical practice do you mean when you were out as an attending? I just feel like I don't learn anything. .

Yes. But since most of us are not academics, we don't call ourselves "Attendings". We are just doctors.

If you aren't learning anything, READ, READ, READ. Become self directed in your education. Either try to move to a different program or put your head down and finish so you can do a fellowship.

Back in the old days MSK medicine was an afterthought in PM&R programs. But people still learned. They applied their knowledge of anatomy and muscle physiology to develop novel treatments for MSK problems.

 

[lossnwilderness]

You are not alone. It could be worse where you are in an environment where your attendings are bullies and degrading in addition to lack of learning and horrible rotations. Things will get better...when you graduate. I agree with option 3b above otherwise you will end up in the same situation as Steve.

Care more about what you will be doing after you graduate than what is going on in residency. Do a fellowship to make up for your deficits. Don't quit. It is only 3 years. It will seem long, but will be over before you know it. Did I mention you should do a fellowship?

Reading can only get you but so far in training when you are not able to apply it with guidance. That is what training is for. Otherwise, we could go from medical school to practice. Did I mention, do a fellowship? So quit asking for more, act like you're content, and get some good letters of recommendation and move on.

 

[Jitter Bug]

Hence my Q about how far along you are. If you are just PGY-2, worth considering changing residency. But you must first find an open PM&R slot, and successfully apply for it. All very quietly. This pathway is difficult because there aren't many open slots.

If you are farther along, then you should stay and get it done. Remember being the 'warm body to do all the work" means that some day you will be able to do all the work alone, which is good training for real life when you will be alone doing all the work. If your attendings won't give you guidance, then you need to read, attend lectures (there must be some, its a GME requirement of all programs). If you round at the crack of dawn, you should be free later in the day to hit grand rounds for other departments: ortho, medicine, etc. Are there any private practice PM&R docs in your town? Even if you can't formally rotate with them, maybe you can buy somebody lunch one day and ask about how to become proficient in different areas. Or use your vacation time to spend a week working with a private doc. You won't get academic credit for it, but you may learn something. Your malpractice won't cover you, so you can't do procedures or see patients independently this way, but you can shadow and pick someone else's brain. Focus on resources outside your residencies: study material aimed at your PM&R boards. Make a study group with your fellow residents. Surely they are frustrated too and you can work together to figure out important topics.

I know this is not what you want to hear. But you can't make your attendings suddenly develop a work ethic and a love of teaching. You have to look out for yourself and figure out how to get what you need from this residency. Without pissing anyone off too badly. If they were physically or emotionally harassing you or asking you to commit fraud, that would be one thing. No-one cares about benign academic neglect.

 

[100YardDash]

Lostin_space. I'm a PGY-4. I think everyone is giving great advice here. I agree with Dr. lobel.. Head down, mouth shut, and finish. Every program has its negatives., attending who don't teach, inconsistency with rotations year by year and timing of rounds etc. Just hang in there. PM me if you'd like to talk more.