Considering PM&R as backup, advice please.

[just in time]

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I am starting a prelim year in surgery next week hoping to match into ortho in 2010, but I must have a backup as I am an IMG and didn't match into ortho last year. Here are my stats and questions follow:

Step 1 = 240
Step 2 = 233
2 to 3 publications (1 first author this year)
Basic sciences top 10% of class
Caribbean medical school

Question #1: Aside from acceptance to a mid-cycle PGY2 opening outside the match, if I apply to a 3 year program and match in 2010, I must sit out a year before I start PM&R, correct? (remember, I am fulfilling my PGY1 year now with prelim surg)

#2: I did not do a PM&R rotation in medical school, but I can probably get a letter from the chair of PM&R at the institution where I am interning now by scheduling some face-to-face meetings (not that it will mean a lot without a rotation). Does the lack of rotation matter? If yes, what to do?

#3: My family and I want to be in California. I've looked at west-coast programs. I do not see any IMGs in the "current resident" lists. Will my IMG status preclude me from acceptance into a west coast program? (does anyone even really know the answer to this?) Likewise, will my IMG status preclude me from acceptance into a top-tier program. (Seattle, Mayo, Baylor, Chicago, NJ?)

#4: How often do PGY2 positions become available throughout the year? I see the Wisconsin post for a PGY2 spot in early June. Residency swap "appears" to have 3 PGY2 spots listed currently, but I m not willing to pay the $30/month to look right now. Are these anomalies, or somewhat regular occurrences?

#5 Finally, does anyone have suggestions for how to approach the personal statement and interview when PM&R is a backup, and you really are interested in it - but only as a second choice to ortho? I fear being honest about that preference is not beneficial to matching to a program. They are looking for 100% dedication to their field, right...?

Thanks for your help.

 

[topwise]

I'll answer a couple of these:

PM&R spots seem to open up sometimes during the year for whatever reason (new funding, interns dropping out), so you may have a chance to start your PGY2 year in 7/2010 by going outside the match. This is very common. You can try calling programs you're interested in to see if any spots open up.

As for the California programs, I know that in my three years at Stanford, I have not seen any IMGs. That is not to say that the program would not take IMGs (I have no idea), but there have not been any in five straight classes of residents.

Certainly it's a little troubling that you haven't done a PM&R rotation and you're only considering PM&R if you can't get into ortho. I suggest that you learn more about PM&R before you start to apply. Figure out why (and if) you want to do PM&R, other than "can't match in ortho".

 

[Ludicolo]

Question #1: Aside from acceptance to a mid-cycle PGY2 opening outside the match, if I apply to a 3 year program and match in 2010, I must sit out a year before I start PM&R, correct? (remember, I am fulfilling my PGY1 year now with prelim surg)

#2: I did not do a PM&R rotation in medical school, but I can probably get a letter from the chair of PM&R at the institution where I am interning now by scheduling some face-to-face meetings (not that it will mean a lot without a rotation). Does the lack of rotation matter? If yes, what to do?

#3: My family and I want to be in California. I've looked at west-coast programs. I do not see any IMGs in the "current resident" lists. Will my IMG status preclude me from acceptance into a west coast program? (does anyone even really know the answer to this?) Likewise, will my IMG status preclude me from acceptance into a top-tier program. (Seattle, Mayo, Baylor, Chicago, NJ?)

#4: How often do PGY2 positions become available throughout the year? I see the Wisconsin post for a PGY2 spot in early June. Residency swap "appears" to have 3 PGY2 spots listed currently, but I m not willing to pay the $30/month to look right now. Are these anomalies, or somewhat regular occurrences?

#5 Finally, does anyone have suggestions for how to approach the personal statement and interview when PM&R is a backup, and you really are interested in it - but only as a second choice to ortho? I fear being honest about that preference is not beneficial to matching to a program. They are looking for 100% dedication to their field, right...?

#1 Yes.

#2 The lack of a rotation will matter to good programs. And as you alluded to, a LOR from someone you haven’t directly worked with is kinda useless. Is there any way you could do a rehab elective early during your prelim surgery year? Ortho, urology residents often rotate through SCI rehab rotations as part of their residency education. Perhaps the PM&R chair could help you out in this regard.

Your performance during intern year and your subsequent prelim surgery PD's letter can help sell you to rehab programs - you should be honest to him/her that you are looking to both ortho and PM&R.

#3 Can’t speak for the west coast. IMG status in and of itself doesn’t exclude you from any program, but your overall application package will need to be stellar, and a lack of rehab exposure is a knock against you.

#4 Positions do open up. Additional funding comes through. Residents, during their prelim year, sometimes have a change of heart and decide to pursue something other than rehab. Or – some residents matched into PM&R as a backup and during their internship they find and land an open residency spot in their original first choice specialty. It's not uncommon. You’ll need to keep your eyes and ears open.

#5 Good programs are looking for committed residents. Perhaps you could emphasize your love for musculoskeletal medicine. You could acknowledge the fact that initially you were interested in ortho, but it just wasn't meant to be, and eventually came to realize that rehab was the field for you, albeit a bit late. But without anything on your transcript or your LORs to back up your statements, your words may ring hollow.

 

[Llenroc]

PM&R is not that easy to match into. The day to day work also has about zero in common with orthopedic surgery, despite the popular belief that it's a poor man's ortho or whatever. They're alike maybe in the sense that Neurology and Neuro Surgery are alike, but probably even less so. So I would explore why you actually want to go into the field.

PM&R can be a tough match, especially for IMG's. Don't let the board scores fool you. If you're just looking for safe backup, Internal Medicine, Psychiatry, and Family Medicine might be better bets. Your board scores, class rank, publications, etc. None of that stuff matters now. You're an IMG in a Prelim Surgery spot. As you will find, from that spot it's a tough progression to anything, much tougher than you seem to realize it is right now.

 

[Octagonecology]

Seems kind of insulting to those who have dedicated their careers to physiatry which is a competitive specialty that you simply consider it your "backup". But that's just me.

 

[drvlad2004]

I do not think that PM&R is a safe backup anymore. The number of applicants have significantly grown higher year after year. I personally medical students who have been interested in PM&R since their 1st year. It is safer to say that the vast majority of applicants now apply for physiatry positions as their first and only choice. California PM&R programs are very competitive to get into. I am a New Yorker and it was easier to land interviews in NY and the northeast for me. There are a small number of California programs and they tend to stick with their state residents, mainly AMGs. Also, there are many open spots in CA. You might have better luck in NY, PA, or Illinois. I think PM&R crosscuts several specialties such as Ortho, Neuro, and Rheum. However, there is not as much direct connection with those specialties with what we do as physiatrists in our practice.

You really need to do a rotation because most programs will not take you seriously at all. Do your homework and research. Take time to really think why PM&R is the right fit for you.

 

[imagoodmanyea]

There have been several students in my medical school who did not match in PM&R, and this is from an American medical school. Others have not been able to obtain their #1 or even dropped down to #5 on their rank list. Our specialty is going through a transition where it needs to redefine itself in both its perception to other specialties and to the public in general. The last thing PM&R needs is uncommitted applicants who would rather match into another specialty.

 

[drvlad2004]

There have been several students in my medical school who did not match in PM&R, and this is from an American medical school. Others have not been able to obtain their #1 or even dropped down to #5 on their rank list. Our specialty is going through a transition where it needs to redefine itself in both its perception to other specialties and to the public in general. The last thing PM&R needs is uncommitted applicants who would rather match into another specialty.

Thank you. There are many of us who take our field seriously and show pride for it.

 

[Disciple]

PM&R is not that easy to match into. The day to day work also has about zero in common with orthopedic surgery, despite the popular belief that it's a poor man's ortho or whatever.

True, for parts of the training, but you're forgetting that a significant number of Physiatrists ending up working in Ortho groups, full-time.

 

[axm397]

Question #1: Aside from acceptance to a mid-cycle PGY2 opening outside the match, if I apply to a 3 year program and match in 2010, I must sit out a year before I start PM&R, correct? (remember, I am fulfilling my PGY1 year now with prelim surg)

yes

#2: I did not do a PM&R rotation in medical school, but I can probably get a letter from the chair of PM&R at the institution where I am interning now by scheduling some face-to-face meetings (not that it will mean a lot without a rotation). Does the lack of rotation matter? If yes, what to do?

yes - the lack of rotation will matter to all but the lowest tier programs. A PD's worst nightmare is a disgruntled resident who may or may not quit in the middle of residency. Your lack of rotation increases that risk. An insincere letter from a chair of PM&R who can't comment on your clinical abilities will not help your case much.

#3: My family and I want to be in California. I've looked at west-coast programs. I do not see any IMGs in the "current resident" lists. Will my IMG status preclude me from acceptance into a west coast program? (does anyone even really know the answer to this?) Likewise, will my IMG status preclude me from acceptance into a top-tier program. (Seattle, Mayo, Baylor, Chicago, NJ?)

Your IMG status will not preclude you but your lack of rotations and LORs will preclude you. California is competitive because of location. You will be competing with AMGs from some of the better med schools in the country (especially the UC schools). Your board scores and couple papers won't help your case much either - many of the top tier programs have applicants who are AMG AOAs and MD PhDs with PM&R relevant research.

#4: How often do PGY2 positions become available throughout the year? I see the Wisconsin post for a PGY2 spot in early June. Residency swap "appears" to have 3 PGY2 spots listed currently, but I m not willing to pay the $30/month to look right now. Are these anomalies, or somewhat regular occurrences?

There are some PGY2 positions that do open up but there's no consistent pattern that I have seen over the past few years. Your best bet is to scramble into a PGY2 spot outside of the match if you don't want to waste a year. However, the pickings will be slim and there will be unmatched AMGs competing for those spots.

#5 Finally, does anyone have suggestions for how to approach the personal statement and interview when PM&R is a backup, and you really are interested in it - but only as a second choice to ortho? I fear being honest about that preference is not beneficial to matching to a program. They are looking for 100% dedication to their field, right...?

You would have to make a really good case for why you "really are interested" in PM&R without doing a rotation. I think you might have an idea of what PM&R is but you will be unhappy and disappointed in residency if you think of it as "ortho-lite". More importantly, you will have a hard time convincing a hard-core academic physiatrist that you are sincerely interested in PM&R when you don't have experience rotating through inpatient rehab and working with disabled patients.

so bottomline - if u don't match ortho this year - you might match in a lower tier PM&R program probably not in the location that you want - or you can chance it and try to scramble into a PGY2 spot - or take a gen surg, IM, or fam med spot that may open up in the location that you desire.

 

[njdevil]

You have a lot of red flags for a PM&R program. I think you should either explore this speciality and give it, its due respect like I am sure you did for orthopaedics with rotations in which you showed up early and left late and read all night, trying to get good letters of recommendation or move onto a speciality you have been exposed to during medical school/internship that you liked. To fit this in you will need an elective during your internship or during vacation time, weekends or when your clinical load is light.

As a non-US student that wanted a US residency in orthopaedics, I am sure you knew you needed a back-up and apparently during school it wasn't PM&R or you would have more experience. You can't hide your lack of interest in an application and interview.

Honestly, you need to access your professional situation. Good luck.

 

[just in time]

I have read everyones responses and take the advice to heart.

The surgery program director where I am interning is allowing me to do a one month rotation in the PM&R program here in October (instead of Trauma, lucky me). It is a little late, but I will still be able to use LORs from here and include mention of the rotation in my personal statement.

Unfortunately, I did most of my medical school rotations at a community hospital that lacked PM&R. I really did not know much about the field until after I locked in my elective rotations. I know I am a "late bloomer", but I am doing all I can to make the right choices for my career and my family.

Thanks again,

JDM

 

[njdevil]

Good luck.