Free standing RIC vs University setting in Seattle

[jonnylingo]

---

Members do not see this ad.

It's seems that residents at free-standing rehab hospitals (RIC) would practice more "pure" rehab medicine, vs. residents in an inpt setting within a large university hospital (Seattle) where one deals not only with rehab but also relatively more acute/subacute needs (hypertension, diabetes, INRs, etc.) from pts fresh off of the ortho/neuro/surgical/medicine services. Do any of you who are practicing feel this? Which setting do you prefer in terms of training?

What do you like about free standing vs. in-house rehab?
Is in-house rehab dumping grounds for ortho/neuro/medicine?
What does a free standing facility lack in terms of good inpt PM&R training?

Thank you for any input.

 

[lobelsteve]

Both programs are outstanding. Both have excellent musculoskeletal staff.

1. In my humble training, while the 75% rule was being talked about but not fully implemented, and in a rehab hospital separate from the main hospital in name only (the 9th floor)- we had both in house (med, trauma, ortho, neurosurgery, oncology) and shipped in (SNF, from home, other hospital systems) "dumps" onto our service. I have seen "excellent rehab candidates" as reported from an admissions coordinator nurse come onto the floor with a GCS of 7. Location of the rehab is not as improtant as having the appropriate consultant staff and admissions policies. The payor (medicare) may have changed the way things get done as far as rehab admissions to help limit rehab to those that can participate.

2. Location does not change training- staff does.

The most important thing you can do to help pick the best program fit is determine the practice you wish to enter when done your training. If your focus is on SCI- look at X, Y, Z. If you want TBI, look at A, B, C. Stroke, EDX, amputee, P&O should be well covered at most programs. I can't fill in the blanks as to what programs are best for what- but it will easy to get qualified folks to fill in those variables within a few posts.

 

[rehab_sports_dr]

I don't think free-standing v. hospital based rehab facilities are a particularly useful criteria for judging the quality of rehab facilities and training.

First off, there is a huge variability in what kind of pathology is seen at different facilities. The level of acuity is more a function of the medical director and referral base, rather than whether it is free-standing or not. Certainly places like RIC and Kessler see plenty of serious pathology in their facilities. If anything, when I was a resident at Kessler, I thought they were too quick to take some patients who had too much pathology.

When I was at resideny at UMDNJ, we covered two free-standing rehab facilities (actually 4- the three Kessler facilities, plus the Rehab Institute of Morristown Memorial). Kessler had more serious pathology there. RIMM had a mix- part of it was a sub-acute, which has a lot of ortho, but the acute portion was still more mild than Kessler (although it did have a lot of brain tumor patients who weren't great rehab candidates)

Other things to keep in mind is that residency programs are not neccesarilly defined by their inpatient facilities. In most residencies, that will only cover a subset of your training experience.

I would focus more on the specific faculty working at each reisdency program- that will tend to have the biggest impact on the quality of your trianing.