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Help for an MS4


Full Member
Jan 24, 2013
  1. Resident [Any Field]
Hey guys, so I'm an MS4 who applied to IM and anesthesiology for this years match. However, I recently did a private practice PMR/pain med rotation and absolutely loved it. I think had I done this rotation earlier this year, I would have applied to PMR.

I'm interested in going into private practice pain management, and think that PMR is the best way for me to get there. However, it is too late for me on this application cycle and I'm not sure what to do now.

I did do an inner-city inpatient PMR rotation in the beginning of the year where I was on the spinal cord unit, and did not like seeing the young paraplegics/quadraplegics due to GSW's who were now screwed for the rest of their lives. Seeing them struggle with incontinence, pressure ulcers, etc on a daily basis kinda depressed me. So at that time, I decided not to pursue PM&R. But now I have realized that what I saw was only a small subsection of PMR, and some of the other stuff like sports medicine and pain is really cool.

Anyways, now I have to decide what to do in terms of the match. I can either go for IM and then possibly switch to PMR (not sure how that would work), go for anesthesia and then pain (although I did not love my anesthesia rotations), or just do a prelim year and apply for PMR again (however, I might have to take a year off after the prelim since most advanced positions for the next year would already be filled).

Any thought/advice for me? Thanks.


Damnit Jim!
15+ Year Member
Mar 4, 2002
  1. Attending Physician
pain fellowships are still mostly in anesthesia departments so you're eventual goal may be best suited to doing an anesthesia residency.
I wouldn't gamble on doing IM with the goal of switching, that is an unpredictable and tough road. It may sound arduous but do a residency to completion and then go from there. Switching is never easy
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Staff member
Volunteer Staff
15+ Year Member
Feb 1, 2005
  1. Attending Physician
well..... what could you tolerate better during residency (inpatient rehab vs. OR anesthesia) and which would you rather fall back on for the rest of your career if you decide pain is not for you or you don't match into a pain fellowship?

Other points to consider.... Pain fellowships are definitely easier to get through anesthesia..... but also think long and hard about what you really liked about Pain w/ the PM&R doctor.... if that included peripheral musculoskeletal care (ie hips, knees, shoulders, soft tissues, etc) and EMG's in addition to spine with interventions... then really consider doing an internship and re-applying for PM&R.


Junior Member
10+ Year Member
Jul 6, 2005
  1. Attending Physician
There's a decent chance you could find an open PGY-2 position and not have to take a year off. However, like you said, you would run the risk of having to take a year off and reapply through the match if you don't find an open position.
You also need to be out of your anesthesia position before you start contacting potential programs since it's an NRMP match violation to speak to other programs while you're still under your anesthesia contract.
Feel free to PM me if you want the details of how I got out of my advanced position during my intern year and got into an open PGY2 position without taking time off.
Like others have said, think long and hard about the switch because you'll do a ton of inpatient rehab if you decide to take the rehab road to pain. As soon as you find out where you're doing your intern year, talk to your PD immediately, tell him your thoughts, and ask him if you can do a PM&R elective during your first month to help you make your decision and so you can get a good letter of recc.


Full Member
7+ Year Member
May 1, 2009
  1. Resident [Any Field]
Personally if I had to do it. I'd do IM and try to get an open PMR spot. I can't imagine doing GAS if I hated it just for a chance at pain. Just like it might vex easier now for GAS to get into pain because most pain fellowships are anes based, so true is of the numerous sports fellowships run by Family med compared to 12 accredited PM&R based sports programs. This is why I didn't do IM or FP to get to sports. Remember your base and what mashes you a doc at your core. I would rather be a physiatrist and risk not getting sports.
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