help me!

Discussion in 'PM&R' started by gwen, Sep 13, 2002.

  1. gwen

    gwen Senior Member
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    hi guys. i'm doing a pmr outpatient rotation right now and HATE it. but most ppl who have rotated here told me this physiatrist is awful (nice that they tell me now) and that i should do my inpatient pmr rotation to make sure i really do hate it. but i won't be doing the inpatient stuff til october. it will be too late to decide. my other option is IM and then rheum. what do you guys think? this is really a BIG dilemma for me. i have 2 weeks to pick a career!!! heeeeeeeeeeeeeeeeeeeeeeeeeelp!
     
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  3. Camber314

    Camber314 Junior Member
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    Gwen:

    Disclaimer : I'm a student just like you, so take this advice for what it's worth.

    Your reaction isn't surprising. Like any other specialty that offers hours and training less grueling than surgery, etc., some students are drawn to PM&R primarily for "lifestyle". However, the key question here is whether you actually LIKE dealing with patients that others may not, or trying to diagnose and treat illnesses that are essentially incurable, or diseases that are relentlessly progressive. The PM&R doc's role is often that of maximizing function in a compromised situation, not curing or fixing. This doesn't sound like big difference from what most other physicians do, but it is a fundamental shift in the treatment paradigm that is difficult to understand until you've participated in it. The same thing applies to both the inpatient and outpatient sides, in my experience. You are often in the position of informing patients that "we can try this or this and you may be marginally better, but you will still have pain and still have functional limitations, albeit lessened." Now don't get me wrong, there are many, many specialized interventions that physiatrists can offer both in the acute, sub-acute, and outpatient settings, it's just a different approach to patient care than what some people expect.

    Having said all that, I know how difficult it can be to separate out the experience of a specialty on a rotation from the personalities you encounter during the rotation. Ask yourself what it is you dislike about the rotation; is it the pace, the patients, the physician(s), the staff, some combination of these things? I've certainly been surprised during my rotations with my rather visceral reaction to some of the services I've been on. Some things I thought I might enjoy, I HATED, while some services I assumed I would hate were fun. After two months of PM&R rotations, I discovered that it didn't matter WHO I was working with, I truly enjoyed the field itself.

    I realize you have a time crunch at this point; perhaps your best option would be to sit down with a couple of other physiatrists or residents you have access to and discuss your concerns with them honestly. I would be very concerned if I "HATED" any significant part of the field I was choosing. Best of luck to you.
     
  4. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    That's an awesome reply, Mr. Crisp!
     
  5. Camber314

    Camber314 Junior Member
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    David:

    You've got a PM.

    Wes
     
  6. gwen

    gwen Senior Member
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    thanks so much for your responses. i took some time away from my crazy pmr doc and realized that i still do love pmr. you are so right that the personalities and the profession sometimes blend in so much that its hard to tell them apart. i have one more pmr doc to meet tomorrow and then i'm submitting my application. i hope i'm not too late...i know a lot of people are getting interviews already...but i figured i should make sure i pick the right career instead of jumping into something without thinking.

    thanks again! all of you pmr people sound so wonderful and i look forward to working with you one day (hopefully!)

    gwen
     
  7. rehabdoc

    rehabdoc Member
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    I am happy that you liked PMR after all. As chief resident and a PGY 4 , I will tell you that it is great profession and hope to have you on board. Apply to TUFTs or Spaulding if you are a first rate student. RIC is a great alternative.

    good luck
    rehabdoc
     
  8. I have to say that I am somewhat perplexed as to why you view Tufts as a top program. The program has a rich history and used to be a great program, but things have really changed for some time now. This was relayed to me by graduates of the program and by residents I met during my interview a couple of years back. What exactly about the Tufts program leads you to think that it is one of the top programs? Personally, I think RIC is more than just an alternative. RIC is viewed by many as the top PM&R program and is usually the first or second choice of most applicants I've met.
     
  9. Discount

    Discount Junior Member
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    Inpatient rehab basically consists of two parts:

    Part I is taking care of the medical issue... basically this involves consulting multiple services (i.e., internal medicine, GI, cardiology, endocrine, neuro, psych) and following their recommendations. The general trend is that each patient should have a minimum of 4 consults. Hence, communication skills are essential especially a command of the English language. No need to make real medical decisions if there are enough consultants on board.

    Part II is taking care of the rehab issues... basically this involves writing PT and OT orders. Usually I write "assess and treat" and let the therapists do the rest. Whatever they recommend I order and at times I even renew a few orders. No need to make any real rehab decisions if you have good PT and OTs.

    Oh, I forgot Part III.. the most important.. which is knowing how to code the patient so you get paid. This also involves insurance clearance, medicaid and medicare stuff. No need to worry about financial clearance if you have good office managers/admissions office.

    So, I guess all you need to get good at is to count the bucks rolling in.
    :clap:
    Have a wonderful day.
     
  10. Well......maybe that's the way you've decided to practice inpatient rehab, but that's certainly not in my plans.

    I agree that a good PT and OT is very helpful, but unfortunately, not all PTs and OTs are as independent (nor should they need to be) as you think they are. PTs do not always employ the proper physical therapy for a patient's given diagnosis. Also, they are several things that can limit a patient's progress in rehab. For instance, spasticity (which may require phenol/botox injections), problems with gait (which may require gait analysis), pain (which might require meds, joint injections, SNRBs, IDETs, etc.), medical problems (hx of CHF, COPD, etc.), and so on. These things often impede the progress a patient can make with PT, OT, SLP, etc.

    With regards to consults, I don't think this is something unique to PM&R. As an Intern on the Surgery service or Medicine service, we would often get unnecessary consults because the attending was worried about a potential lawsuit or just wanted to get another opinion. This was actually one of the most frustrating things I found about Medicine.
     
  11. rehabdoc

    rehabdoc Member
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    As a person who has seen the changes in the Tufts education in short few years, I truly believe you could become a competent and skilled physiatrist out of Tufts program.

    The resident selection had been quite poor in the early 90's leading to poor quality resident who have all graduated since (Boards pass rate despite of it was 100%). The student body has dramatically changed. We have a uniform and focused group of residents for the past 3 years; all concerned and fully commited to improve the quality of this program.

    The education has been completly redesigned with emphasis on on topics relevant to day-to-day physiatry and board relevant topics, thanks to time and effort from residents and all the attendings.

    The department has done a great job of integration with NEMC which makes us part of the medical center , close association with orthopoedic , stroke and and neurosurgical teams. The Pediatric rehabilitation at NEMC lead by Dr. Webster is second to none in the city of boston.

    I don't know what is your understanding of the ranking of a program but hearing it from one of the designers of the ranking system, it is heavily based on financial status, research papers and name recognition of leadership/institution. Do you truly believe that you are any worse than a person from RIC? I personally don't. Residency is what you put into it, if you work hard and if you have the opportunities available to you, you could become a capable physiatrist. I am respectful of all the programs in the ranking, but I continue to recommend Tufts PM&R to good and serious candidates.
     
  12. Actually, my perception of the PM&R program at Tufts was based not on the ranking but rather on discussions with residents, applicants, and practicing Physiatrists. I also interviewed there as a medical student. I'm glad to hear about the changes at Tufts and I think the field of PM&R is really growing in Boston and I'm sure that's in part due to the Tufts program too. Thanks for the insight into your program. Good luck with matching into Pain fellowships.
     
  13. Discount

    Discount Junior Member
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    Stinky,

    So can I ask what kind of medical schools that your fellow colleagues at Spaulding graduated from.

    My program includes:

    Ross
    St George
    Autonomous Univ of Guadalajara
    India University- i forgot the name
    Some Chinese University

    Pretty prestigious list, eh?
    Just wondering where the residents from other programs are from...
     
  14. Our residents have graduated from places like Harvard, UMichigan, Hopkins, UCLA, UCSF, AECOM, UNECOM, Duke, Northwestern, Mt. Sinai, Georgetown, etc. See the following link:

    http://www.hmcnet.harvard.edu/pmr/resident.html

    Our website is being updated to include the new residents. For more information about our residency program, go to the Spaulding website:

    http://spauldingrehab.org/
     
  15. rehabdoc

    rehabdoc Member
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    We as a department have realized the problems. Treditionaly Tufts has been 3rd for many years and around early 90's many changes including multiple changes in the Chair has cost the program the Ranking.

    with new changes, including increase in research emphasys, improve quality of didactics as well as quantity (currently around 200hrs/calender year) we are hoping to reestablish the character and strengh. it has worked well so far and we are optimistic.

    Many Other plans are being worked on that will make a huge impact that I can not tel you people but once it is out, you will be surprised. We are investing on future....

    good luck on the boards.
     
  16. Discount

    Discount Junior Member
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    Sounds like Tufts is an awesome program. How about Boston University in the boston area.

    So is the boston rankings?

    #1 Tufts
    #2 Spaulding
    #3 Boston University

    Don't just invest in the future... invest in your pocketbook...
    because the future may bring famine.

    Old Chinese Proverb
     
  17. Discount

    Discount Junior Member
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    Stinky,

    Can I ask what prestigious medical school you graduated from?
    You sound like a midwesterner...

    Just being nosy.

    How come Spaulding does not accept people from the Carribean. I think they must be elitist.
    Please comment.
     
  18. rehabdoc

    rehabdoc Member
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    :eek:
    I am not in the position to rank Programs in Boston but we are excited abouth the changes.

    If you are well trained, doors to financial security will open. you can not fool people with glorifying your CV, you need to show productivity ...
     
  19. Discount

    Discount Junior Member
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    Hmm... i like rankings. Americans like to rank everything. It helps keep things in order. I personally like the US News and World Report rankings. It helps me organize. How come RIC is always #1. Somebody else should be #1. I am tired of the same old rankings yr after yr.

    Tufts has model SCI program right?
     
  20. hayixie

    hayixie Junior Member
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    Stinky Toufu, I know that there are IMGs in your program, not only one. What about their background?
     
  21. Actually, there are no FMGs in our program currently (including the incoming class of 2006). We've had three FMGs in the past. One had a PhD in Neuroscience from Cornell, the other a MS in Sports Medicine from Oregon, and another had a MPH from Yale. You can click on the link below for more information:

    http://www.hmcnet.harvard.edu/pmr/resident.html
     

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