How to get what you want?

[MSKalltheway]

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So for those who have families or SO's with jobs that keep them within a certain geographic area (among other reasons to stay within a region) one may end up in an area where there are not a lot of choices for programs to apply to. In that scenario, opportunities could be limited. So for those with limitations, and since not everyone can get into a "top 5", what do you all recommend for those who go to a residency program where they may not get exposed to procedures such as MSK ultrasound, spinal injections under floro, extensive P&O training, etc? Fellowship could fill the gaps, but what if there is not one within a reasonable distance?

From all the years of reading this board, I already know the general opinion about weekend courses. Is there a happy medium between weekend course and fellowship (if distance is limiting)?

 

[topwise]

I can definitely sympathize with this.

I think a lot of PM&R residencies don't provide comprehensive training in spinal injections, MSK ultrasound, etc, so a lot of graduating residents I know (who didn't want to do fellowship) have joined practices where a senior person gave them training during their first year. And in turn, they got paid a little less. It's sort of an unofficial fellowship. 🙂

 

[RUOkie]

No matter what, you need to sacrifice a little to "get what you want". If you are "hell bent" on a pure MSK practice, you probably want a fellowship no matter what. There are many "unofficial fellowships" for a lot of things like Lumbar injections and ultrasound, but in those practices you are going to be doing a lot of scut for the senior partners in the group. It is a very unusual postion to find that will train you in high reimbursement procedures for nothing. That said, you learn a lot in such an environment (I did!🙄) In many jobs, people travel extensively and see their family little. Some people do a 1 year fellowship by leaving their family for a year. I would not want to do that, but for you it may be worth it in the long run. The other option if you can't find what you want is to sacrifice the type of practice you are in, and get to live where you want. I see a lot of patient types I don't want to, but I get to work solo in a community I love! No matter what you do, life is about sacrifices.

 

[PMR 4 MSK]

You can also discuss this concern with the Program Director where you end up. They may be able to allow you some extra elective time to spend with phsycians who can train you for what you want to do, or may be able to assist you with outside courses for this. Keep in mind their needs for the program and their goals for your training.

Perhaps you could spend an extra month in a pain clinic, or every other Friday in Radiology learning ultrasound or Interventional Rad. Maybe 1 afternoon a week on rotations that are less time-intensive.

Maybe there are ways to do some time-swapping for this with other residents. You take on more pts on certain rotations, to allow you more time for your pursuits on others.

Also keep ni mind most programs have certain strengths that may not be readily apparent, but may benefit you in the long run. I went to a heavily inpt-focused program (MCW) because I thought that's what I wanted to do. I did inpt for a few years out of residency but now I only do outpt. But the experience I received in EMG has led to a very rewarding (personally and financially) part of my career. I have not seen the inside of a rehab ward in years.