Looking at PM&R as a career

[ShadyMedicine]

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I've been looking through the Forum and have found some old information regarding PM&R residency "ratings."

I'm investigating programs and I've read conflicting information on the following places: NYU, Columbia/Cornell, Jefferson, Temple and Kessler.

--It seems like NYU has broken through the "old" comments about being a malignant program.
--Columbia/Cornell seems much stronger and is now a "top" program.
--Temple and Jefferson seem to be both solid, top programs.
--Kessler is a "powerhouse" from my understanding.

How do you think these programs rank in relation to one another? I'll be applying in a few years and wanted to get a "feel" for these programs since I have yet to visit them.

Any current applicants like to weigh in on how you view these programs after interviewing at them this year?

 

[DocTalk12]

Dear Shady,

I have interviewed at some of the places you mentioned and can speak about my experience with them, and my general ideas about all of them.

Columbia/Cornell is a really great place, the residents get to rotate thought some really top notch facilities like Hospital for Special Surgery, Memorial Sloan-Kettering, Burke, Blythedale rehab, and obviously Columbia NYP, Cornell NYP. The program director is really pro-active and friendly, the chair is also very approachable and kind. All the residents that I interacted with were very honest, seemed bright, and loved the program.

Jefferson is also really nice, I was able to attend lecture before the interview. There is a very strong focus on education there - and also, there is some degree of flexibility in the curriculum (not the case at Columbia/Cornell). As a senior, there is elective time - and you can go anywhere - including internationally. A very strong exposure to SCI, and a classically top tier rehab place. Exciting ultrasound guru who teaches the residents the newest techniques in the field. Overall, a very strong program.

I believe the other assertions you made to be correct for the most part. What I learned from interviewing at 15 different places is that although they are all unique in some way, you will get a very strong education almost anywhere. As far as reputation goes, there are a lot of places that are incredibly strong PM&R programs but may not have the same name in other fields. Also, you should realize that most of the reputation of an institution is based on how much research it puts out, and if you are not interested in research than it should not really matter that much.

At this point in your career, I would be much more focused on getting a strong foundation in medicine, preparing for your USMLEs and getting exposure to the field of PM&R. Best of luck!

 

[Dharma]

Dear Shady,

I have interviewed at some of the places you mentioned and can speak about my experience with them, and my general ideas about all of them.

Columbia/Cornell is a really great place, the residents get to rotate thought some really top notch facilities like Hospital for Special Surgery, Memorial Sloan-Kettering, Burke, Blythedale rehab, and obviously Columbia NYP, Cornell NYP. The program director is really pro-active and friendly, the chair is also very approachable and kind. All the residents that I interacted with were very honest, seemed bright, and loved the program.

Jefferson is also really nice, I was able to attend lecture before the interview. There is a very strong focus on education there - and also, there is some degree of flexibility in the curriculum (not the case at Columbia/Cornell). As a senior, there is elective time - and you can go anywhere - including internationally. A very strong exposure to SCI, and a classically top tier rehab place. Exciting ultrasound guru who teaches the residents the newest techniques in the field. Overall, a very strong program.

I believe the other assertions you made to be correct for the most part. What I learned from interviewing at 15 different places is that although they are all unique in some way, you will get a very strong education almost anywhere. As far as reputation goes, there are a lot of places that are incredibly strong PM&R programs but may not have the same name in other fields. Also, you should realize that most of the reputation of an institution is based on how much research it puts out, and if you are not interested in research than it should not really matter that much.

At this point in your career, I would be much more focused on getting a strong foundation in medicine, preparing for your USMLEs and getting exposure to the field of PM&R. Best of luck!

I'm a newbie myself, but thanks for the above comment. Comments like these make SDN the gem that it is.

 

[ShadyMedicine]

Thanks, DocTalk12. I appreciate your feedback. I'm just trying to get a sense of things since I had a friend just go through PM&R interviews and he said that a lot of what's posted about programs is very outdated. He mentioned that places that once had malignant reputations are no longer malignant and that the "top places" have been shuffled around over the years.

One thing that caught my attention is that he said he was going to rank programs he liked that allowed moonlighting at the top of his list.

Is moonlighting really everything that's is cracked up to be? Should I add moonlighting in to the equation when I am at the point of ranking places? I thought ranking places where you will be trained the best should be at the top of one's list regardless of the ability to moonlight.

My friend was also telling me that places like Hopkins and Penn aren't that great in the PM&R world. I was surprised by this because these are well-regarded institutions.

I guess the interview trail will really open up my eyes regarding how programs stack up to one another.

Thanks again and good luck with the Match!

 

[Phillyborn]

I'm ranking programs this year, and moonlighting didn't factor in at all. I figure, at times, it might work into my schedule and would be nice to pick up a little extra money, but the goal of residency is to get quality training and set you up for your future career.

 

[Taus]

Moonlighting can be great $$..... However, ranking programs based upon moonlighting opportunities doesn't make much sense if you are sacrificing quality of education. You only have 3 years of residency to lay the foundation for becoming an excellent Physiatrist. A few grand extra over these 3 years won't make up for a $hitty education. If it's a good program that just happens to allow moonlighting.... sure why not

And your friend is right.... many programs with big institutional names do not have premier PM&R programs. For some the "XY Ivy" name on the diploma makes up for the sub-par education. I'm not specifically talking about Penn or Hopkins.... just in general.

Thanks, DocTalk12. I appreciate your feedback. I'm just trying to get a sense of things since I had a friend just go through PM&R interviews and he said that a lot of what's posted about programs is very outdated. He mentioned that places that once had malignant reputations are no longer malignant and that the "top places" have been shuffled around over the years.

One thing that caught my attention is that he said he was going to rank programs he liked that allowed moonlighting at the top of his list.

Is moonlighting really everything that's is cracked up to be? Should I add moonlighting in to the equation when I am at the point of ranking places? I thought ranking places where you will be trained the best should be at the top of one's list regardless of the ability to moonlight.

My friend was also telling me that places like Hopkins and Penn aren't that great in the PM&R world. I was surprised by this because these are well-regarded institutions.

I guess the interview trail will really open up my eyes regarding how programs stack up to one another.

Thanks again and good luck with the Match!

 

[DocTalk12]

Thanks, DocTalk12. I appreciate your feedback. I'm just trying to get a sense of things since I had a friend just go through PM&R interviews and he said that a lot of what's posted about programs is very outdated. He mentioned that places that once had malignant reputations are no longer malignant and that the "top places" have been shuffled around over the years.

One thing that caught my attention is that he said he was going to rank programs he liked that allowed moonlighting at the top of his list.

Is moonlighting really everything that's is cracked up to be? Should I add moonlighting in to the equation when I am at the point of ranking places? I thought ranking places where you will be trained the best should be at the top of one's list regardless of the ability to moonlight.

My friend was also telling me that places like Hopkins and Penn aren't that great in the PM&R world. I was surprised by this because these are well-regarded institutions.

I guess the interview trail will really open up my eyes regarding how programs stack up to one another.

Thanks again and good luck with the Match!

It is great to get a sense of things, and if you read this forum you will definitely gain some good perspective - but everyone is different and accordingly experiences things differently.

From my limited experiences (2 rotations, interviews), The field in general is pretty chill, and with the advent of the new limit on resident work hours - I think it would be difficult to find many "malignant" programs out there. That was once written about Rusk (NYU) PM&R, but you can find threads from the early 2000's that indicate that is old information!

As far as top places, I have asked a lot of people about what programs are considered top programs - and honestly, there are lots and lots of great institutions with awesome resources and opportunities. To get fixated on going to a "top" program will limit you - it is best to check out programs with an open mind, if you are interested in a particular location or school - then talk to those at that place and get a feel for it. Of course, if it very important to you to go to a top program, then just consider looking at the US News and World report rankings, that will give you a good indication of what people feel - but be aware, that is a popularity contest - but at least it gives you a rough idea .

I went to a couple places where moonlighting was allowed, and sure it gives you a little bit of extra income but I would definitely NOT factor that into my decision for a residency program. Sure, it is a nice fringe type benefit, but has NO bearing on quality of education, training experience.

The notion that great institutions do not necessarily have great PM&R programs is true. It can be further supported by the fact that many top notch institution do not have PM&R residencies. Again, I would caution you on worrying to much about prestige - I believe that both Hopkins and Penn have nice PM&R programs and I have met very successful individuals from both of those places, although their programs might not be considered in the same regard as other specialities in those respective institutions.

Interviews will definitely help sort things out, but also you can ask around. Speak to Physiatrists, read information about programs on their websites, get involved in AAPM&R. Feel free to PM me if you have any other questions.

 

[yappy]

Just throwing this out there: What is the employment modality for the majority of PMR physicians? Is it feasable in the new world of changing compensation to run a privite practice? Is the trend towards hospital based or group practice?

Thanks.

 

[shantster]

As far as top places, I have asked a lot of people about what programs are considered top programs - and honestly, there are lots and lots of great institutions with awesome resources and opportunities. To get fixated on going to a "top" program will limit you - it is best to check out programs with an open mind, if you are interested in a particular location or school - then talk to those at that place and get a feel for it.

Totally agree with this. I think that fixating on the "top" programs should only be done for people that only want to do careers in academics with research because a lot of that is based on standing in the academic community. Given that is my goal for life, I went through the process focused on those but still with some non-"top" programs. If it wasn't, I would have ended up ranking certain programs that aren't "top" programs higher based on the clinical training. But they did not have the same research opportunities and mentorship that I want in my training.

 

[PhysiatristDoc]

It is very feasible to start your own private practice. Older established practices will try and make you think you can't because they will be able to get away with employing you at a 'low' salary to help pay their 'overhead' which may be bloated senior salaries. The safest way to do this is to find a hospital that wants to help you out for the first few years, but even in more saturated cities, you can still go out on your own. Collect lots of ideas of cost from docs in practice in your area. It would be similar to cost of primary care office without a lab.

 

[RUOkie]

It is very feasible to start your own private practice. Older established practices will try and make you think you can't because they will be able to get away with employing you at a 'low' salary to help pay their 'overhead' which may be bloated senior salaries. The safest way to do this is to find a hospital that wants to help you out for the first few years, but even in more saturated cities, you can still go out on your own. Collect lots of ideas of cost from docs in practice in your area. It would be similar to cost of primary care office without a lab.

I'm not sure I completely agree with you, despite the fact that I have been in solo practice for the past 9 yrs, and remain there. ACO's are not dead yet. If that model comes into existence, it will be the death knell for the solo practicioner not in an IPA.

The economics have changed more in the past decade, than in any decade in recent memory. I am very concerned about my ability to continue in the model of care that I enjoy. I would not be surprised to find myself an employed physician within the next 10 yrs.

 

[PMR 4 MSK]

Just throwing this out there: What is the employment modality for the majority of PMR physicians? Is it feasable in the new world of changing compensation to run a privite practice? Is the trend towards hospital based or group practice?

Thanks.

Feasible? Sure. By "private" I assume you mean a solo practice, or maybe small group. Solo PM&R is rare, but there are a couple solo guys in my town. One allies himself with other practices for EMGs and injections, the other runs a sort of pain practice, but with Chinese medicine as much as western/allopathic.

The problem is being profitable. Overhead is a killer of salary for the solo practitioner. If you do a lot of procedures that don't cost you much to do, you can make a lot of money. If you are doing just E&M with Medicare patients, you'll go broke.

Getting the patients into your door is also part of the problem. Referring docs need to be educated about what you do and how you can help them and their patients. Word of mouth needs to get around of what you do and the assets you bring to the community. But if you are ni a community of IPOs, or soon ACOs, the little guys get squeezed out and get left with patients with crappy health care plans.

 

[Gauss]

But if you are ni a community of IPOs, or soon ACOs, the little guys get squeezed out and get left with patients with crappy health care plans.

All the good primary docs have jumped ship to boutique, non-Medicare, or into large hospital groups. What remains are IPO's=ACO's which are now swallowing up medicaid. And that is the future of private practice because you have no ability to negotiate against the large hospitals for the better health plans