Matching Again? Any Help Appreciated

[MegaVoltagePhoton]

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Ok, I have to correct a gross misconception here. Numerous people keep talking about PMR. PMR has gotten more and more competitive every year, and PMR fills to near capacity just about every year. So it's unrealistic to assume that and think that someone who has had a number of problems in med school and residency would just be accepted nilly willy at a PMR program. PMR PDs have no issues filling their programs with quality people who don't have any performance and/or clinical issues. So please let's stop suggesting that. In addition it is also a serious misconception to think that there are no emergencies in PMR and that it is an all outpt. specialty. Plenty of PMR docs work solely in an inpt. setting, and emergencies unfortunately do certainly come up, from the spinal cord pt. who needs to be transferred for autonomic dysreflexia, to the TBI pt. who destabilizes, not to mention that a successful intern year needs to be completed before this.

As an attending, sure you can find a job in a solely outpt. setting, but getting through residency is not that simple. The only residencies where it will be highly unlikely where you have true emergencies are derm - which will be impossible, and maybe Ophtho or Rad Onc which again you would not really have emergencies.

Realistically occupational medicine is really the only residency that is entirely outpatient where the OP could get into and there really are no significant issues with excessive clinical judgment, emergencies, competitiveness, etc.

LOL. Yeah, PMR has emergencies but Ophtho and Rad Onc don't? Ever heard of ocular trauma or cord compression?

 

[clausewitz2]

As far as ophtho emergencies are concerned, more prosaically, see also acute angle-closure glaucoma (vision loss within hours) or central retinal arterial occlusion (vision loss beginning around 100 minutes after onset by some estimates). The whole "doing surgery" part does not really fit the bill for stress free.

 

[drkristy85]

redemptionMD,

I really appreciate you coming forth and sharing the details of your story. You were honest. You truthfully described your faults and errors without sugar-coating and most importantly, without making excuses. You left out the self-praise and patting-yourself-on-the-back nonsense. This shows maturity, insight, and understanding on your part.

I think you have several options:

1. Your current out patient primary care job. It seems that you thrive in the outpt clinical world and your goal has been to attain an outpt job. You seem to be doing well at this job, and your boss has asked you what your long-term plan is. Seems like you enjoy your job. Would you consider staying at this job? It looks like it is a good fit for you. And you are making money doing it. If you stay here, you wouldn't have to attain residency or board-certification, but can keep doing what you're doing.

2. Psychotherapy. Above poster mentioned this, and it sounds like a fantastic idea to me. You like psych, and you specifically like the interviewing aspect of it. You like out pt work. You are known to be good at psych-interviewing as evidenced by your prior experience. I believe you can get certified in psychotherapy without formal residency. This would be a great option for you. Many patients will pay straight up cash for this.

3. Occupational Med. Seems like a good choice for you, but as mentioned above, you will need to learn more about the field. You should do some shadowing in the field to see if you'll like it. Google Occ Med docs in your area, and try cold-calling or emailing, if you don't otherwise know any personally.

4. Have you considered SOAP-ing into Family Med? If you do the Match, but don't actually apply to any programs and just wait for SOAP, you will save a lot of money on interviews/individual applications. Granted, the competition is stiff for SOAP. However, last year 10% of Fam Med positions didn't fill (AFTER SOAP) based on NRMP match data. So there are certainly spots open. I think the upside with this is, the SOAP cycle moves fast and the PD's of programs you're SOAPing into may not get the chance to talk to your PD because of the lack of time before they have to make a decision. As I understand it, they have limited time and each interview only lasts 5-10 minutes. So maybe you can get a spot this way. If I am wrong on this, someone please correct me.

5. There are other jobs one can do with a license, but no residency or board eligibility. Some urgent care/pharmacy retail clinic type jobs. They usually hire NP's and PA's but maybe can hire you too. Not sure how much they pay.

 

[redemptionMD]

New information/posts noted and gratefully received.

And your narrative / tone doesn't do you much benefit here. Above you asked what the salary of an Occ Med doc is. A simple answer is: "More than zero, which is what you might end up with.". How much an Occ Med doc makes is immaterial to you now. You are very close to having no career in medicine.

This is perhaps what hurts worst of all. It is the reality, however; and I accept that.

drkristy85,

1) Current job a consideration; doesn't leave much growth potential in the future. Will consider.

2) Psychotherapy only. It's an interesting idea. Not sure how that really fits into the MD rubric, so definitely an idea with some drive behind it, but I'm not really sure where it "falls", so to speak, so will shelve for the moment (???)

3) Been familiarizing myself lately with Occ Med. To whatever degree I can solicit info from online; yet I'm well-informed enough (I say that with a grain of salt) that I need to advance to the "feet on the ground" phase. The idea about shadowing is a good one, thank you; been trying to look for public health internships.

I have a good idea of what I'd like my MPH concentration to be in.

Have drafted my Occ Med Personal Statement (had done one for Public Health/General Preventive Medicine quite some time ago. Time to get out the red pen).

Allopathic Prev Med/Occ Med residencies seem to fall under the September cycle this year. Decisions seem to be handed out in December. So, to summarize yet not beat a dead horse, the question on funding, is it fair to say (based primarily on aProgDirector's comments), that Occ Med-->NIOSH funds, Clinical Informatics-->internally funded?

I'm thinking that I would try to ERAS into an Occ Med/Prev Med program (Advanced Residency as per BlondeDocteur) during the season proper and try SOAPing into an FM spot if not successful--being very realistic about the respective chances.

4) Licensed MD/not Board eligible option. I'm curious to hear more.

Thank you all.

 

[redemptionMD]

Would you consider staying at this job? It looks like it is a good fit for you. And you are making money doing it. If you stay here, you wouldn't have to attain residency or board-certification, but can keep doing what you're doing

My concern in this--being reflective of my concern in any clinical venture I could undertake with *just* a license--is that there is, of course, a fine line between what I *can* do with just a license/no Boards--hanging out a shingle/running my own practice, although that's legally an option, comes to mind--and what I *ought* to do.

The Boards are there for a reason. I'm well-liked among patients and staff (that's not ego, that's simply the truth); but isn't it an ethical slippery slope to be "marginal" guy running around with a license when it comes down to talent, skill, knowledge and ability?

The law is no less strict because I'm a GP, as the state has seen it fit to give me a license with the full scope of anyone else's license.

That I'm in a tight spot doesn't hold me to a less strict ethical and moral standard.

On a daily basis: I am perhaps hyper-aware of my own limits, confident in my abilities *SUCH AS THEY ARE; perhaps that's what came off as arrogance and ego?*, but aware of the need for more.

I really owe my patients no less.

 

[redemptionMD]

Granted, the competition is stiff for SOAP. However, last year 10% of Fam Med positions didn't fill (AFTER SOAP) based on NRMP match data

Curious about your source. Where do I find this NRMP Match data?

Thank you.

 

[drkristy85]

If you literally Google "NRMP match data" the first listing is the one:

http://www.nrmp.org/match-data/main-residency-match-data/

Then click on #1, which is a 120 page PDF with all of the most recent Match data

 

[drkristy85]

I'm on there pretty frequently----I like statistics 🙂