MS 1 to be is interested in PM&R. But.....

Discussion in 'PM&R' started by cmshopeful, Jun 1, 2008.

  1. cmshopeful

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    I get the sense from reading some threads that since PMR is a very small field, a PMR physician may not be able to find a job in an area he/she wants to live. For an example, I'll be starting MS 1 at Rosalind Franklin this fall but would like to do residency in Socal and work in Socal. As say an internist, hospitalist, EM, radiology physician (and many others), is the chance of working in say Socal greater than a PMR physician in your opinion?

    Another concern of mine is the field on PMR in general. Although I'm very interested in the field, I get the sense that it's a field that needs to try to find a place in the medical field. At this one hospital, a neurologist called himself a "rehab doctor". It seems that other fields have much clearer scope of practice or is better known by other physicians/medical staff and get used in place of a PMR physician. Is the field as stable in its existence as other more established ones?

    And finally, are there any significant 'quality' difference among the socal and Stanford programs?

    Thanks!
     
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  3. Baritonebass

    Baritonebass Junior Member
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    "rehab" is kinda a general umbrella like "hopitalist"(which can be more than internal medicine) but PM&R as it was explained to me is essentialy two parts. Physical medicine: (sports medicine, musculoskeletal, pain management) & Rehabilation: return of funtion(TBI, SCI, inpatient rehab, using things above)
     
  4. Disciple

    Disciple Senior Member
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    There is no shortage of PM&R jobs. Even in desirable locations like SoCal.

    PM&R has become much more well defined over the past 10-15 years, and we've really just started solidifying our subspecialties in the past 5-10.

    By the time you get out, everything should be just fine and dandy.
     
  5. SSdoc33

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    i wish i could have your foresight. you are planning WHERE you are going to do your residency already? damn. you must be like clark w. griswold on a family vacation.

    PMR is a great field. stable, broad, lots to do, plenty of jobs, decent pay, good hours. nobody (including a good deal of docs) will know what you do or what kind of doctor you are. its disheartening, but if you can get over yourself, then you realize that this is not a huge deal.

    there are only a few PMR programs in SoCal, and none of them would be considered "top tier" right now. (things may be different in 5 years, though). one of the biggest mistakes you can make is to limit yourself geographically in residency, because unlike other fields, you cant just go to a big city and expect there to be a good PMR residency there. there are some really shady programs out there.

    probably be best to 1. graduate college, 2. go to med school, 3. decide what field you'd like to go into before planning where you'd do a residency.

    best of luck.
     
  6. ampaphb

    ampaphb Interventional Spine
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    Which ones do you think are shady, and why (just leaving it out there like that damns all of them that aren't top 5)
     
  7. cmshopeful

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    Haha, Clark Griswold...or Sally Albright (my gf's fav movie "when harry met sally").
    Thanks for the replies.
    I'm sure that rehab hospitals such as Rancho Los Amigos employ PMR physicians. Do all general hospitals also employ PMR docs as well? I can't see community hospitals using them although county hospitals or regular hospitals likely uses them.

    What'd be the best way to get some info about the field and what it's like to work as a PMR doc from local/socal PMR docs?
     
  8. topwise

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    I think it probably does help to do residency in California if you want to work out there, since there aren't tons of jobs and connections made in residency will help you. Unfortunately, there are only 5 programs in California so not a lot of choices for you, but a lot of competition.
     
  9. PMR 4 MSK

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    I can't tell you anything about SoCal, except it's nice to visit now and then. There are jobs all over, likely to be more in the future as the boomers age - you'll be looking for a job roughly 2016. With an aging population, PM&R grows.

    Yes, we still have the identity problem. Hopefully it's getting better as we as a field grow.

    It is a very small field, by some estimates, less than 1% of all physicians out there. That presents great opportunities for growth.
     
  10. eforest

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    People are surviving more catastrophic accidents, and rehab medicine itself can do so much for people now. It's definitely a burgeoning field. At least I hope- because I'm interested in going into it.
     
  11. SSdoc33

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    im not gonna smear any programs, but i think that they ALL should be approached skeptically. PMR residency training is very poorly organized, regulated, tested. RRC requirements are vague to the point of being almost ludicrous. standardization is atrocious. the RRC moves at a snails pace. i would strongly recommend to getting as much information as possible into every program that one is interested in, rather than assuming that b/c it is attached to a well-known school or institution or city, it is a good program
     
  12. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    Word. :thumbup:
     
  13. lobelsteve

    lobelsteve SDN Lifetime Donor
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    When training is based on a minimum standards, the most important decision in choosing a program is one that has an active faculty with the interest in teaching. Seems simple enough. But figuring out what programs are doing that is quite difficult.

    Many programs teach out of Delisa or Braddom- and the info is only 10 years old. Some will update this information with new clinical data- SOME DO NOT.

    Getting a consensus from doctors is unlikely to happen. WHat is needed is to get thought leaders together to put on paper what needs to get taught to new doctors coming out. THen soem magic needs to happen where this information gets to the residents without getting destroyed or modified by Department CHairs, RRC's, the ABPMR for the sake of simplicity, individual political agendas, etc (the old gaurd you always hear about). The academy has taken a step in the right direction, and within 10 years there may a focus for PM&R- but I wouldn't hold my breath. Nobody who is a so-called expert in their field likes to be told what to do. Vox clamantis in deserto...
     
  14. axm397

    axm397 SDN Moderator
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    I'd say either do a residency in SoCal or do a residency at one of the top residencies. My classmate (RIC) will be working at UCLA/Greater LA VA next year but she had 4 other offers - mix of private practice and academic (not sure what Kaiser would be classified as...).

    She will be doing mostly inpatient TBI/trauma rehab with some EMGs. That's what she wanted to do. There were also plenty of pain/interventional spine jobs in the area as well.

    I think jobs in PM&R are mostly word of mouth - who you know counts a lot.

    That being said, if location is the only priority for you - then perhaps another field would have more opportunities. (family med, int medicine??) You are still early in your career and have a lot of time to decide what you like and don't like.
     
  15. ampaphb

    ampaphb Interventional Spine
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    IMHO, by not smearing any of them, you smear all of them, and thus let those you believe of poor quality again fall under the radar. The reason so many programs are able to get away with the crap they pull is that residents and former trainees stay quiet under the guise of being politically correct and not wanting to offend.
     
  16. ampaphb

    ampaphb Interventional Spine
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    Dr. Lobel is showing his Dartmouth roots:
    Dartmouth's motto, chosen by Eleazar Wheelock, is "Vox Clamantis in Deserto". The Latin motto is literally translated as "The voice of one crying in the wilderness", but is more often rendered as "A voice crying in the wilderness". The phrase appears five times in the Bible and is a reference to the College's location on what was once the frontier of European settlement.
    Of course, Dartmouth, while a great place to spend 4 years, is not without it's own wacko controversies:
    Dartmouth has never had an official mascot.The nickname "The Big Green," originating in the 1860s, is based on students' adoption of a shade of forest green ("Dartmouth Green") as the school's official color in 1866. Beginning in the 1920s, the Dartmouth College athletic teams were known by their unofficial nickname "the Indians," a moniker that probably originated among sports journalists.This unofficial mascot and team name was used until the early 1970s, when its use came under criticism. In 1974, the Trustees declared the "use of the [Indian] symbol in any form to be inconsistent with present institutional and academic objectives of the College in advancing Native American education." Some alumni and students, as well as the conservative student newspaper, The Dartmouth Review, have sought to return the Indian symbol to prominence, but no team has worn the symbol on its uniform in decades.

    Various student initiatives have been undertaken to adopt a new mascot, but none has become "official." One proposal devised by the College humor magazine the Dartmouth Jack-O-Lantern was Keggy the Keg, an anthropomorphic beer keg who makes occasional appearances at College sporting events. Despite student enthusiasm for Keggy,the mascot has only received approval from the student government. In November 2006, student government attempted to revive the "Dartmoose" as a potential replacement amid renewed controversy surrounding the former Indian mascot.
    Go Big Green!
     
  17. lobelsteve

    lobelsteve SDN Lifetime Donor
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    I was kicked out in my sophomore year. ;)
     
  18. SSdoc33

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    i hardly think that naming a few programs on a discussion forum will magically improve the quality of poor residency training programs.

    programs get away with "the crap they pull" because they often suck in residents who don't know any better while they are 3rd or 4th year medical students. they get away with it because the RRC is a weak body that rarely wields the power that it claims to have.

    i am a HUGE advocate of agitating for change. unfortunately, those who are in the best position and are most knowledgeable to help change the residency training are already out of residency. it is difficult to have a real, strong voice when your program director has a recommendation letter hanging over your head.
     
  19. ampaphb

    ampaphb Interventional Spine
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    Whole-heartedly agree that those in the best position to agitate are residents, but also are the most vulnerable

    Second best are recent grads, who can make it known to future applicants the flaws the programs are trying to hide.

    I only know the flaws first hand of the programs I was a part of. If you know the flaws of yours, you should post them. Will it piss your program directors off? Absolutely. But given that there is such little information that med students have to base a huge decision on, this board has far more clout that you might imagine. Multiple PDs have posted on here when they or their programs have come under criticism (UW most recently, I believe, but UC Davis and UCLA have as well). When NYU came under critcism, itsn current residents came to the aide of their program, and med students got a balanced view of the good and the bad of the program.

    Programs typically tell their residents to keep quiet about internal problems when the RRC comes around. I have heard multiple residents from multiple programs report that they were told point blank that "this is not the time to vent", and "all you can do is hurt the program" by speaking up when the RRC asked questions. And there is an element of truth to that - if your program goes on probation, it tars YOUR reputation as much as it does the program.

    Oh, and as far as working within the system, or with members of the AAPM&R Board? Ask our two former RPC presidents exactly how much their opinions counted, or for that matter were even acknowledged during their tenures. I heard them both go in guns blazing, ready to change the world, and came out the other side disenchanted with the system, but don't let me put words in their mouths. Ask them how far student initiatives for change got during their tenure. Hell, the current AAP&R President seemed hell-bent on dismantling the RPC altogether
     
  20. cmshopeful

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    Thanks for the great insight into the field and residency programs.
    After reading some of your replies, I have some questions.

    *So, which ones are considered to be the top 5 PMR programs? How about say top 10? I'm sure they will be somewhat subjective. But, what list would most agree with?

    *Are PMR programs run more poorly than most other specialties, in your opinion?

    *I was recently given a great advice from a retired urologist. He told me to get as much training as possible....do the residency and do fellowship and really hone my skills as a physician. After a PMR residency what other fellowships are available? I'll be 42 when I'll be set to begin residency. How do you think age will factor into applying to various PMR residencies....then ultimately a fellowship? With my age, I was told by a physician (older brother of my friend) getting into a residency may be a bit of an uphill battle let alone a fellowship. Any thoughts?
     
  21. lobelsteve

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    I know this guy who was an agitator for change. Fired as chief resident, bad letters of rec, anonymous letters to his fellowship director trying to get his spot dropped. Mysterious academic probation/problem appears a few years after graduating from the program. In the end: PD was dismissed, no real changes in the Dept, and he has to write an explanation letter when applying for privileges (never as issue- just an explanation). I think he went on to teach at a fellowhsip program for awhile, made too much money and went into private practice. Now he just sees patients, advocates at the state level, reviews files for the Medical Board, and races Subarus on the weekends.
    Turn 12 in the rain at Road Atlanta is worse than anything that can happen in residency.
     
  22. axm397

    axm397 SDN Moderator
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    You can do a search on the "top programs": programs that have been mentioned in the past: Kessler, RIC, Baylor, U Washington, Spaulding, Mayo
    U Michigan, etc. (I think the number has ranged from "top 5" to "Super seven" to as many as 8 programs) http://forums.studentdoctor.net/showthread.php?t=446136

    Fellowships available: also do a search and read the FAQs thread: http://forums.studentdoctor.net/showthread.php?t=187469:
    TBI(traumatic brain injury), Stroke (or combined "neurorehab"), SCI(spinal cord injury), pediatrics (2 years or 5 year combined + 1 year), pain (ACGME and non ACGME), sports medicine (ACGME and non ACGME), MSK/spine (combo of the above), hospice palliative care, neuromuscular rehab, EMG, research.

    "Are PMR programs more poorly run?" - can't generalize to the whole field. I think there are some programs that are better run than others. Talk to any resident in any field and they will have complaints about their residency program. I think the happiness level a lot of times depends on the leadership of the residency - department chair and program director. The more flexible and approachable they are, the better the programs tend to be. You want leaders who advocate for their residents.

    Age: Residencies and fellowships should not discriminate based on age. If you have interesting experiences that explain your advanced age, then that may even count for you. It's all about how you spin it - emphasize your maturity, experience, etc. - just look at the presidential race :)

    If pain is a priority for you and you don't care what field, anesthesia will give you the most number of options in ACGME accredited pain fellowships.
     
  23. Disciple

    Disciple Senior Member
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    Who?

    Dr. Cifu?

    Speaking of which,

    http://forums.studentdoctor.net/showthread.php?p=6739804#post6739804
     
  24. SSdoc33

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    i think one solution to increase the overall quality of residency education is to simply shut down the bad programs. i realize that this is easier said than done, but the requirements need to be stricter and the regulations tighter. even when a program is on probabation, it rarely closes. AND, if it wants to, it will fill up with residents. what you are left over with is residents who do a ton of inpatient work for the hospital who use them as indentured servants, and who havent the slightest idea about real PM&R (both in and outpatient). we churn out these automatons who try to stand up in the world of ortho/anesthesiology/pain and they look like invalids, by and large. secondary affects are that other docs see these physiatrists who dont really know their trade, which gives the specialty a tarnished reputation. the better ones out there need to work extra hard to overcome this stereotype. even though we are a small field, decreasing the number of residents coming out will improve the quality of our field as a whole
     
  25. ShrikeMD

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    While ample employment opportunities exist for physiatrists in most regions of the country, I wouldn't count on jobs at Rancho. They have employed physiatrists, although they built their rep as an orthopedics run outfit. There was talk of closing this county-funded hospital in 2003, and I am unsure that its long-term funding status is secure.
     
  26. ShrikeMD

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    i
    Your residency program director won't always have something hanging over your head. Perhaps for the 1st job, but depending upon how well you do there, that is probably it. Build your own reputation, burnish your credentials, and you can stand and speak about the challenges/weaknesses of our educational system for any who will listen.

    The real challenge is this: When you get to the point that you can write your own ticket, will that fire still burn within you to try and right the wrongs? Many have made so many compromises by that time, that they really don't see the problems any more, or just don't care. :(
     
  27. ampaphb

    ampaphb Interventional Spine
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    Within three years of your graduating from a residency, there will be no residents who you trained with remaining. Any criticisms about the program will be met with "We have changed that since you were here", and regardless if it is true, you will have no way of verifying the response.

    The only relevant criticism is that made by current residents, or those within a year or two of having graduated. The problem is, those who are critical may have their own axe to grind, and thus even their complaints may not be entirely objective. These relevant critics are also at their most vulnerable to the problem director and chair's withholding of LORs at that point.

    Every resident grows jaded re the system they work in during the three or four years they are there. Every program has flaws. The problem is, it is rare that those imperfections are aired publically. Residents realize that a program's reputation is part of what their own professional rep rests upon, and so most are loathe to sully the good name of the place, even if they complain to their colleagues over a beer.
     
  28. lobelsteve

    lobelsteve SDN Lifetime Donor
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    Or not.
    Cake and eat it too can occur, but pie is better. Key Lime Pie.
    Program directors get fired or retire, Chairs grow old and weary. Residents come and go. Easy answer is do not rock the boat. Best answer is have a drysuit on and rock away. And grab lunch with the head of the ACGME when you can.
     

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