Must do fellowship?

[sirus_virus]

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Is it common to land jobs in PM&R without a fellowship, or do you pretty much have to get a fellowship to qualify for most jobs?

 

[sirus_virus]

I guess there are no gurus on this issue here

 

[drusso]

Sure you can. Half my residency class took jobs doing general PM&R, outpatient MSK, EMG, etc. Even inpatient PM&R very different as a community-based attending compared to a resident in an academic center.

 

[Hemisphere]

could you elaborate on the differences between inpatient as community attending and as resident? besides salarly, lol. most people don't do inpatient i'm guessing because of the call...
so i'm guessing there are other differences u had in mind?

 

[axm397]

could you elaborate on the differences between inpatient as community attending and as resident? besides salarly, lol. most people don't do inpatient i'm guessing because of the call...
so i'm guessing there are other differences u had in mind?

I'm doing a community inpatient rehab rotation now and it is definitely very different from my inpatient months at RIC.

First of all, there are 6 attendings (including 2 MSK/pain out pt, 2 EMG/consult outpt, 2 inpt) in the group, they take turns taking home call each week. They round Saturday on the inpatients (about 16patients). no rounds Sunday. Rounding literally takes at the most 2 hrs in the morning because all the notes are computerized and the patients are super stable. The nurses call the on-call rehab doc for things like fever work up, falls, ?pain that can't wait. all non-urgent issues wait until the morning. I was on home call last week and the most I got called was twice in one day. Probably over the week I got called about 8 times. I called in before I went to sleep and I had home access to their medical records system to put in notes and the nurses took verbal orders. If there's an unstable patient, then the hospitalist service or the medicine resident sees the patient and transfers him/her to the floor. Even if patient's not unstable but need to be examined in the middle of the night, the medicine resident will go see the patient.

We do team conference once a week for each patient and the super duper social worker takes care of all the disposition family issues.

It's great. The turn over is kind of quick - average 1-2wk stays for most. Get a lot of brain stuff - stroke, hemorrhage, tumor, etc. Some deconditioning. almost no spinal cord no vents.

 

[drusso]

I'm doing a community inpatient rehab rotation now and it is definitely very different from my inpatient months at RIC.

First of all, there are 6 attendings (including 2 MSK/pain out pt, 2 EMG/consult outpt, 2 inpt) in the group, they take turns taking home call each week. They round Saturday on the inpatients (about 16patients). no rounds Sunday. Rounding literally takes at the most 2 hrs in the morning because all the notes are computerized and the patients are super stable. The nurses call the on-call rehab doc for things like fever work up, falls, ?pain that can't wait. all non-urgent issues wait until the morning. I was on home call last week and the most I got called was twice in one day. Probably over the week I got called about 8 times. I called in before I went to sleep and I had home access to their medical records system to put in notes and the nurses took verbal orders. If there's an unstable patient, then the hospitalist service or the medicine resident sees the patient and transfers him/her to the floor. Even if patient's not unstable but need to be examined in the middle of the night, the medicine resident will go see the patient.

We do team conference once a week for each patient and the super duper social worker takes care of all the disposition family issues.

It's great. The turn over is kind of quick - average 1-2wk stays for most. Get a lot of brain stuff - stroke, hemorrhage, tumor, etc. Some deconditioning. almost no spinal cord no vents.

It can be even better than that. Some community rehab groups have IM docs or geriatrics following every patient and doing the heavy lifting on the medical issues while the physiatrist manages only the rehab issues.

 

[axm397]

It can be even better than that. Some community rehab groups have IM docs or geriatrics following every patient and doing the heavy lifting on the medical issues while the physiatrist manages only the rehab issues.

that's what I forgot to say - the patients here are all followed by hospitalists or PCPs and all medical management including annoying stuff like coumadin dosing, blood sugar management, etc. are done by them. If they get sick, the hospitalists admit them back to acute care under their care.

 

[Disciple]

that's what I forgot to say - the patients here are all followed by hospitalists or PCPs and all medical management including annoying stuff like coumadin dosing, blood sugar management, etc. are done by them. If they get sick, the hospitalists admit them back to acute care under their care.

Then what does the Physiatrist do besides fill out forms and do daily checks for heel ulcers?






Just kidding

 

[Disciple]

could you elaborate on the differences between inpatient as community attending and as resident? besides salarly, lol. most people don't do inpatient i'm guessing because of the call...

You're dead on. Though I'd put call and salary as roughly equivalent.
As an inpt attending, you'll have to go in to do weekend rounds.

I do almost 100% outpt right now (occasional hospital pain consult) with shared home call (about 1 week in every 4-6). So far I've been averaging 1 phone call per week when I'm on. I have yet to be called in to the hospital.

 

[axm397]

Is it common to land jobs in PM&R without a fellowship, or do you pretty much have to get a fellowship to qualify for most jobs?

You can definitely land jobs without fellowship. You can even do some interventional procedures (mostly lumbar ESIs) without fellowship. Last year, out of 12 ppl, only 2 chose to do fellowships. All the others got great jobs ranging from medical director of a rehab, academic, private practice outpatient MSK where they trained people to do interventions.

This year, half the class will be going on to fellowships. My class will most likely only have 3-4 people going on to fellowships. many jobs are word of mouth and alum/connections definitely help. Most jobs aren't even advertised. Several of the graduates took jobs with former graduates of their residency program.

If you want to do higher risk procedures - cervical, pumps, stims, etc. then definitely need to do a fellowship. Otherwise, you don't.