DrMarchMadness

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I am having serious doubts about PM & R right now and am very unhappy. Is it just because I have only done inpatient rehab, which I really don't like? Does it get better? Talk me down from the ledge, please!:scared:
 

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I am having serious doubts about PM & R right now and am very unhappy. Is it just because I have only done inpatient rehab, which I really don't like? Does it get better? Talk me down from the ledge, please!:scared:
A strong dislike of inpatient is the backbone of all good Msk/Pain guys.
 

RUOkie

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I am having serious doubts about PM & R right now and am very unhappy. Is it just because I have only done inpatient rehab, which I really don't like? Does it get better? Talk me down from the ledge, please!:scared:
While there is certainly nothing wrong with changing specialties, you need to evaluate what it is that you dislike. If it is just working the wards like an intern (which most "inpatient" rotations are like") then stick with it and you will see it does get better. If you are more geared toward outpt spine/msk, then look at this as an opportunity to learn your biomechanics (even when taking care of hips/knees and stroke) by evaluating your patiets and working with the PT's.

On the flip side, some of the best docs I know, changed residnecies mid stream. One of my med school roommates matched in ENT, then transferred to an IM prelim year, then changed again to a categorical IM (at a different program), and then did Heme/Onc fellowship. He loves his job.
 

SSdoc33

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if you dont plan on doing inpatient medicine for a career, then dont switch. do your 2 years of crappy inpatient medicine, and be completely unqualified to practice what you actually want to do when you get out. then, learn on the fly or better yet, do a fellowship. you know, just like the rest of us. i couldnt stand residency -- especially inpatient, but im quite happpy with my outpatient practice. believe me, you are not alone....
 

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very common to get a bit depressed or have low morale during inpatient rotations. assuming your program has some decent oupatient rotations, do not despair.
 

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Your feelings are normal. Check out this thread that you might find interesting:

http://forums.studentdoctor.net/showthread.php?t=442057&highlight=rehabres

That was my post when I first started residency (lied about being on the west coast though). Now that I'm finishing up residency and about to start my pain fellowship I can tell you that I'm really happy I stuck around. If a pain residency existed I would never have come to PM and R but considering that it doesn't, I feel PM and R is the best prep for a pain fellowship. While a lot of rehab was a waste of time for me, there's a lot that I took out of it. If you are going into pain and/or you're interested in hearing about it, let me know.
 
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I am having serious doubts about PM & R right now and am very unhappy. Is it just because I have only done inpatient rehab, which I really don't like? Does it get better? Talk me down from the ledge, please!:scared:
Given this recent post in another thread, I think there may be more to it than just dissatisfaction with our field:

Yea, the MATCH sucks. Don't let anyone tell you otherwise. Ended up matching into my 5th ranked program a couple of years ago, I am now a resident there, and I am very unhappy.
I had to move my family far away, I have a young child and a baby, and they never see family or friends because I live too far away now.

Some attendings here suck. They only care about work you do, nitpick and don't teach.
Residency is a grind, and I have about had enough sometimes. I wish I never went into medicine. I like helping people and that is all I like about it. I am stuck now. I have gone too far in this process, and changing would involve too much to put my family through.

The advice I would give anyone during the MATCH now is to never rank a place you wouldn't go want to go to because you could end up there. I thought I would match at my home state program, and it didn't work out for reasons I will never know.

So, you have every right to whine about this today. You will eventually come to grips with it like I did and try to make the best of it. You will always wonder why you ended up wherever if you don't like it and it will bother you til you finish.
There are my encouraging words of the day. Seriously, if its the specialty you wanted, stick it out, and make the best of it. If its not the specialty you wanted, turn it down, use the year for something constructive, and go for what you really want. It is a lifetime of that specialty and you don't want to look back. I never did get my first choice in specialty, and I think that is why I am unhappy overall in medicine too.
 

DrMarchMadness

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Given this recent post in another thread, I think there may be more to it than just dissatisfaction with our field:
Yes, while a lot of that is true, not all of us are able to match into our first choice in specialty, and we have to decide what we will do from there.

Yes, it is true, I don't think I like my program, but maybe the grass is always greener somewhere else and it really isn't.

I am starting to think that it is mostly because I am unhappy doing all inpatient now.

Someone asked earlier what I don't like about it. I think I am just more inclined to do outpatient in general, and am more interested in pain or muskuloskeletal/sports. I am just concerned that the program I matched into doesn't have good experiences in those areas. I think we are more strong on the inpatient side, but maybe that is how all programs are? I don't know.
 

DrMarchMadness

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:nono: I still enjoy inpatient.......... I just like doing the whole MSK clinic / EMG / fluoro injection thing more.
I want to make it clear, I am not knocking anyone for doing it or liking it, but I personally just don't seem to like it. Most of it has to do with my personality not being in mesh with inpatient. I think I knew that before, but I ended up matching into a place that seems inpatient strong and I am not so sure about the other experiences.
 

DrMarchMadness

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if you dont plan on doing inpatient medicine for a career, then dont switch. do your 2 years of crappy inpatient medicine, and be completely unqualified to practice what you actually want to do when you get out. then, learn on the fly or better yet, do a fellowship. you know, just like the rest of us. i couldnt stand residency -- especially inpatient, but im quite happpy with my outpatient practice. believe me, you are not alone....
I am happy to hear someone that feels the way I do now content with their career. Most of the other residents in my program are not like me, they are more gunner types it appears and most of them don't seem interested in pain. In fact, many of them have a bad opinion of it.:(
 

ml2001

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I am happy to hear someone that feels the way I do now content with their career. Most of the other residents in my program are not like me, they are more gunner types it appears and most of them don't seem interested in pain. In fact, many of them have a bad opinion of it.:(
Hey man:
Sometimes you just have to do what you have to do to get to where you want to be ultimately. I was not a big fan of inpatient also before I started my residency and I still am not, but used to it now. Having done 6 months of intensive IM inpatient during my prelim year and 6 months of rehab inpatient so far, I don't mind it at all. The reason I don't mind is because I can see that it is only 9 more months before I never have to see inpatient again. I came into the residency thinking that I will get through myself through the inpatient like a soldier during a war, but now that I'm in it, I actually don't mind it. I guess I have just developed resistance to everything that inpatient throws at you. Again, keep you target in sight and inpatient would feel like a breeze...

-ML
 

DrMarchMadness

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Classic Physiatric Low Esteem and Suffering Experience (PLEASE). Textbook.

http://forums.studentdoctor.net/showthread.php?t=588818
Thanks for the link, that is part of how I feel, and it gives me some perspective because I feel like the only one in my residency program that feels this way. Maybe not, maybe the other residents just aren't saying how they feel.

I recently admitted a patient that never should have come to acute rehab and then had to turn around and discharge that patient the very next day. Very frustrating how the powers that be seem to be calling the shots and not so much the attendings in some cases. Almost feels like they just want to keep the ward filled sometimes. This is just one example of a recent frustration. And of course who gets to do all that work with the quick admission/discharge, me of course, but I get paid, I'm "learning" and I deal with it.

It's encouraging to me to get this feedback from all of you. Thanks.
 

Disciple

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That's the thing, I am not sure if they do.

Uh oh...


You may have to go with the 8 year plan.

MSK fellowship, followed by

Interventional Pain fellowship, followed by

Sports fellowship, followed by

Neurology Neurophys fellowship (for EMG)


Upon completion you should be able to compete for a desirable MSK/interventional job in a desirable geographic location.


Just kidding.

But you get the picture.
 

ml2001

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I recently admitted a patient that never should have come to acute rehab and then had to turn around and discharge that patient the very next day. Very frustrating how the powers that be seem to be calling the shots and not so much the attendings in some cases. Almost feels like they just want to keep the ward filled sometimes.
Are you sure you are not talking about where I'm doing my residency now??:laugh::laugh::laugh::laugh: Just kidding......Like I said in my previous post, you are not alone. Just hop on and enjoy the ride:soexcited:

-ML
 

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Please do not to forget to feel pity for the newer, lower level on the echelon inpatient attendings. They were like you a few years ago, and then something happened in their lives. They cling for safety. Kind of like Pediatrons. They are easy to spot because admission orders are not complete without consulting 3 other services. But keep your eyes on the ball. Time slips away quick even when you are hating your job. Take out your frustration at the gym, or on Netter and Fenton. Show up early, leave late, mouth shut. (2/3 ain't bad)
 

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Thanks for the link, that is part of how I feel, and it gives me some perspective because I feel like the only one in my residency program that feels this way. Maybe not, maybe the other residents just aren't saying how they feel.

I recently admitted a patient that never should have come to acute rehab and then had to turn around and discharge that patient the very next day. Very frustrating how the powers that be seem to be calling the shots and not so much the attendings in some cases. Almost feels like they just want to keep the ward filled sometimes. This is just one example of a recent frustration. And of course who gets to do all that work with the quick admission/discharge, me of course, but I get paid, I'm "learning" and I deal with it.

It's encouraging to me to get this feedback from all of you. Thanks.
I had a guy who had a guillotine BKA and vascular said they weren't going to be able to take him back to the OR for the closure until Friday (it was a Monday, I think). My attending said sure, bring him to rehab for a few days until then. No sooner did I finish typing the H&P, with the patient tucked in all cozy and warm, wound care orders and all, vascular calls me at 4pm saying they had to cancel a case and they could take him to the OR in the AM. So, I saved my H&P, called my wife to b***h, and started my discharge paperwork and orders. Patient got no rehab. I did 3 hours of work...and had to admit him again 2 days later! Point is...it happens to all of us.

I liked seeing my patients on rounds, controlling their pain, and helping them get better. I think I learned a lot. What I found I didn't like about inpatient was things are unpredictable. I don't want a ton of admits on a Friday because we have open beds, I don't want a chest pain call when I'm about to walk out the door. I like the control over my day I have with outpatient practice and I like the pathology I'll diagnose and treat.

Luckily my program splits IP and OP the first 2 years to mix it up. Without neglecting my service obligations, I coped on inpatient by using some of my time on SCI to read about spine, gen rehab - MSK and neuroanatomy (had EMGs coming up), BI - sports concussion etc. When I had to give a lecture it was always an MSK topic (for my benefit). For the SAE's I studied a lot of areas I hadn't seen or my program was weaker in. When I was on EMG or outpatient MSK/pain rotations, it really paid off. I guess what I'm saying is make the best of the situation and be pro-active if your program is soft in MSK (you're not alone there either).
 

DrMarchMadness

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Please do not to forget to feel pity for the newer, lower level on the echelon inpatient attendings. They were like you a few years ago, and then something happened in their lives. They cling for safety. Kind of like Pediatrons. They are easy to spot because admission orders are not complete without consulting 3 other services. But keep your eyes on the ball. Time slips away quick even when you are hating your job. Take out your frustration at the gym, or on Netter and Fenton. Show up early, leave late, mouth shut. (2/3 ain't bad)
Good advice that I will definitely heed. I definitely took my eye off the ball recently due to frustration, but the advice and experiences mentioned here have helped me to recollect myself for sure.
 

DrMarchMadness

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Luckily my program splits IP and OP the first 2 years to mix it up. Without neglecting my service obligations, I coped on inpatient by using some of my time on SCI to read about spine, gen rehab - MSK and neuroanatomy (had EMGs coming up), BI - sports concussion etc. When I had to give a lecture it was always an MSK topic (for my benefit). For the SAE's I studied a lot of areas I hadn't seen or my program was weaker in. When I was on EMG or outpatient MSK/pain rotations, it really paid off. I guess what I'm saying is make the best of the situation and be pro-active if your program is soft in MSK (you're not alone there either).
Thanks for the advice. Sounds like a good plan.
 

Llenroc

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Inpatient rehab is da bomb diggity fo sho.

What, you don't like sticking your finger inside people's *******s and the fragrant smells of their pressure sores? Or the indignities of interacting with unionized hospital staff whom you don't employ? :cool:

Come Sunday, the whole rehab field is ****ed anyway, inpatient and outpatient. Gov't will send people to nursing homes/subacute instead of inpatient rehab. And it's cheaper to hand out percs and MS Contins to the masses than to do any kind of injections or other interventions. Boy did you make a mistake! But it's OK. Just ask your rich father for money. And if you don't have a rich father, then get one. See problem solved.
 
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Come Sunday, the whole rehab field is ****ed anyway, inpatient and outpatient.
No Come Sunday we will finally be able to insure our working/middle class, who dont qualify for Medicare, who dont qualify for Medicaid ,and who depend on an unreliable employer-based system or who dont have an employer because they own a small family business and have a pre-existing condition that makes it impossible to afford health insurance. So they dont get it. Instead they walk around without insurance, dont take care of their high blood pressure or diabetes, because they cant afford it. Until of course, they have an MI or they have a stroke, and are faced with a 400,000 hospital bill that they cannot afford, because of course we dont refuse anyone in the ER for treatment but we still send them the bill. The hospital social worker then tells them they dont qualify for any aid because they have more than $3000 so therefore they should be able to afford the $400,000 bill. They are discharged home and the bills start coming with more zeros at the end than they have ever seen in any bank account. They keep ignoring the bills, cant afford the hospital follow-up appointments, until they get a collector civil suit threatening to put a lien on the home that they worked all their life to be able to buy. We expect them to sell away their assets until they are left with nothing and then we'll give them Medicaid. We pay too much taxes in this country and spend too much money on defense (a trillion) to be denying people the right, yes the RIGHT, to quality health care that is accessible to all.

Pray that youre really poor, over 65, or rich enough to afford your own health insurance in ths country because if youre anywhere in between we're just gonna hang you out to dry.

Unfortunately the Republicans have made so many edits to our health care bill without even changing their vote to a YES that there is no longer a public option, but at least some tax breaks for those paying out of pocket for health insurance. It's a start to something historic.

Thank you President Obama for starting what could be history tomorrow. I didnt go into medicine for status, prestige, money, reimbursements. I didnt go into medicine to make sure Medicare reimburses me for every 3 epidurals I put in my patients spine every 6 months. My personal statement from college says I went into medicine to help people. Where is my altruism? Still intact, I hope. Yes Id like a decent living and a decent home to support my family in. I think medicine will always be able to give me that. But for now, I want to make sure my neighbor, my friend, my sister, and every other person I know out there that doesnt have health insurance, and falls in the cracks where there are no Medicare or Medicaid protections, is provided with a human RIGHT to health insurance and health care coverage. Afraid of a government take-over? Dont be, it's times like this where we need one.


http://www.cnn.com/2010/POLITICS/03/20/health.care.main/index.html
Keeping my fingers crossed for Obama Care tomorrow!!
 

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That was extremely inappropriate Llenroc.
 

PMR2008

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Thanks for the advice. Sounds like a good plan.

I know exactly how you feel DrMarchMadness. My advice is to focus on anatomy and MSK examination skills during the inpatient months. Another way to make the months tolerable is to order outpatient procedures like EMGs, peripheral injections etc on the patients and try to go to clinic when the procedures are performed. I am also spending time with the therapists to learn the modalities they use daily. Some of the MSK/Ortho PTs and OTs at my home institution are excellent in there examination skills so I spend time with them as well. But honestly I am sick and tired of getting extremely sick and tired patients who can not tolerate 1+ hours of therapy and than I have to do all the work of admitting and discharging them within 2 days.
 

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Llenroc said:
*inappropriate content deleted*
I would never have said that. I wish I was wittier. But I agree with you completely. Right to health care? Not a chance. Legal to take my labor and skills? No way.
 
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Llenroc

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Yo thanks, that's like a "best of" collection for the Llenroc fans out there. :thumbup:
 
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RUOkie

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I had a guy who had a guillotine BKA and vascular said they weren't going to be able to take him back to the OR for the closure until Friday (it was a Monday, I think). My attending said sure, bring him to rehab for a few days until then. No sooner did I finish typing the H&P, with the patient tucked in all cozy and warm, wound care orders and all, vascular calls me at 4pm saying they had to cancel a case and they could take him to the OR in the AM. So, I saved my H&P, called my wife to b***h, and started my discharge paperwork and orders. Patient got no rehab. I did 3 hours of work...and had to admit him again 2 days later! Point is...it happens to all of us.
OK, this is exactly why we are in the mess we are with healthcare. If we (meaning staff physicians) do not police ourselves, we deserve what we get with the govt. controlling things. As an earlier poster said, the "powers that be" are running the show. If you do inpt (I mean staff guys-residents do NOT get yourself in trouble here!;);)), then you need to learn to say NO! to your screeners. This kind of situation is exactly why the for-profit rehab management comps don't like physiatrists as their medical directors.
 

kelvination

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No Come Sunday we will finally be able to insure our working/middle class, who dont qualify for Medicare, who dont qualify for Medicaid ,and who depend on an unreliable employer-based system or who dont have an employer because they own a small family business and have a pre-existing condition that makes it impossible to afford health insurance. So they dont get it. Instead they walk around without insurance, dont take care of their high blood pressure or diabetes, because they cant afford it. Until of course, they have an MI or they have a stroke, and are faced with a 400,000 hospital bill that they cannot afford, because of course we dont refuse anyone in the ER for treatment but we still send them the bill. The hospital social worker then tells them they dont qualify for any aid because they have more than $3000 so therefore they should be able to afford the $400,000 bill. They are discharged home and the bills start coming with more zeros at the end than they have ever seen in any bank account. They keep ignoring the bills, cant afford the hospital follow-up appointments, until they get a collector civil suit threatening to put a lien on the home that they worked all their life to be able to buy. We expect them to sell away their assets until they are left with nothing and then we'll give them Medicaid. We pay too much taxes in this country and spend too much money on defense (a trillion) to be denying people the right, yes the RIGHT, to quality health care that is accessible to all.

Pray that youre really poor, over 65, or rich enough to afford your own health insurance in ths country because if youre anywhere in between we're just gonna hang you out to dry.

Unfortunately the Republicans have made so many edits to our health care bill without even changing their vote to a YES that there is no longer a public option, but at least some tax breaks for those paying out of pocket for health insurance. It's a start to something historic.

Thank you President Obama for starting what could be history tomorrow. I didnt go into medicine for status, prestige, money, reimbursements. I didnt go into medicine to make sure Medicare reimburses me for every 3 epidurals I put in my patients spine every 6 months. My personal statement from college says I went into medicine to help people. Where is my altruism? Still intact, I hope. Yes Id like a decent living and a decent home to support my family in. I think medicine will always be able to give me that. But for now, I want to make sure my neighbor, my friend, my sister, and every other person I know out there that doesnt have health insurance, and falls in the cracks where there are no Medicare or Medicaid protections, is provided with a human RIGHT to health insurance and health care coverage. Afraid of a government take-over? Dont be, it's times like this where we need one.


http://www.cnn.com/2010/POLITICS/03/20/health.care.main/index.html
Keeping my fingers crossed for Obama Care tomorrow!!
Amen.
 

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OK, this is exactly why we are in the mess we are with healthcare. If we (meaning staff physicians) do not police ourselves, we deserve what we get with the govt. controlling things. As an earlier poster said, the "powers that be" are running the show. If you do inpt (I mean staff guys-residents do NOT get yourself in trouble here!;);)), then you need to learn to say NO! to your screeners. This kind of situation is exactly why the for-profit rehab management comps don't like physiatrists as their medical directors.
Funny thing is that the inpatient attending and the consult attending were the same person. He at least apologized to me about it.

I find it funny how the criteria for IP rehab changes based on how many beds are available :rolleyes:
 

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I think most physiatrists who end up doing MSK/pain did not enjoy inpatient rehab much.

I didn't enjoy it because in the academic environment, I felt we were just keeping beds filled, often with inappropriate patients. It was also frustrating as many of my attendings didn't teach, I would work the ward most of the day while they were in clinic, and they would just come cosign my notes. Talk about worthless scut. There were rotations where I rarely rounded with the attendings. Additionally, I felt like some of the attendings didn't know their medicine well enough to take care of the patients. A few particular examples stick out. We had a patient with metastatic brain cancer, who for some reason had a sed rate ordered, came back obviously elevated, and because of this my attending wanted me to get a rheum consult (no history of arthralgias/arthritis, no acute sx, ie no reason to consult rheum). I refused to, got into an argument with the staff, and the rest of my rotation was brutal. (BTW she called the rheum consult and they came by wrote a quick note stating the consult was completely inappropriate). There was also a time where I was on a clinic rotation and came in for weekend call, and the nurses told me this patient was having 'dark stools for the past week.' I ordered a Hg and it came back at 6! The guy had sarcoidosis, was on 40mg prednisone daily and didn't have a PPI ordered. GI scoped him and he had three bleeding ulcers! Experiences like this really turned me off to inpatient rehab.

However I have heard that at community based hospitals, inpatient rehab is practiced much differently. It would also be nice to properly screen for appropriate rehab candidates.

My advice is that if you like pain/MSK, grind it out and wait for those outpatient months. :)
 

ml2001

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My advice is that if you like pain/MSK, grind it out and wait for those outpatient months. :)
Which is what I'm doing at this point even though I don't find it less likening for now during residency. However, I'm pretty sure I won't go back to inpt. once I graduate.

-ML