Outpatient-oriented residency programs

[austin2612]

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I am VERY interested in outpatient PM&R. I am uninterested in inpatient PM&R.

Who knows which residency programs are more geared toward outpatient medicine?

 

[fozzy40]

What aspects of outpatient PM&R are you interested in? All PM&R residencies do have a 12 month inpatient requirement. That being said, what aspects of inpatient are you not interested in specifically?

 

[austin2612]

I feel strongly about having the ability to be autonomous and entrepreneurial in my future practice. My dream has always been to own or co-own a practice which I can build up. I enjoy the business-aspect of medicine and working for an inpatient rehab hospital is not my dream.

Ideally I can find a program that has a higher outpatient/inpatient training ratio that exposes me to the areas of PM&R that are conducive to that dream. I find some areas like pain, musculoskeletal, and spine interesting, however, I think during my residency program I will get a better feel for which areas I most enjoy treating patients.

I have seen some posts on here talking about specific programs' outpatient/inpatient mix, but was curious if anyone knew offhand which programs were more outpatient-oriented.

 

[bedrock]

mayo. great weather right now, too.

 

[austin2612]

Lol, riiiight. Any others? 🙂

 

[Prof Moriarty]

Stony Brook
UCLA

 

[fozzy40]

This is really a tough question to answer.

By ACGME requirement, almost all residencies have a 12-13 month inpatient requirement. The rest of your 23-24 months are considered "outpatient."

If you are interested in training at a program that provides you with a lot of hands-on procedural experience, that is definitely a different question.

If you know that you do not like inpatient rehabilitation, I would probably look at rehab programs that are not at stand alone facilities (i.e. RIC, TIRR) since these probably require in-house call and likely very medically complex patients with less ancillary support.

 

[bedrock]

By ACGME requirement, almost all residencies have a 12-13 month inpatient requirement. The rest of your 23-24 months are considered "outpatient."

That's not entirely accurate. ACGME requirements simply stipulate that all PM&R residencies have a minimum of 12 months of inpatient rotations and a minimum of 12 months of outpatient rotations.
How the third or other 12 months is spent out of a 3 year residency greatly depends on the individual residency program. Residents at some programs spend close to 2 years on inpatient services, and residents at other programs spend close to 2 years on outpatient rotations. So the OP question is valid as they might spend a year doing something they'd rather not depending on the program.

 

[fozzy40]

That's not entirely accurate. ACGME requirements simply stipulate that all PM&R residencies have a minimum of 12 months of inpatient rotations and a minimum of 12 months of outpatient rotations.
How the third or other 12 months is spent out of a 3 year residency greatly depends on the individual residency program. Residents at some programs spend close to 2 years on inpatient services, and residents at other programs spend close to 2 years on outpatient rotations. So the OP question is valid as they might spend a year doing something they'd rather not depending on the program.

Almost two years inpatient? News to me but I don't claim to know everything! Let's start a list since the OPs question is a common One.

"Strong" Inpatient:

"Strong" Outpatient:

 

[Llenroc]

Some places that are inpatient heavy, are also good at outpatient (i.e. you get to do a lot of procedures).

Some places have the bare minimum of inpatient (12 months general rehab), but their outpatient rotations are crap also because the attendings won't let you touch the patients.

So it's hard to tell from rotation schedule alone whose good at what.

 

[austin2612]

Yeah, let's start the list that Fozzy suggested! Starting it off...

Strong Outpatient:
Mayo
Stony Brook
UCLA

Strong Inpatient:

 

[Dreami123]

Some places that are inpatient heavy, are also good at outpatient (i.e. you get to do a lot of procedures).

Can you give examples of such programs? I am interested in these types of programs, Thanks!

 

[Llenroc]

Supposedly RIC is above average with respect to procedures. University of Michigan (has pretty intense inpatient months) is also pretty good for procedures (especially interventional spine procedures). At Ohio State they do a lot of EMG's and botox injections.

 

[fozzy40]

From personal experience, RIC's inpatient experience is probably more intense compared to most but EXCELLENT! I can honestly say that RIC produces great generalists! Great training! From a procedural standpoint, EMG experiences is not a problem. Hands on experience for epidural injections is not one of our strengths. We get a pretty good amount of peripheral joint injections.

 

[cubsfan]

To add to this thread, Tufts program is as follows:
PGY2: All inpatient
PGY3: 4 mo inpatient, 4 mo consults, 4 mo outpatient peds/adult clinic split
PGY4: all outpatient and EMG

 

[olafa]

To add to this thread, Tufts program is as follows:
PGY2: All inpatient
PGY3: 4 mo inpatient, 4 mo consults, 4 mo outpatient peds/adult clinic split
PGY4: all outpatient and EMG

.... which sounds like it is probably classified as heavier inpatient when adding in consults (which is really more inpatient that out). Although, technically I think consults count for neither and are classified as neutral.

 

[Ludicolo]

.... which sounds like it is probably classified as heavier inpatient when adding in consults (which is really more inpatient that out). Although, technically I think consults count for neither and are classified as neutral.

Correct. Programs need a minimum 12 months inpatient, 12 months outpatient. Consults don’t count toward either. Neither do EMG months.

 

[austin2612]

Strong Outpatient:
Mayo
Stony Brook
UCLA

Neutral:
Tufts

Strong Inpatient:

 

[axm397]

I would actually ask about opportunities to rotate with private practice PM&R docs who practice in settings like you describe.

There are also studies that show that residency grads tend to stay within that geographic area - so you may want to consider the location of the residency.

If you plan on pursuing fellowship training - then you may want to look at fellowship availability, track record in placing grads, etc.

 

[MedBronc23]

I echo the sentiment. Programs like Mayo, Utah...to name a few have really great MSK/SPORTS/SPINE people. I would hope that you at least enjoy inpatient rehab a little because you will have to do it in residency...and it is better to enjoy the inpatient aspect of what you are going into...if not...would make for long pre-li/transitional/intern year....and a long residency if you did not enjoy inpatient at all.

I specifically picked my program because the inpatient side prepared me well enough if I went that route and also provided knowledge I would be able to use in the outpatient setting to better myself and my future practice. Everything we learn in PM&R builds upon itself in my opinion. I matched to my program of choice and a place where most consider outpatient focused...but I also knew that the inpatient staff/training was top notch too.

Good luck with your search. Outpatient is definitely awesome, but the inpatient side of PM&R balances it out in a good way in my opinion.