PGY 1 - Reapply

[MAK86]

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Hi Guys,

I am currently a PGY 1 in Internal Medicine program. I graduated this year from a DO school with a fairly descent grades. (Step 1 - 212, Step 2 - 246, Comlex 1 - 581, Comlex 2 - 618, class rank - top 15%). Unfortunately, I am not satisfied with the program that I have matched into. Even before I interviewed for med programs, I was debating between pm&r and med. Now I am considering reapplying and changing my line to pm&r.

As a student, I did an out patient rehab rotation and I really enjoyed it too. I didn't do a hospital based rotation at that time. I can still get the LOR from the attending who I worked with. I was just wondering, what would be my chances of getting into rehab if I reapply.

I will really appreciate any feedback. Thanks in advance.

 

[PhysiatristDoc]

what is it you love about pm&r?

medicine is much more flexible in the long run.

if you really really love pm&r and can't live without it, spots are always opening up, people drop, people decide they want medicine, occ med or something else instead and leave pm&r.

just make sure you get a well rounded pgy1. i highly recommend taking rheum if you can. don't talk about leaving or annoy people with negativity until you have a spot elsewhere because you will most likely need your current program director to give you a letter when/if you switch programs.

let all of the program directors in your area know you want a spot and send them your ERAS in case something opens up. in some systems, they will favor a current resident who wants to switch internally if PM&R is available in your system, so that is also an option, but I would say tread carefully and be kind, do great work, and things will work out for you. Your score are fine for PM&R, medicine is actually more competitive.

you can also consider sports med fellowship which qualifies you to do 90% of what pm&r does in outpatient. the best programs are training in musculoskeletal, injections, and ultrasound.

if you love pm&r inpatient, i would say stick with medicine...

 

[MAK86]

Thanks for your feedback PhysiatristDoc.

Another question for you...
Since I have done a clinic based pm&r rotation but not a hospital based rotation, would that effect my chances of getting into rehab negatively?

 

[Jitter Bug]

Not sure I agree that there is a great similarity between PM&R and internal medicine.

Now the PGY-2 year of PM&R is very heavy IM, so much that you may not know you had changed residencies. PGY3 and 4 will really teach a very different skill set in PM&R than IM.

Switching into PM&R will be difficult because there are so many more IM programs than PM&R. You should be open to moving to a new city. If you don't plan to go through the match you only have access to currently open slots, and you will need to call programs directly and inquire about that. If you go through match, you will need something to do for your year off. Maybe research?

Last thought, since IM is a 3 year residency and PM&R 4 year, I don't know if that has implications for the program that picks you up in terms of their allotment of federal money. Hopefully others can chime in.

I recommend talking to your medical school deans-they have a vested interest in your success and can hopefully give you some advice how to proceed. You will need big names to write letters and make phone calls on your behalf, so don't piss anyone off until you get settled in your new slot.

Good Luck

 

[PhysiatristDoc]

Sorry to mislead, what I meant was, if someone loved inpatient PM&R, they may actually like inpatient internal medicine as well, there is lots of overlap.

I think it is possible to get a spot in PM&R even if the rotation was only an outpatient rotation, and even at this time.

It would help considerably to get a PM&R letter from that outpatient doc, and politely ask (read: "beg") said doc to make phone calls for you. Phone calls can make a huge difference in this field as it is a relatively small field and the academics often know each other, either personally or by name.

It definitely CAN be done, and I can tell you, in my former life as a university attending, most of our residents wanted to do something else before they found PM&R. Some examples: internal medicine, orthopedics, neurosurgery, family practice, emergency medicine... you get the idea. I can think of a few examples where a very strong letter from me secured some mediocre scoring residents who were hard working clinically, some very competitive pain fellowship spots. I am an unknown in PM&R, so it wasn't my name helping the resident, it was my description of their work ethic, personality, and team skills. The personal factor is very important in PM&R.

I do suggest exploring medicine sub-specialties as well, because there are some that can offer similar quality of life, patient interaction, and pay scale. There is also a one year sports fellowship available to internal medicine, some places will train in epidural injections and ultrasound.

I have posted this comment before and will again say the following: Primary care is much more flexible that PM&R because you will always be able to find an employed position no matter where you are, and you will be the first stop for your patients. In PM&R you are a specialist and will need someone to send you patients. In a managed care environment, getting referrals can be an issue.

 

[Jitter Bug]

I have posted this comment before and will again say the following: Primary care is much more flexible that PM&R because you will always be able to find an employed position no matter where you are, and you will be the first stop for your patients. In PM&R you are a specialist and will need someone to send you patients. In a managed care environment, getting referrals can be an issue.

Depends on your practice and geographic region. In my region ( midwest, 2 million draw area) a physiatrist who does a general practice will get their patient directly from the hospital: CVA,SCI, TBI, etc etc. Built in steady referral source. Most outpatient docs either build referrals from primary care in their network, in their region or in their country club. They can also accept self referrals if they market directly to patients.

Around here there is so much demand for PM&R and such small supply that most of us pick and choose our work, or go solo if we don't like what's on the table.

I think any town large enough for a community hospital would be able to keep a f/t general physiatrist well fed.

 

[PhysiatristDoc]

It is great that Jitter Bug finds it easy to get a referral base, but in the metro area I am in, there seems to be an oversupply of PM&R docs with 'exclusives' at the rehab wards and though a new doc can make a name for himself or herself, it takes a lot of toe stepping to do so. I have not found it that easy, It has been a real source of frustration for me. Some private PM&R docs here don't even talk to eachother because one has stepped on the other's 'territory' and there seems to be badmouthing and lying to get inpatient 'territory.'

There are more lucrative opportunities in smaller areas with fewer docs, I am in a large midwestern region but we graduate lots of physiatrists which makes for lots of competition.

If location is not an issue, my vote is wholeheartedly for PM&R over almost any other medical specialty. It is fun, lucrative, laid back (generally), and mentally stimulating.

Selection to most programs is getting more competitive, but the original poster's scores are high enough, and I would encourage pounding the pavement while keeping a solid second choice open.

 

[Bossman2313]

In the same boat as the OP except slightly different. I had posted earlier in the neurology forum.

I have not done any PMR electives I just did some shadowing during medical school while I was trying to decide which specialty to apply for. I ended up choosing and matching into neurology. I don't know if I'd be able to schedule any electives with PMR at my Transitional Year hospital right now. Will this effect me if I re apply? The only thing I can say about why I want to do PMR is that there is obvious basic science interest in neurology which has a ton of overlap in PMR. But honestly I've always liked PMR but was just never able to schedule a proper rotation in it as a student. I suppose Neurology was the closest thing I got to it and I ended up liking that rotation a lot. I always had an interest by shadowing here and there both Inpatient and outpatient but it was only for a few days.

I guess the main reason I want to switch into PMR (besides realizing neurology is too much like medicine) is that I realized I can do more for people as a PMR doctor than as a neurologist. I feel so empty coming up with diagnoses and then not being able to really treat someone. I think neurology rotations as a student were fun beacuse it was fun playing House MD at the time but now I really like treating patients.