PGY2 Slump

[Butterfly23]

The way I feel about inpatient rehab is that you do not feel like an expert. Nowadays, we get much sicker patients and many attendings(I will probably do same when I become an attending) feel like they have to call medicine consults to protect themselves and medicine gets annoyed with those consults. But in fact, We are the experts, if hospitalists run the rehab floor, ,it will be hard to coordinate therapies and medical issues. Inpatient rehabs is necessary portion of PM&R but the nature of the work is not attractive for me.

 

[bachelorpad]

The way I feel about inpatient rehab is that you do not feel like an expert. Nowadays, we get much sicker patients and many attendings(I will probably do same when I become an attending) feel like they have to call medicine consults to protect themselves and medicine gets annoyed with those consults. But in fact, We are the experts, if hospitalists run the rehab floor, ,it will be hard to coordinate therapies and medical issues. Inpatient rehabs is necessary portion of PM&R but the nature of the work is not attractive for me.

I think you said it well ... "you do not feel like an expert." ... That's another thing that bothers me ... for every minute medical problem I am consulting medicine because my attending doesn't feel comfortable. I, personally - want to get certified in central lines - procedures that I may need or could be useful to my patients... heck, they are my patients - so if I am comfortable in medicine and medical procedures, I can get things done faster and more efficiently. I found that during my inpatient rotation - I get most of my work out of the way by latest 11am - and from then on I have a lot of spare time, so why wouldn't I be able to do procedures on my patients if I was adequately trained in them?

 

[lobelsteve]

I think you said it well ... "you do not feel like an expert." ... That's another thing that bothers me ... for every minute medical problem I am consulting medicine because my attending doesn't feel comfortable. I, personally - want to get certified in central lines - procedures that I may need or could be useful to my patients... heck, they are my patients - so if I am comfortable in medicine and medical procedures, I can get things done faster and more efficiently. I found that during my inpatient rotation - I get most of my work out of the way by latest 11am - and from then on I have a lot of spare time, so why wouldn't I be able to do procedures on my patients if I was adequately trained in them?

You can and should. As a pgy2 I removed a pedunculated schwanoma off a thigh for a patient s/p BKA. Let him get fit for prosthetic tather than family training.

 

[RUOkie]

I agree with Steve. When I did my inpt rotations, I did debridements, LOTS of joint injections, and even some EMGs. When I had free time, I would go to the MSK clinics and help out (or just observe so I didn't take things away from other residents). Or I'd go to radiology and hang out with the MSK radiologists.

Residency is what you make of it. If you are bored, there are lots of places in a hospital to expand your knowledge.

 

[j4pac]

If you have free time couldn't you go down and watch rehab? Just trying to figure out the flow

 

[bachelorpad]

I've done some soul searching and realized this field is just not for me (I think it's a noble field) but the things I am missing or yearning for - is actually medicine. And I think it's because I had such a great medicine preliminary year that I am now feeling this way. That being said, how can I go about this in a ethical manner? I don't want to step on other people's toes - I am willing to stick it out for this year and then switch to IM. Any advice would be appreciated.

 

[j4pac]

I've done some soul searching and realized this field is just not for me (I think it's a noble field) but the things I am missing or yearning for - is actually medicine. And I think it's because I had such a great medicine preliminary year that I am now feeling this way. That being said, how can I go about this in a ethical manner? I don't want to step on other people's toes - I am willing to stick it out for this year and then switch to IM. Any advice would be appreciated.

Have you considered that it may be your program and not the specialty in general. Are you going to one of the big 6? Every once in a while someone flees from a program like Baylor because it is TOO medicine heavy. Is residency swap and option for you?

 

[bachelorpad]

Yes, I have considered that it may be my program, and it might to a certain degree. However, the main issue is that I find myself sitting down and reading about stroke and wishing I was reading about medicine - something non-rehab or PMR related. I never felt this way during my preliminary year. And if I had known I felt this way - I most definitely would not have gone this route - but going through my prelim medicine program and liking it definitely opened my eyes. I read another post - and they said it well, it's like I had a great relationship and abandoned it ... and wish I was with that person/residency again.

 

[bachelorpad]

By the way, I really appreciate

Have you considered that it may be your program and not the specialty in general. Are you going to one of the big 6? Every once in a while someone flees from a program like Baylor because it is TOO medicine heavy. Is residency swap and option for you?

Yes, I have considered that it may be my program, and it might to a certain degree. However, the main issue is that I find myself sitting down and reading about stroke and wishing I was reading about medicine - something non-rehab or PMR related. I never felt this way during my preliminary year. And if I had known I felt this way - I most definitely would not have gone this route - but going through my prelim medicine program and liking it definitely opened my eyes. I read another post - and they said it well, it's like I had a great relationship and abandoned it ... and wish I was with that person/residency again.

 

[bachelorpad]

Have you considered that it may be your program and not the specialty in general. Are you going to one of the big 6? Every once in a while someone flees from a program like Baylor because it is TOO medicine heavy. Is residency swap and option for you?

I really appreciate everyone's input - this has been such a heart wrenching decision - that I assure you I don't take lightly ...considering i have given it time before I made it. But it is something that I must do, for my happiness, peace of mind and for my family's sanity (because I assure you - they had enough of hearing my sobbing)

 

[RUOkie]

I really appreciate everyone's input - this has been such a heart wrenching decision - that I assure you I don't take lightly ...considering i have given it time before I made it. But it is something that I must do, for my happiness, peace of mind and for my family's sanity (because I assure you - they had enough of hearing my sobbing)

Good luck then. PM&R is not for everyone, and far better to discover that in your PG2 yr than after 10 yrs of practice. Good luck in whatever you choose to do.

One of my Med school roommates started in ENT, switched to Gen Surg. Then to Internal medicine. Did an oncology fellowship, and now 17yrs later is happy with his career choice. Sometimes it takes time to figure out what you love.

 

[j4pac]

By the way, I really appreciate



Yes, I have considered that it may be my program, and it might to a certain degree. However, the main issue is that I find myself sitting down and reading about stroke and wishing I was reading about medicine - something non-rehab or PMR related. I never felt this way during my preliminary year. And if I had known I felt this way - I most definitely would not have gone this route - but going through my prelim medicine program and liking it definitely opened my eyes. I read another post - and they said it well, it's like I had a great relationship and abandoned it ... and wish I was with that person/residency again.

Good luck!

 

[padresp]

A good friend of mine switched out of PM&R after her PGY-2 year to do IM and is glad that she did. I stuck with PM&R and was glad I did. Do what you like best, know what you're getting into, then don't look back!

 

[DOctorJay]

someone in the class below me in residency switched from PM&R to medicine. I lost touch but assume he's happy.

I will tell you this opened up a spot for another guy who just happened to complete residency and then his fellowship at my program and was hired on as staff there as well. So you may be paying it forward by opening up a slot to someone who really wants PM&R.

 

[bachelorpad]

I really appreciate all the input, I am waiting to talk to my prelim PD (which is difficult when I am in a residency already) - to weigh out my options. This is a huge deal, but now that I realized my decision, somehow I feel less distressed and unhappy, like I have a plan to go back to what I like best. I am definitely okay doing one year in PM&R, if anything it will make me a better internist to understand the ins and outs of rehab. I have no hatred towards the field, just love something else better🙂

 

[bachelorpad]

UPDATE: So a lot of thinking, talking to others - residents, fellows, attendings and even my preliminary program director on the options. I've decided to stick it out with PM&R - I started following a pain doc who has put me under his wing and really has gotten me interested in the possibilities with pain - eventually maybe I could do both - PMR inpatient and pain outpatient, I am not opposed. However, I am excited about the future and the possibilities and really thankful that this "questioning of my profession" got the fire started under me and I have made the right connections to make going to work more worthwhile for me. Thank you to all for the insight ... so I'll be riding the pain train for the next three years of my residency career.

 

[Kissmyabjj]

teaching programs have been unable to adapt to the rapid decline in rehab stays, reimbursement, and admittable diagnoses. Quads used to stay on rehab for a year, paras for 6 months at least, etc. If you took on a tenuous patient you had weeks to stabilize them and usually they would not decompensate after that. So you did some medicine and watched them rehab for weeks to months. Now you're lucky if you get a month for a new para. Rehab is used to offload overflowing medicine units. You admit constantly because turnover is so fast and your census increases because you need 3 patients to reimburse what 1 used to. You barely stabilize them and then they get a few days of rehab and go home. You don't see much rehab anymore. Everyday is an admit and discharge sprint. Ages ago you admitted 1-2 patients a week because your unit was full of long stay patients. This is turning inpatient rehab into a 2.5-3 year IM internship. Even PGY2 IM's have interns to scut out.

But look at it this way, you're a doctor so you're duty is to practice medicine even if it's not all rehab. So take pride that you're still THE doctor.

I wanted to bring this thread back up just in case there were any PGY-2's out there who hadn't gotten a chance to see it. This is the post I relate to the most.

 

[j4pac]

I wanted to bring this thread back up just in case there were any PGY-2's out there who hadn't gotten a chance to see it. This is the post I relate to the most.

I wanted to bring this thread back up just in case there were any PGY-2's out there who hadn't gotten a chance to see it. This is the post I relate to the most.

My co-residents and I joke that inpatient would be great it if wasn't for admissions, dismissals, notes, and people trying to constantly die on us. 🙂 I have a strong appreciation for inpatient...but it is a lot of "work". The time that I spend with patients isn't near as much as I would like...but that's the reality of the profession. I get to see therapy sessions about 10-15 minutes a day, and that is with good effort to attend.

Half of the job is either documenting or rounding, it seems. We stay very busy and have very interested cases...but it can be a grind. I am interested in how inpatient functions in less acedemic centers and in private practice.

With all that said...I still love PMR and I could still see myself doing inpatient rehab for a living if it came down to it. But as a PGY-2 you really are pumping out a large majority of the documentation at an academic center. It's in many ways is a a rite of passage to better things.