Physical med. and Rehab

[AP]

Thought I would pose a question to all you folks out there who are in or hope to be in the field of physical medicine and rehab. Do any of you have any insights as to what it takes and what (if any) one can do outside of actual medical school things (ie. exams, boards, rotation reviews, etc.) to secure a spot in a top residency and fellowship subsequent to that? Any feedback would be much appreciated.

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[GreatPumpkin]

AP,
Getting a top residency in PM&R is not unlike getting a top residency postion in any specialty. Good grades, USMLE scores, and good recommendations are the top things. Over the last few years PM&R has not been very competitive overal. But, I am sure there are certain individual programs that are tough. Doing a rotation early during your M4 year is also a good way for the staff at the program you are interested in to get to know you. And, if you make a good impression will certainly help your chances. I would also suggest that you can get the email address of the chief resident and write them, usually they will be happy to talk to you about their program.

------------------
Rob
http://views.vcu.edu/medimf/rob/greatpumpkin.shtml

 

[kimberlicox]

Stinky Tofu here just recently matched into PM7R. You might consider posting your question in the Everybody forum since he seems to live there more than here, if he doesn't respond in a couple of days.

 

[Stinky T]

There are a handful of top programs that everyone wants to attend. The competition for those programs can be tough. Research, great LORs, and sub-internships are very helpful. Getting honors on rotations in Neurology, Urology, Orthopedic Surgery, Neurosurgery, and Radiology would be helpful too. I think a good personal statement helps in PM&R also.

I matched into my top choice. Here's some of the things I had:

1. Research and papers in Neurology, Traumatic Brain Injury (specialty of PM&R), and Neurosurgery.
2. 4.0 GPA throughout all my clinical rotations.
3. Sub-internships at major universities and in a variety of fields.
4. Six Letters of Recommendation from a variety of fields.

I'm not sure how PM&R did this year as a whole (percent unmatched), but I do know of several people from good US MD schools who dropped to their 4th and 5th choices. My guess is that the field will become more popular (if not already) in the years to come. There are only a handful of spots in the top programs. Harvard has six, Columbia/Cornell has eight, RIC has 11 (4 for Categorical & 7 for Specialty), etc. If you want to get into these programs, consider doing some of the things listed above.

 

[AP]

Thanks to everyone for the info. Stinkytofu - I have a q for you - What do you mean by sub-internships?

 

[Stinky T]

AP,

This was something I posted on another thread:

Clerkships are used to refer to the rotations you do at your school's affiliated hospitals. Externships are rotations done by a student from a visiting school. Same rotations but different names depending on your relationship to the program.

Externships are usually done during the fourth year because most schools do not want MS IIIs. Additionally, your own school will want you to do your core rotations at their own facilities.

Other names you might come across would include acting internship (A-I), sub-internship (Sub-I), or audition rotation. A-Is and Sub-Is come with more responsibility since you will be the acting intern. If you know you will 'kick some butt' go ahead and do a Sub-I. They can be a double-edged sword, however, because this Sub-I can show what an awesome intern you'd make or it can show what a terrible intern you might be. If your numbers speak volumes, it might not be worth the gamble. Who knows? You might get an attending who just lost 80% of his savings in the stock market that month.

I did several Sub-Is in different fields and I think it helped me tremendously in obtaining interviews. I got into my first choice program without having done a Sub-I there, but I have no doubt that my LORs helped secure that match. Good luck.

Stinky ? Copyright 2001 Stinky Tofu & Co, Inc.

 

[Teufelhunden]

Stinky Tofu,

Traditionally, how have DO's fared matching into competitive, MD PM&R programs? Is their OMM training looked upon as a plus, negative, or is it a non-issue? Do you know of any DO PM&R residecies that are highly regarded? Also, you mentioned that the field is gaining in popularity, and hence competitiveness - any thoughts on why this may be occuring?

 

[Neurogirl]

I could be wrong but I think Stinky said that Harvard (where he matched) has started teaching and using OMM. A DO friend of mine matched last year and said that his OMM training had been viewed as a big plus and that many programs are starting to incorporate it. If my memory is correct and Harvard has embraced it, then it won't be long before everyone else catches on.

 

[windex]

I work at the Rusk Institute of Rehab Med which is affiliated with NYU Medical School. They have many PM&R DOs here on staff as well as PM&R DO residents and find them equally competitive to their allopathic colleagues.

 

[Stinky T]

According to US News, Northwestern has been ranked #1 for the past ten years. The program happens to be run by a D.O. When I interviewed there, OMM seemed to be viewed favorably. In fact, all the residents (M.D.and D.O.) are taught OMM.

Dr. Garrison, M.D. wrote one of the major textbooks in PM&R and also teaches OMM at OMM conferences. I've heard that Baylor and Northwestern actually favors D.O.s

As far as Harvard is concerned, I only know of one D.O. that has gone through the residency program. I'm not aware of OMM being integrated or taught at Harvard. Even though Harvard was my top choice, I know more about Northwestern, Baylor, and the CA programs.

I think that the additional training in the musculoskeletal system is very helpful in PM&R. I could see why D.O.s would match well in PM&R.

I think PM&R is gaining in popularity because it is a new specialty and very little was known about the field before. As the field grows, it gains more exposure and thus more applicants. Also, many medical students are more concerned nowadays with lifestyle and compensation. PM&R pays very well and the hours are short. There are also many different areas witin the field that makes it attractive (Pain Management, Sports Medicine, Traumatic Brain Injury, etc.) The shift away from IM and FP leads to more applicants applying for Anesthesia, PM&R, Radiology, and EM.

 

[ringo643]

This PM&R thing sounds pretty interesting to me. What types of stuff do these docs do? How is pain management different from anesthesiology? Is there a website or something where I could learn more about it? If my school doesn't have a PM&R dept., what would be the place to go for research opportunities and connections?

 

[Neurogirl]

Oops! Sorry for posting bad info.

 

[Stinky T]

Neurogirl,

If your friend is at Harvard, I'm sure he has more information than I do. I'm just a lowly intern for now. I wouldn't be surprised if Harvard was incorporating OMM into the program -- it would make sense to do so.

When do you start internship? I am starting on June 11th. Will your friend start at Harvard in July? The PGY-2s told me that the call schedule at Mass General is q3. The PGY-2 year sounds worse than my PGY-1 year.

 

[Neurogirl]

Stinky,

Regarding Harvard, you were the one to whom I referred. The friend I mentioned matched
to another program. I start internship on July 1, but have orientation starting June 18. I'm not sure why we need 2 weeks of orientation...everyone else I've talked with does one week. They do have plans for us every single day though. At least it'll be a fairly leisurely orientation.

 

[slaminsam]

I work at RIC currently (Northwestern Univ PMR). We have a fair amount of DOs cycle through. The next chief resident is a DO, the director is a DO, and the place reflects excellent collaboration between DO and MD (as it should).

If you are serious about going with this program or another competitive one, try for the summer externship. This is a great opportunity to meet folks, experience Chicago during the best part of the year, and get some research experience (which is well regarded during interviews).

 

[AP]

Hey Slaminsam - Where can I get one of these applications for that Externship? I have info about the program, but the info is about the externship program for this summer, and I won't be done with MS-1 till next summer. Any thoughts you might have would be much appreciated. Also, would be willing to set up some sort of e-mail with me so I can communicate with you and ask questions about PM&R and the RIC residency program? Let me know. Thanks

 

[slaminsam]

No problem, AP. Email me anytime (see profile). As far a collecting an app for 2001, try emailing the program. This should be available at the usual places. Also, check with the web page...rehabchicago.org

 

[fiatslug]

Anyone have any thoughts about the long-term viability of PM&R? I ask because I worked in rehab therapy as a PT/OT aide for 2 years, and I know from experience that rehab is one of the easy targets in budget-slashing times. The Medicare reforms of the mid-late 90's really hurt PT & OT; many of my friends left the profession. What I'm wondering is: how safe are physiatrists? I know there's a lot of places physiatrists can go in terms of specialization, but isn't there also a lot of duplication within physiatry subspecialties? I mean, someone with an physiatrist-treated injury could just see a neurologist or neurosurgeon or orthopod; you could make the argument that medicine docs could handle the inpatient aspect of rehab. Now, I'm not saying PM&R docs are unnecessary at all; I love rehab, and I'm very interested in the field. It's just that rehab has historically been very "expendible" when it comes to budget crunches. I'd love to hear some input on this!

 

[spreesbeers]

hey stinky tofu,
whats your opinion on the post above (by fiatslug)? id like to hear your thoughts. thanx.

 

[Stinky T]

From what I've seen this has not been the case. Even if Orthopods and Medicine could take over for a Physiatrist, they probably wouldn't want to. In fact, the opposite is happening. Physiatrists can actually save the hospital money because they are more likely to try other things before surgery that will work. If you can avoid surgery, both the hospital and the patients would obviously be happy about that. Physiatrists are taking over some of the patients that would be normally seen by an Ortho or Anesthesia. They are also doing Interventional Pain Management which used to be run mostly by Anesthesia. Many Pain Fellowships are jointly run by PM&R and Anesthesia now.

I think that before Physiatry was mainly concentrated in doing inpatient medicine and maybe with the cut in funding, they expanded the residencies to focus more on outpatient medicine and now they are making more than they ever did before.

My wife has been a OT for four years now. The inpatient funding has been cut down, but she never lost her job. My wife was making $60,000 per year in Northern California now makes significantly more. She is not alone, most of here colleagues and friends from school are very well-compensated. I'm not sure if maybe this was just the region that Fiat worked at. I just know how the field is for my wife and friends.

In fact, when my wife moved to the East Coast, we were afraid that she wouldn't be able to find a job. The first day she just randomly called some Rehab centers, she was offered three jobs over the phone.

Physiatrists deal with certain conditions and learn things during residency that Neurologists, Orthopods, and Neurosurgeons do not learn about or do not spend enough time treating and diagnosing. These are not terribly difficult things to learn, but I imagine that most Orthopods and Neurosurgeons would rather spend their time in the OR. This is probably the main reason that Orthopods have a Physiatrist in their group.

 

[tari]

As a former orthopod finishing PM&R, I can pretty safely say that all sorts of surgical specialists are finding the virtues of physiatrists too valuable for it to go away any time soon. As far as having a low starting salary, it is higher than internal medicine, pedatrics, psychiatry for the most part. Furthermore, those are published salaries. Private practices, especially those with high procedure count are usually much higher. It comes down to utilization of resources. A surgeon makes money when she is in the OR. Time spent seeing non-op low back pain, neck pain, shoulder pain is time taken away from a much higher paying procedure. Most surgeons would be very happy spending 4 or 5 days a week in the OR and none in the clinic. By having a physiatrist in the practice, the algorithm flows much more efficiently. Like others have mentioned, the ads in the journals are academic surgical/specialist departments who are hiring PM&R physicians, which has a trickle down effect.

Another nice thing about PM&R is that there are enough open-minded practitioners within its ranks to keep it from being artificially bounded. There are physiatrists who do nothing but medical acupuncture and are incredibly successful. Some only do Botox or other local procedures. If you are not one who sees opportunities and are able to execute on them, perhaps PM&R has too much pioneering freedom for you.

The financial rewards of medicine is related to business acumen. Why are young physicians so concerned about "salary"? Whatever happened to "practice"? During a PM&R residency, one actually has time to bone up on private practice business law, accounting, marketing, etc. Why are physiatrists not the ones employing surgeons as technicians? I have managed to read enough business books over the past two years for an MBA, and (God-willing) plan to live on no less than my surgical counterparts. In the time I have been in residency, my stock portfolio has effectively doubled. In the past three months, I have written up my H&P/Consult/Follow-up templates for the top ten diagnosis my practice will probably see. I am now developing my billing sheets, weekly clinic design, web-page, filling out my applications for UPIN, state licensing, and other practice related documentation so that I will be paid at the end of my first month in practice. None of this will be taught to you, but you will have more time than your surgical/specialist colleagues to get a headstart.

Last but not least, PM&R practices medicine as it should: with the whole patient in mind. Physiatrists consider not only the disease, the cure, but also the social, economic, and long-term impact on patients with acute or chronic disability. It has had an unfortunate reputation of rather "lifestyle" oriented persons who are not as motivated in general. I saw things differently and have planned to use my time and my mind to create the best life possible for my patients and my family.

Best wishes to all of you with the imagination and motivation to live well, regardless of your chosen specialty.

 

[axm397]

Wow Tari, you are a great resrouce to this forum. Do you have any particular business books you would recommend to us "newbies"?

 

[bbbmd]

What I'm wondering is: how safe are physiatrists? I know there's a lot of places physiatrists can go in terms of specialization, but isn't there also a lot of duplication within physiatry subspecialties? I mean, someone with an physiatrist-treated injury could just see a neurologist or neurosurgeon or orthopod; you could make the argument that medicine docs could handle the inpatient aspect of rehab.

Physiatrists offer much more and make quite a difference in the patients seen by neurologists, orthopods, neurosurgeons, pain-anesthesia, IM, pedi. Remember that we are doctors of FUNCTION and none of the other disciplines are trained in the evaluation and MEDICAL management of FUNCTION. We are the ones these other disciplines turn to when a patient has complexed functional deficits such as spasticity needing botox, phenol or pump evaluation, complexed non-surgical musculoskeletal problems, debility, spinal cord injury and so on. Our skills are valuable and I can only foresee a greater need for these skills in the future. I think the talents of physiatrists are currently under-utilized, but as our field becomes more and more popular and other physicians are more informed of what services we provide, our importance in the spectrum of medical care will be better realized. It is just a matter of time.

I too worked as a rehab aide prior to med school. I loved rehab then, but now that I have more tricks up my sleeve to improve one's function than just individual therapies (OT, PT, ST...), I love it even more! I can see the whole rehab picture, not just mobility needs or ADL deficits like what our therapist counterparts focus on; or not just the localization of a lesion and a diagnosis that our neurology counterparts focus on; or not just "to cut or not to cut" like our surgery counterparts! Yes, it seems like we duplicate what the other disciplines have done, but our role is to PUT IT ALL TOGETHER using physiatric evaluation and management. We then proceed with adding/adjusting meds, focusing rehab therapy, coordinating care and perform procedures if indicated. "Putting it all together" is what all other diciplines lack and it is what we are EXPERTS in. I cant tell you just how much other physicians, social workers, case managers, insurance companies, hospital administrators VALUE our expertise! Once you get a physiatrist on board, quality of CARE and the patient's/families quality of LIFE drastically improves!

Budget crunch??? Yup... But this is with all fields of medicine, not just PM&R. One issue facing our field right now is the 75% rule, but I do not feel like discussing this on this thread. PM&R reimbursement may be a good idea for a new thread all together.

B

 

[rehab_sports_dr]

I echo bbbmd's thoughts.

While it is true that other disciplines overlap with us, and thus in theory could do much of what we do, in truth none do. And that is because of our focus on function.

I remember as medical student, during my medicine sub-internship, discharging home an elderly diabetic patient, and being upset that all of her home needs weren't being met. In theory, someone should have been able to assess her need for adaptive equipment, had assessed her gait and appreciated her fall risk, been making non-pharmacologic recommendations for her osteoporosis, etc. But nobody did. And I knew that she would probably be back in the hospital soon again with another medical complication, because nobody addressed her functional needs.

I see this is as similar to something like, say, endocrinology. Other doctors could meet those needs, but most docs don't have the specialized knowledge to meet all but the most simple endocrine cases. Sure, some simple new onset DM type II could be managed, but anything beyond that would get neglected.

At my medical school, there was no PM+R department. And because of this, many of the stroke patients and cerebral palsy never had their spasticity adequately addressed, brain injury patients stayed longer than they needed to without adequate support at home when they left, patients were left on anti-convulsants longer than medically indicated, and patients with back pain had surgery more frequently than indicated.

Without specialists in functions, all those needs were neglected.