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PM&R residency

Discussion in 'Medical Students - DO' started by aDObo, Dec 11, 2008.

  1. aDObo

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    Hi! I'm a OMSIII and very interested in PM&R. Can anyone tell me which programs are DO friendly and if that program accepts just COMLEX, USMLE, both or either.

    How are some of you scheduling your 4th year electives? Is there a best time (months) to schedule?

    Also, can someone verify this info... I heard that if you match with a osteopathic residency that your allopathic residency will automatically be disregarded.

    Thanks in advance for any suggestions, comments, information!!!
     
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  3. 4Doc4

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    It is true that if you match with a osteopathic residency that your allopathic residency will automatically be disregarded. This is because the osteopathic match happens first.
     
  4. djnels01

    djnels01 "You're the man now dog!"
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    I've heard that most (if not all) PM&R programs are DO friendly. Perhaps one of the "friendliest" allopathic residencies - remember there are no osteopathic PM&R programs. As for what test to take, I know people at U of MN and Mayo PM&R who both got in with only comlex. Can't say for any other programs though...

    As for why they are so apt to accept DO students, maybe it's because of our training in OMM/OMT? Who knows?
     
  5. Taus

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    Hey, I'm an MSIV from PCOM who is currently in the middle of the interview process for PM&R. Just about every program is "DO friendly" and it is not really something you should concern yourself with in this field. I took the USMLE (and did well), but I have friends who only took the COMLEX and have received a lot of excellent interviews. There are many very prominent DO's in this field (such as the chairman at Harvard and program director at Northwestern to name a couple) and DO residents at all the great programs.

    You want to have them early enough to A) decide if the field is definitely for you and B) get letters of rec in early enough for the match. I would suggest trying to schedule them b/w June-September and possibly October at the latest. Nov & Dec are do-able as well, but you want to be careful that you aren't leaving for too many interviews during your PM&R electives (most of mine were from mid Nov to late Dec)

    sort of...
    Most PM&R programs (regardless of MD/DO) require you to do a separate internship before starting your 3 year PM&R residency in the PGY-2 year (2nd year after graduating from med school). There are a few programs that include the internship year and have all 4 years together. These are the programs that you could run into trouble with. If you match into a DO internship you will be prevented from matching into the programs that have an overlapping year (ie the PM&R programs that include the internship). This is generally not an issue in PM&R, as the majority of programs start at PGY-2 and many of those that don't offer both options (intern year included or not included). Clear as mud?

    I hope this was helpful and I highly suggest that you visit the PM&R forum in the residency section at the bottom of the SDN forum main page.

    If I can be of any further help, feel free to ask
     
    #4 Taus, Dec 11, 2008
    Last edited: Dec 12, 2008
  6. HarveyCushing

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    I believe there is 1 DO program in MI and 2 in NY for PM&R.
     
  7. Taus

    Taus .
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    MSU and Nassau/NYCOM are dually accredited and accept applications through the MD match. Longbeach/NYCOM is the third DO program, but I'm not sure if its dual or not.
     
    #6 Taus, Dec 12, 2008
    Last edited: Dec 12, 2008
  8. djnels01

    djnels01 "You're the man now dog!"
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    Whoops, my mistake. Thanks for clearing that up Taus!;)
     
  9. fozzy40

    fozzy40 Senior Member
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    bump

    I wanted to bump this thread since new 3rd years are transitioning into clinical years and 4th years are applying.

    Other students may want to post this in the PM&R forum though.

    Good luck!
     
  10. idoc2014

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    What exactly does a PM&R doc do? I've searched around on the internet, but can't find a clear and concise explanation. Also, is this a very competitive specialty?
     
  11. NJWxMan

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    Honestly, most PM&R physicians ask the same thing. Most have an identity issue. The places where I see them work with pts, they normally consult PT/OT and Internal Medicine. Well...what else is there to do?
     
  12. VCU07

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    Currently, I work in a large hosptal that has an inpatient rehab unit. The medical director of the unit, as much as I hate to agree, does little in the way of everyday care. Usually, the hospitalist is consulted for all their patients and although there aren't a lot of codes, the PM&R doc will not respond. We had one a few months back that I responded to and was kind of shocked that this physician sat there while her pt. was coding. Again, the hospitalist came uo to run the code. While I don't think this is a true reflection of PM&R docs, it does support the previous posters comments.
     
    #11 VCU07, Jul 16, 2010
    Last edited: Jul 16, 2010
  13. fozzy40

    fozzy40 Senior Member
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    Here is a link to the AAPM&R's Medical Student Website which gives a pretty good description of my field.

    Despite the fact that the field has been around for the past 50 years, we definitely do still have a difficult time explaining what we do. Conceptually, our field is unique in the sense that our field does our "organ" is function. Physical function and quality of life issues are not traditionally taught in medical school which makes understanding what we do difficult.

    PM&R is one of those fields that has such a broad scope of practice that it's difficult to describe succinctly. However, my "one-liner" for what I do is "I work with people with medical problems and physical disabilities as a result of acute or chronic musculoskeletal or neurologic diseases."

    Our bread and butter diagnoses inpatient diagnoses are stroke, spinal cord injury, traumatic brain injury, pediatric rehabilitation, cancer rehabilitation, multiple sclerosis, amputee, and post-operative joint replacement care.

    In the outpatient setting, physiatrists see patients with musculoskeletal problems, chronic pain issues, and perform electromyography/nerve conduction studies. Some physiatrists also perform CT guided spinal epidural injections, facet and caudal injections, to list a few interventional spinal therapeutics. We are also using a lot of ultrasound for musculoskeletal diagnosis and guidance for injection.

    In terms of daily care, I guess it depends on what you consider "an issue." There typically aren't acute issues on a day to to day basis. If they have too many acute issues, then they probably are not ready for the rehabilitative phase of care. However, we still have many problems that we manage on a day-to-day basis. Many of our patients still have common medical problems (i.e. HTN, DM, CHF, coumadin therapy, etc.) in addition to new issues such as pain, bowel/bladder care, pressure sore management, and patient/family education. Some physiatrists do elect or have the option to consult medicine to assist some of these medical problems, if they choose. However, I suspect that the decision to manage is dependent on the provider. I know I typically manage all of these issues.

    In my opinion, one of the reasons that medical students, residents, and attendings do not understand the field is that we are not taught rehabilitative medicine and/or management of chronic medical illness. In 4 years, our focus is primarily on diagnosis and acute care management. When a patient comes in to the hospital, the assumption is that once they are medically stable that they should be able to return to their normal day to day function. The reality is that some patients need help regaining their function and develop new medical problems as a result of their new diagnosis i.e. neurogenic bowel/bladder, spasticity, visual and cognitive impairment, paralysis, pressure sores, and pain. All of these factors do affect a patient's ability to go home and care for themselves. This is what rehabilitative medicine is about.

    Someone give me a case and I can give you the rehabilitation issues that come up that we help manage. I really LOVE my field and feel that it's the best thing ever! Let me help you understand what it is we do.
     
  14. malisa

    malisa OB/Gyn
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    Don't know if anyone still is interested in PM&R but when I worked at UAB their residency program had several DOs in it. Not sure if they require USMLE scores though.
     
  15. fozzy40

    fozzy40 Senior Member
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    The entire field is DO friendly. COMLEX is pretty well accepted in the PM&R world.
     
  16. DrWBD

    DrWBD Formerly 'wanna_be_do'
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    PM&R is wide open for osteopathic students. With PM&R you should be aiming for the best residency you can get, not worrying about which programs are "DO friendly" or being concerned about dual-accreditation (who cares?).
     
  17. Hextra

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    I'm really digging this thread--thanks to the more senior members for adding their thoughts.

    PM&R is one of those fields that seems to really tie in well with OMM and the musculoskeletal philosophies behind it. For those in the field who are also DOs, does your OMM training come into play much while treating and managing your patients?
     
  18. fozzy40

    fozzy40 Senior Member
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    I definitely feel that my palpation and OMM skills help me in the field. In addition, I find that my attention to asymmetry when it comes to posture and gait analysis is really strong as well. Physiatric and osteopathic philosophies are very similar which makes it a great field for DOs.
     
  19. fozzy40

    fozzy40 Senior Member
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    Any takers to throughout a patient to use as a case or example of when to consult physiatry?
     
  20. NJWxMan

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    At some VA locations, they use PM&R consults as their means of chronic pain consults. Unfortunately, PM&R tends to be a disposition mostly. It's much easier to discharge a stroke victim, burn victim, etc. to the PM&R floor than to home.
     
  21. fozzy40

    fozzy40 Senior Member
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    Unfortunately, I NJWxMan is right in that most people view the PM&R consult purely for disposition or discharge planning. While this is a common practice I don't think that this is the best way for services to view our field. This is a very small focus of what we do. It would be like consulting urology strictly for foley placement.

    We have a lot to offer but unfortunately most medical schools do not provide enough education on subacute and chronic illness management. We have a lot to offer such as:

    -neurogenic bowel/bladder care
    -wound care
    -pain management
    -spasticity management
    -agitation management

    Just to name a few....

    "The out of sight, out of mind" philosophy unfortunately works pretty well in terms discharge in the inpatient medicine side. You get positive reinforcement for fast discharges and only get feedback when there is a "bad outcome." Bad outcome usually means death, permanent injury, or just about anything that puts you in medicolegal crosshairs. I challenge all of you to broaden your "outcome" definition to include function and quality of life issues. After all, wouldn't you consider not being able to return to your home and family a "bad outcome?" Is oversedation prior to transfer to the rehab floor or skilled facility for an "agitated" patient considered a "good outcome?" When and if these functional and quality of life issues pop up, consult PM&R early!

    You are all physicians or physicians-in-training. I challenge all of you to learn about PM&R. I promise that you will be doing a huge service for your patients.

    Anyone want to throw out a case? Just about any ICU patient will do!
     
  22. fozzy40

    fozzy40 Senior Member
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  23. DOwnage

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    I wanted to ask this to people going into PM&R as well as those already in it: Are any of you concerned about the future of PM&R due to the lack of a strong identity as a specialty?

    The reason I ask this is...take this scenario. If the government is going to limit the availability of PM&R services someday in a "rationing" scenario (let's face it, this is a possible but not certain future. If we're going into this career, we have to be aware of threats.) what is stopping the government from really giving PM&R the screwjob? If the government screwed over people like OB/GYN, general surgery, or other specialties with a better "public identity" and it directly affected a large amount of people, there would be a very loud uproar from the general public. However, if they severely limit PM&R services because they feel it isn't a good investment or for some other reason, as stupid as the reason may be, you aren't going to have that same public outcry because the public doesn't really know what a physiatrist does. Do you agree or disagree?

    What I'm saying is NOT meant to offend anybody. And honestly, PM&R sounds like a really sweet career to me. I've looked into it and I've actively sought a mentor to shadow in this specialty in particular. However, I feel that the above-mentioned scenario is by far the biggest threat to the specialty.
     
  24. Colbert

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    You listen to Sarah Palin too much. The government isn't going to come in and ration health care. They're not pulling the plug on Grandma. There are no death panels.
     
  25. fozzy40

    fozzy40 Senior Member
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    Personally I'm not too concerned. I do agree that we have identity problems in the public eye as well as the physician community. Visibility does play a role for sure in a specialties "existence" but in the case of PM&R it has never been the ultimate threatening factor. We have been around for 50+ yrs now and have managed to maintain our position without much fluctuation lie other specialties so I do thinker are "time tested.". In regards to healthcare reform, it seems like everyone is taking a hit as you've said. Even though the public do not know what we do specifically, they do recognize our services which I think is the bottom line. I'm not a political expert by any means but I think that the government is more concerned about how much is a service/product vs who is providing it.

    My 2 cents...
     
  26. fozzy40

    fozzy40 Senior Member
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    DOwnage,

    Are you interested in PM&R?
     
  27. jaywalk

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    Hey guys,

    Just wanted to thank all the later year med students, residents and attendings that have contributed to this thread. I do not have a set path yet but I have been intriguied by PMR for quite sometime now. Your responses have been very infomative about the field.

    Thanks :thumbup:
     
    #26 jaywalk, Sep 2, 2010
    Last edited: Sep 2, 2010
  28. fozzy40

    fozzy40 Senior Member
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    I just wanted to bump this message. Also, they are offering travel stipends for students traveling from out of state for those interested.

    fozzy40

     
  29. Brooklyndo2.1

    Brooklyndo2.1 polytrauma monkey...
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    the long beach ny program is the only solely AOA accredited program in the country at this point in time. I am the chief resident over here so if you want any particulars give me a holler. We do pretty well with only our third class graduating this year. So far one is doing an interventional spine fellowship in San Diego and another is doing a traumatic brain injury/ polytrauma fellowship.
    as for the field's identity "issues" they have been around for a looong time and they will not stop as we can do many things in almost any medical field out of the gate which happen to intersect other fields (anasethesiology (interventional pain), sports med/non surgical ortho, addiction and pain management, stroke and brain injury care as well as spinal cord injury, pediatric rehab, burn rehab, prosthetics and orthotics etc etc. I could go on and on but as someone else mentioned, give me a case and I can show you the rehab part. problem usually is lack of ms3/4 exposure to the field and older docs not being all that familiar with it.
     
  30. bones

    bones Osteopathic Physician
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    My experience echoes this. Many DO students I know have gone into PMR, and many of the MD's think we have an unfair advantage because of our prior musculoskeletal training. I know many years in a row Rusk Rehab in MO has taken OMM fellows from KCOM, and some years 3 of their 4 spots go to DO's.

    PMR is not very similar to an OMM/NMM specialty however- the subset of patients you see, and your training of how to deal with them will be substantially different. PMR programs do a good job of doing evidence based medicine and building your knowledge base. in my experience most PMR's subspecialize to where most patients present the same way (brain injuries, for example, or spinal cord injuries, or amputees) and you do similar interventions to manage that subset of patients all day, and progress is slow and stepwise. Skill with OMM is still very instrumental in improving biomechanics in this population, and in minimizing their discomfort.

    If you have a lot of patience and compassion, like routine and have good hands for osteopathy PMR might be the field for you.

    OMM specialists on the other hand cover more physical medicine and less rehab. It is better for those who enjoy instant gratification for exceptional work. Cures are possible here- sometimes with a single office visit, but only if you are very good or lucky with that particular patient. You get a huge variety of presentations and patient populations unless you specifically request a given group. The bias is to get a lot of pain complaints if you do not specify a subpopulation to work with and advertise accordingly.

    If you are less patient or get bored easily but you're an excellent problem solver, an out of the box thinker and you have the drive to self-teach based on whatever comes your way in clinic- OMM may be a better fit. OMM may be a bit more stressful since there is the expectation to perform each and every patient encounter and you never know what you'll be getting, whereas PMR the outcome is predicted based on patient presentation and not too dependent on you as the doc so long as you follow the guidelines.

    FYI
     
    #29 bones, Oct 8, 2010
    Last edited: Oct 8, 2010
  31. EMTK

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    As an OMS-1 at PCSOM, one of my interests is towards PM&R. As we do not have a PMR club/organization here at PCSOM, I am currently in the works of getting one going. Therefore I turn to the practicing PMR world to help with this task. I would greatly appreciate anyone located near to PCSOM or that knows of anyone near PCSOM (eastern KY) that may be able to help me with my mission, to please let me know.
     
  32. cbest

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    Hey EMTK,

    Check out the American Osteopathic College of PM&R website's student section. We at LMU-DCOM in East TN got a chapter started up just last year, which seems to be growing in popularity among the students. Hope that helps!
     
  33. fozzy40

    fozzy40 Senior Member
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    Where are you exactly in the process? Do you guys have a faculty mentor at PCSOM?
     
  34. EMTK

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    I just spoke with the Dean of students earlier this week to obtain the appropriate paperwork for club recognition through PCSOM. Beginning next week I planned on meeting with another dean to talk and get his take seeing if he knows of any area PM&R physicians.
     
  35. fozzy40

    fozzy40 Senior Member
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    I just PM'd you some names to look up.
     
  36. tostadaeng

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    Hi,
    I am a 3rd year starting to apply to PM&R residencies - all the programs require a PGY1 but very few of them have it as part of their program. Does anybody have any information about how to apply for PGY1 in order to satisfy this requirement for residency? I'm very confused about this one.

    Help Please!
     
  37. fozzy40

    fozzy40 Senior Member
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  38. kirbyross

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    I've really learned over the past 2 years of OMM/OMT that I pay a lot more attention to the 'small' things, such as posture and bogginess, which I'm forever grateful for.

    I went on a rotation w/a Sports Med M.D. and he was trained in his fellowship by a DO and had a lot of respect for what we do and the extra 400 hours of palpation practice we get while in medical school.

    Thanks; I'm glad to hear PM&R is relatively DO friendly; it makes sense to me!
     
  39. tbone0705

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    I agree. Most PM&R programs are very DO friendly
     
  40. slammer922

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    Foz your passion def comes out in this tread. My main intrest is sports med. Is there a fellowship associated or do u know of routes to go to end up in sports med as a physiatrist?
    Thanks
     
  41. cbest

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    There are about a dozen PM&R-based ACGME accredited sports medicine fellowships and I'm guessing that this number will only continue to rise. Check out the FREIDA residency search website.

    Fozzy - is the RIC sports and spine fellowship applying for ACGME accreditation?
     
  42. fozzy40

    fozzy40 Senior Member
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    RIC just received ACGME accreditation for sports medicine.
     
  43. fozzy40

    fozzy40 Senior Member
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    Any med students interested in PM&R, please PM me:)
     
  44. fozzy40

    fozzy40 Senior Member
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    Here's a great video on what PM&R is about.
     
  45. jp104

    jp104 Member
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    Great video. Thank you!
     
  46. donkeykong1

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    this is awesome. i just got back from shadowing a pmr physician today and had a great experience.
     
  47. fozzy40

    fozzy40 Senior Member
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    Awesome! Let me know if you have any questions:)
     
  48. fozzy40

    fozzy40 Senior Member
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    I made this slide to differentiate how PM&R is different from the other medical/surgical specialties. I hope this helps!
     

    Attached Files:

    #47 fozzy40, May 13, 2011
    Last edited: May 14, 2011
  49. EMTK

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    Medical Student
    I will be an OMS-II in a short couple of weeks... I'm leaning more and more towards PM&R. Is it recommended to take the USMLE along with the COMLEX?
     

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