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PM&R

Discussion in 'PM&R' started by patton, Nov 24, 2001.

  1. patton

    patton Junior Member

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    Has anybody interviewed yet this year in PM and R? Does anybody have any info on the program at Eastern Virginia U or Medical College of South Carolina or any PM&R program. I have some interviews coming up and would like to start up a discussion on the field, the programs etc. Any info would be great. Thanks
     
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  3. bbbmd

    bbbmd Pain Doctor/Physiatrist
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    I had a few interviews, but I didn't apply to those two programs. Have you had any interviews yet? For the most part, PM&R interviews are pretty laid back, just be prepared to answer why you want to specialize in Rehab.

    Have you heard from RIC, the Mayo, Columbia/Cornell, NYU, Kessler??? Some people that I met on the interview trail received interview offers from the Mayo and RIC, but I haven't heard from them. Hope that does not mean rejections.

    Good luck to you! Thanks for starting this thread!!!
     
  4. patton

    patton Junior Member

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    I haven't heard from any of the places you mentioned. I haven't interviewed anywhere yet but i have scheduled at St Vincents in NY. Carolinas Medical Center and Sinai in Baltimore. I still haven't heard from several programs. I don't know if that means rejection or not at this point.

    Which other programs have you interviewed at or plan to interview with? I'm staying mostly in the northeast and a few down south. How many programs do you plan on interviewing with?
     
  5. psi1467

    psi1467 Senior Member
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    Is there a link to a website listing the approved residency training locales for P M & R?
     
  6. bbbmd

    bbbmd Pain Doctor/Physiatrist
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    I interviewed at Baylor/UT-Houston, SUNY Stonybrook, St Francis in Pittsburg, and University of Pittsburg so far. I havent heard from St Vincents, but I applied there. Hmmm... I wonder if I got rejected??? I didn't apply to Sinai, but I got an interview offer at Hopkins. Will interview in January. I am probably going to about 10 PM&R interviews all in all. I applied all over, mostly in the Northeast and the Midwest How many do you think I should go to for a decent match?

    I am also applying for the PGY1 years which seems more difficult to get a spot than PM&R. What has been your experience with your PGY1 applications?

    I looked up most of the programs using the current greenbook and the FRIEDA site. I also used scutwork.com to find more information about each program. You can also go to the AAPM&R website.
     
  7. patton

    patton Junior Member

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    I hear 10 is a good number of programs to interview with. I'm probably going to do 8-10. Last year it was very easy to match into PM&R but I don't know what this year is going to be like.

    As far as pgy1 spots, I'm an osteopathic student so its easy for us to get AOA approved internships. Do programs send out interview rejection letters or do they just not contact you for interviews? Good Luck
     
  8. bbbmd

    bbbmd Pain Doctor/Physiatrist
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    I wish I knew if all programs send rejections. I am still waiting on the programs in the previous posts.

    I was offered an interview at UT Southwestern today. Anyone know anything about the program?
     
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  10. bbbmd

    bbbmd Pain Doctor/Physiatrist
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    Stinky Tofu,

    Thanks for the info. Good job on choosing a GREAT specialty!!!

    I agree with your list of BEST programs. I interviewed at Baylor-Houston and did other interviews, not on the list, and there were big differences! Do you happen to know if the programs you listed send rejection letters? I haven't heard from many of them! How late in the interview season will interview offers still be sent? (Im thinking of calling the programs by the end of November to ask about my status).

    What do you know about the program at Johns Hopkins? I know its new, but their rehab facility is listed as one of the best according to US News and World Report. What about Univ of Colorado?

    How many interviews did you go to for Transitional and Medicine PGY1s??? I am not getting to many offers and I am getting worried. Looks like I may have to scramble for one!!!
     
  11. LR6SO4

    LR6SO4 Senior Member
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    What's the deal with Double Boarding and PM&R? My little "How to Choose a Medical Specialty" book here says that there are 5 year programs where you can do PM&R and either meds, peds, or neuro. Are these hard to find? I know the res at my school is only PM&R. What would be the advantages? FYI, I am interested in PM&R but being in a pretty Rural area is important to me. Would this allow me to practice PM&R there? I have heard that it is mainly a "big-city" specialty. I also heard that midwest jobs were very hard to come by. Thanks!
     
  12. bbbmd - I think last year (or the year before) was the year the JHU split from Maryland's program. I wasn't sure how that was going to turn out and didn't want to be the guniea pig either. I'm sure it will be an excellent program in time. The current chair there used to run the program at Baylor.

    NYU/RUSK as a Rehab Center is world renowned. However, many of the residents seemed unhappy and many applicants seemed to be cancelling their interviews there (including me). I am sure it is still an excellent program and the attendings there are amazing.

    UTHSCSA is not a popular program, but it provides excellent training. The person who wrote the book on EMGs is there and the Chairman of the AAPMR is also there.

    Columbia/Cornell - Seperately the two programs were above average, but the combination of the two this year should make for a great program. I see some growing pains of the combined program initially, but with all the resources that Columbia and Cornell has to offer, I am sure it will develop into one of the top programs soon.

    University of Washington has a reputation for REALLY working their residents. You used to get a Masters after completing the residency because there was a lot of classroom time and work. I didn't want to go to the program so I don't know all the details.

    Mayo is one the programs I regret not going to for an interview. Last winter was especially rough and they had a really bad snowstorm. After my wife and I froze our butts off at RIC, the thought of going to an even colder climate (MN) was not appealing.

    Baylor is a great program and I struggled with not ranking it higher? How can you not be impressed by the facilities. Ultimately, I didn't want to live in Houston and the program was too inpatient focused. I understand that they are changing things aroung for more outpatient exposure in Interventional Pain Management, elective time, and Sports Med. I know many people in the program because many of my mentors went there for residency.

    I loved RIC and I went back and forth between the two in terms of ranking. The hospital was in an amazing location, with a view of the lake. Actually, I don't really need to sell it, you'll see when you get there.

    Kessler was a great program and the Chair is the person who wrote one of the main texts in PM&R. The only things I didn't like about the program was New Jersey and the lack of elective time. Of course Kessler has its own fellowships so you can always do those. Anyway, I wanted electives so I didn't rank Kessler very high.

    Ultimately, I went with Harvard. Many of the current residents (all from good US Medical Schools) only considered RIC and Harvard. In fact, the resident that interviewed me went to Northwestern for medical school and chose the Harvard program above Northwestern's. The resident who gave us a tour at Northwestern said that Harvard was known as the "East Coast" RIC. Of course he did also say, "Why go to the 'East Coast' RIC when you can go to RIC." :) When I did interview at Harvard, I found out that the their were 8 months of electives. Your last year can really be tailored to you own area of interest be it Sports Med, Interventional Pain, etc. Rotations are done through the Anesthesia department at Mass General in Pain Management. You also rotate through MGH for Neurology, which is an amazing opportunity to work with the most famous people in the field. If I remember correctly, there was also one rotation in Hawaii where a condo and rental car is provided for two months.

    I did my interviews last year, so I hope all this information is still accurate. Just confirm these things again on your interviews.

    With regards to the US News rankings, bear in mind that many of the hospitals listed don't even have residency programs. Rancho and Colorado come to mind. UCLA residents do a couple of rotations there, but the VA is their main site.

    Oh, I almost forgot that if you interview at Baylor, they set aside some TY spots for the PM&R residents. You need to tell them during your PM&R interview and you discuss it with Maureen Nelson, M.D. I interviewed at six places or so for PGY-1 spots. I just didn't have the energy to go to any more interviews on top of the PM&R ones. If I couldn't get the PGY-1 interview scheduled within 1-2 days of my PM&R interviews, I just canceled them. In retrospect, this was somewhat of a gamble and probably accounted for my nervousness the week before the match.
     
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  14. Betrayed

    Betrayed Junior Member

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    My advice to all of you is to STOP what you are doing and strongly consider another specialty in medicine. PM&R is NOT the specialty that many medical students think it is.

    Inpatient physiatry is virtually dead. The bread and butter of inpatient PM&R is NOT SCI, TBI, amputations, etc. Most inpatients in most geographical areas are those with CHF, multiple medical complications post surgery, advanced terminal cancer, etc. Many patients are admitted with the waste basket diagnosis of "general deconditioning." More than a few patients have moderate to severe dementia and virtually no carryover of what was learned in therapy. Acute inpatient rehab in many areas is no more than a SCAM! Nonphysician administrators at for profit rehab hospitals decide who gets admitted. Their motto is to fill every bed without considering if the patient is appropriate for acute inpatient rehab. The physiatrist's role in inpatient rehab is that of a nonphysician, much like PT, OT, or speech. In fact, a neurosurgeon at one university medical center referred to physiatrists as "glorified social workers."

    Inpatient rehab consults are a joke. You are a disposition service. You are not asked to answer a medical question. You are asked "Will you take this patient to rehab?" Most leading hospitals do NOT have physiatrists doing consults. Most acute inpatient rehab is a FRAUD!

    More later on inpatient rehab and outpatient rehab.

    How do I know this? I am a fully trained physiatrist from a program that likes to think it is a top ten program.

    Sign me,

    Been there, done that.
     
  15. Betrayed

    Betrayed Junior Member

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    Dear Future Physiatrists,

    I hope you take my above comments to heart. If you do enter PM&R, at least you were warned. The program director and associate program director in medicine tried to warn me but I wasn't listening carefully. The basic message was that PM&R is for lazy dolts and not for competent physicians who need intellectual stimulation. They told me of a couple of highly recommended Ivy League medical scool graduates who proved so inept and incompetent as medical interns that they helped get them into PM&R where "they couldn't kill anyone too quickly." Alas, times have changed and rehab patients are sicker with a higher acuity than ever before. Heaven help those patients who are at the mercy of a physiatrist's inpatient skills!

    Sorry if I offend anyone, but physiatry is not for someone who graduated in the upper half of her/his class and DEFINITELY NOT for a person who graduated in the upper third of their class. I've been told by more than one internist that the rare physiatrist who ranked highly in school was usually a horrible clinician who often attained his high ranking based on his basic science years.In my personal experience, physiatrists, as a group, are the WORST doctors I have ever worked with. For example, I know of several physiatrists (including one at a U.S. News top-ranked rehab hospital) who have neglected to restart diuretics on their patients resulting in flash pulmonary edema. A risk management official at a leading healthcare company told me that in his experience physiatrists were less diligent (less knowledgeable?) than other physicians in their medical care of inpatients. Some hospitals even require in their bylaws that a physician OTHER THAN A PHYSIATRIST be the attending of record on their acute inpatient unit. The physiatrist's role in patient care is marginalized to that of a PA who writes PT, OT, and speech orders. Let me remind you that ANY physician can write for PT, OT, and speech.

    Later, more on OUTPATIENT physiatry or shall I say chiropractic with a prescription pad.

    Bye for now.
     
  16. Ichi

    Ichi Junior Member
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    Do any of you guys know about the programs in Pennsylvania. My problem is that I have one day in PA to interview and I can't make up my mind at which program to interview at. My choices are Temple, Jefferson, and U of Penn.
     
  17. Devdas

    Devdas Senior Member
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    PM&R sounds like a perfect speciality for ME! :D
     
  18. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    Boy, what a load of crap...I've never met anyone with such an axe to grind against rehab. It's usually such a warm-and-fuzzy specialty. The field is hardly dead. In fact, it's undergoing a Rennaisance. Recovery of function, neural remapping, sophisticated myoelectrically controlled prosthetics, limb transplants, virtual reality environments for traumatic brain injury, etc are the future of medicine. Patients demand not only to have their diseases cured, but they also demand a suitable quality of life. That is where physiatry enters the picture.

    As for being glorified "social workers", I'm not sure what that means. Maybe it reflects that fact that you consider biopsychosocial issues in patient care to be unimportant. Maybe it means that you could care less about what happens to patients once they leave *YOUR* service. Maybe it means that you don't feel like a "real doctor" unless you're cutting a patient, sticking a tube up their butt, or giving them drugs.

    As for physiatrists not being competitive applicants, again, not true. Most students going into PM&R are generally disgusted by the "treat'em and street'em" attitude of internal medicine, the "I only do the knee", surgery's "a chance to cut is chance to cure" mentality, not because they're lowly ranked applicants.

    Interesting...

    Physiatrists are the preferred treating physician for workman comp cases in almost all states. Not orthos, not neurosurgeons nor neurologists, nor general internal medicine doctors.

    Of course rehab has its share of crap patients---name one service that doesn't! Ever been on a general medicine ward lately? How about a stroke unit? I've spoken to several orthopods and neurosurgeons and all agree that PM&R is ultimately where it's at if one doesn't want to be a surgeon. What else is left?

     
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  21. Betrayed

    Betrayed Junior Member

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    Stinky Tofu,

    Harvard faculty??? Is that supposed to impress me? According to your earlier posting, you're only an intern (with a pseudo-faculty title from Harvard?) Ha! Ha! Ha! Your reasoning in defense of PM&R sounds more like it came from Podunk U. than Harvard U.

    It is ludicrous that you compare PM&R to radiology, dermatology, and pathology. The academic quality of the entire cohort of PM&R residents is in NO WAY comparable to the cohort of radiology or dermatology residents. As a group, PM&R probably has more academic third-stringers than the other two combined. This would be very easy to study (grades, class rank, board scores). In fact, this should be done and published in Academic Medicine, a journal that should be familiar to "Harvard faculty."

    Furthermore, very few radiologists or dermatologists admit patients to acute care hospitals. Pathologists do not admit patients. None of these physicians claim to be able to care for acute inpatients. On the other hand, inpatient physiatrists admit lots of patients to acute hospitals (albeit rehab) and bill (DEFRAUD MEDICARE?) accordingly. Many bill for "rounding" and writing notes on 60 to 80 patients EACH weekend day. Many physiatrists do not even carry a stethoscope yet that doesn't stop them from writing Lungs-clear Cor-RRR (no, they don't check the pulse), etc. I have observed this behavior of physiatrists too many times in too many places to believe that it is an isolated occurrence. Is this high quality medical care? Is this what PM&R's mantra of "we take care of the whole person" means? Are insurance companies/Medicare/Congress aware that this is what they are paying for? Of course, this is something for a U.S. Attorney's office to investigate.

    Before you blow a gasket, I will say that I have known a few physiatrists who are good doctors. Sadly, they are a distinct minority.

    It is very important for medical students to deeply investigate any specialty that they are considering. For example, read the articles and look at the classifieds in the back of the Archives of PM&R (essentially, a throw away journal with no ground breaking research.) Call some of the recruiters listed in the back of the journal. Ask lots of questions. Check the AMA statistics. There aren't as many good jobs in PM&R as some people would have you believe!

    BYE and thank you for engaging in debate.

    "Remember, your next patient may be an undercover FBI agent."
     
  22. Okay, I think you need to calm down. With regards to rounding on a patient, have you ever been on a General Surgery service or an Ortho service? Have you seen the type of rounding that occurs on those patients? Aren't General Surgery patients sicker than the average PM&R patient? Not all patients need to have a complete physical exam during rounds, ya know. Have you ever heard of the Ortho point? It's located just above the umbilicus -- you can listen to the lung, bowel, and heart at the same time. :p What do you call two Orthopods reading an EKG? A double blind study. :) Believe it or not, on the surgery and medicine service, we get the vital signs from the nurses most of the time. We don't palpate the pulses ourselves -- the horror! Get real, you don't need to do a complete PE on morning rounds. You do what you is necessary on rounds based on what the nurses tell you, what the post call resident tells you, what the patient tells you, etc. Besides, anything that gets missed was probably your fault, right? I mean you were the resident in the program, correct? Wasn't it your job to make sure the patient was on a diuretic, that the lungs were CTA bilaterally, and the heart had a RRR without murmurs. I guess you were really on top of things as a resident, huh? Inpatient Rehab patients are on the Rehab service for a reason. They are usually pretty stable otherwise they wouldn't be on the Rehab service. I don't know any Physiatrist that pretends to be an Internsist unless they've done a dual residency in IM/PM&R. The fact that a dual residency even exists suggest that Physiatrists are well aware of the fact that the role of Physiatry is not to manage patients that should be on an IM service. Also, many medical students interested in PM&R nowadays are more interested in the Physical Medicine rather than the Rehabilitation aspect. Most of the applicants I met during interviews were looking for programs that gave plenty of exposure to Sports Med, Interventional Pain Management, EMGs, etc. The programs that focused heavily on Inpatient Rehab was generally shunned. Medicine can have the acutely ill patients, it really doesn't bother me at all.

    Yes, I am an Intern and I never tried to hide that fact. My internship consists of rotations in Medicine, ICU/SICU, Emergency Medicine, Endocrinology, Cardiology, etc. I matched at Harvard last year and I finish my internship in six months. The certificate I will receive upon completion of my internship will say Yale U not Podunk U, but thank you for your concern. The reason that I listed my Residency as Harvard is because that is where I matched and will spend three years. My fellow interns in my program are going into Radiology, Ophtho, and Anesthesia. I am obviously considered a competitive applicant otherwise I wouldn't of matched here. Somehow, I haven't been kicked out of internship yet so I must have decent inpatient skills. :rolleyes:

    The reason that I listed the faculty from Harvard was to show that many of them decided to do PM&R after Internal Medicine because they didn't like Medicine. To show that a residency in PM&R was obviously worthwhile in their minds. In fact, many medical students nowadays are less interested in Internal Medicine. I think PM&R is an excellent option and if we are such a danger to medicine, why is it that PM&R has one of the lowest malpractice rates in medicine? I know many Physiatrists who make a very comfortable living. Perhaps your lack of job offers are due to some other factors. Um, I don't recall any Physiatrists rounding on 60-80 patients a day. If they have that many patients, then your assertion that there is no market for Physiatry seems rather contradictory. Since you are a fully trained physiatrist, can you please share with us where you did internship and residency. As in any field, there are good internships and good residencies. Perhaps you just failed to match in neither.

    Lastly, I never said that PM&R residents were comparable to Dermatology or Radiology residents. Dermatology is probably the toughest residency to match into and Radiology has become one of the toughest. My point was that many people choosing PM&R, Rads, Path, Derm, and Anesthesia nowadays are doing so for lifestyle issues.

    "Remember, your next patient should probably be your last one." ;)
     
  23. bbbmd

    bbbmd Pain Doctor/Physiatrist
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    Betrayed,

    I can't believe you despise PM&R so much. Please let us know where you did your training so we can avoid that program! Why didn't you start a different residency if you were so miserable? I wonder if you couldn't get into one? Maybe it was an attitude problem? Physiatrists are known for being the nicest and most laid back physicians, maybe you just didn't fit the mold. I hope you are not practicing in the field right now! I wouldn't want you to release your frustration on the patients! You obviously were not meant to be a Physiatrist so please go find something else to do!

    Now for everyone else who are either applying or enjoying what PM&R has to offer... I have a question. Which would be better? A categorical or specialty program with a preliminary year? Also, can someone explain how the supplementary match works? <img src="confused.gif" border="0">
     
  24. theD.O.C.

    theD.O.C. Member
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    Noticed a couple of you guys making a distinction between physical medicine and rehab medicine. What difference in these two fields? Do PM&R docs have to specialise in one or the other? What kind of fellowships are available?

    One other thing, as a person who's looking seriously into PM&R, I think its great to see the devil's advocate position taken by Betrayed and the vigorous debate that has been raised. The points he brings up echo some of my fears about the field. I hope this will continue albeit with a little less bile and personal attacks. Can't we all be friends? :)
     
  25. limejello

    limejello New Member

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    The posts in this forum have piqued my interest in PM&R. Now that i've heard the negatives, i was wondering, for the rest of you, how did you become interested and why have you chosen this field? Thanks!
     
  26. md2b1

    md2b1 Junior Member

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    Yeah the heated debate has piqued my interest as well. I'm an MS3 with interest in Pain Mgt. Still looking into plus/minus of anesthesia vs PMR. Any suggestions/info welcome?
     
  27. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    The biggest minus of doing anesthesia as a route to Pain Management is spending 3 years under the thumb of a surgeon in the O.R. I considered that option too (which is the more traditional route to pain mngt), then I did a month of anesthesia and changed my mind: Bitter O.R. politics, too early in the AM for me, surgeons (and even nurses) treat you like crap, constant turf wars between CRNA's and MD/DO's, and hours of boredom punctuated by moments of terror. Anesthesiologists who do pain management sort of have a reputation for being "needle jockeys." They emphasize the more interventional approach. PM&R tends to emphasize a more modalities-oriented/psychosocial approach. Still, many PM&R docs who do Pain do interventional techniques. It is possible to do interventional fellowships in PM&R and Anesthesiologists and PM&R docs who do pain fellowships are boarded under the same pain management board.
     
  28. Goofy

    Goofy Senior Member
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  29. md2b1

    md2b1 Junior Member

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    Thanks for the info and opinions. I've just begun to look at different programs and talk to some of the docs around here. I guess I'm still straddling the fence since I'm interested in the pharmacology aspects and the psychosocial but have found that I really enjoy doing procedures. Maybe when I rotate through surgery next month I will start to narrow things down a bit.

    Also, from your comments it seems that PMR resident's can readily enter into Pain fellowships that are in Anesthesia Dept's and not just PMR pain fellowships, is this true?
     
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  31. Devdas

    Devdas Senior Member
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    PM&R Doctors have the reputation of being "Wonderful Spouse" of the medical family.The divorce rate amoung the PM&R doctor involved family is 0%.
    WHY?(Is that because they sleep with their spouse everynight
    :D )

    I think PM&R is going to become the HOTTEST speciality in the 21st century.I have no doubt in this speciality's future and scope.
     
  32. Devdas

    Devdas Senior Member
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    I overheard the following conversation in the hospital corridor:

    Ortho surgeon:
    Who is that guy there wearing a black Armani suit? I saw him in the carpark today driving a new Merc.He must be that new spinal surgeon who moved from LA!

    Ob/Gyn:
    I doubt he is our new spinal surgeon.I saw him in the cafetaria having a three course lunch when I was grabing my sandwich today.I don't think spinal surgeons have so much time to eat in the cafetaria.

    General Surgeon:
    Oh!Are you talking about that guy?I saw him yesterday with three stunning Physiotherapists in the pub.I wonder he is our new CEO?

    Ortho Resident:NO!.Are you all jealous?.He is the new Physiatrist!

    ;)
     
  33. patton

    patton Junior Member

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    How are the PM & R interviews going? I've been to Carolinas Medical Center and St Vincents in New York so far. Was very impressed with both programs. Both had great didactics and great attendings and all of the residents seemed very happy.

    Anybody body else have any good or bad experiences at their interviews so far?
     
  34. DigableCat

    DigableCat Senior Member
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    Just thought I'd bump this to the top, as it had some interesting point-counterpoints.
     
  35. Ronald

    Ronald Junior Member
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    I have an interview scheduled at SUNY at Stony Brook. Does anyone know anything about that program?
     
  36. Ronald - The programs with the best reputation in New York are Columbia/Cornell and NYU. I've heard that the program at Stonybrook is focused more on inpatient rehabilitation.
     
  37. Ronald

    Ronald Junior Member
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    Thanks, Stinky Tofu. I was just going thru your earlier posts about various programs and i found them so informative that i actually took notes :)

    Like the others, i'm worried about the internship year. I might have to scramble for that myself.
    I have another PM&R interview scheduled at Univ of Rochester- Strong Memorial. Any info/advice?
     
  38. DigableCat

    DigableCat Senior Member
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    Attending Physician
    A friend of mine interviewed there, and he thought it was a good program. It's probably worth checking out. Can't imagine there's much to do in Rochester though, except shovel snow. :cool:
     

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