Rush is a smaller program with about 4 residents per year. No malignancy that I know of there...
I can expound a little bit on the Rush experience.
PGY-2 can be a little rough (inpt/consult service is combined) but you only have 5 weeks of call, and its from home (only cover about 30-40 patients, IM moonlighter covers the floor in-house). Alot of money is set aside for books and conferences. Didactics are pretty good as a fair portion of the lectures on associated topics are conducted by faculty from other departments.
In contrast to the sports rotation under Ortho/IM-FP, the 2nd sports rotation (Physiatry run) is based out of U of I-Chicago with an attached PM&R sports fellowship, so you do some NCAA Div I stuff, races and maybe WNBA. The ortho dept has an accredited FP/IM sports fellowship. Dont know if I they would take Physiatrists because it wasnt yet accredited when I was there and nobody had applied for it.
EMGs are primarily through neuro with PM&R rotations for polishing. For spine you have access to some senior PASSOR instructors as well as Neurosurg and Ortho-spine, 2 of whom do a lot of instructing/lecturing through NASS as well as publishing some of the initial studies on Kyphoplasty.
The interventional stuff is a complicated political issue. When I was a PGY-2, and for a few years prior, there was a rotation at an outpt site of the Anesthesia pain clinic where the hands-on experience was great (200-300 procedures if you were motivated), under the supervision of one particular instructor (PM&R sympathizer
). Anyway, he left for private practice and the rotation folded. In fact, I dont think the Anesthesia pain clinic will allow PM&R residents to rotate on their service anymore.
It goes far beyond the residents and fellows, however. During my PGY-3 year, the Neurosurg (CINN at the time) and Ortho depts jointly opened a spine center. There were plans to have a fluoro suite for their spine Physiatrists to use. It was administratively blocked by the gas department. Weird huh? How often do you hear of an anesthesia dept being able to overpower both Ortho-spine and Neurosurgeons? The physiatrists in question were not a bunch of slouches. These were fellowship-trained pain boarded docs, one of whom had taught at PASSOR interventional work-shops for a number of years.
To my knowledge, it is the wishes of the Chairman of the gas dept (president of the medical staff) that that no one else be granted privileges for interventional procedures.
To my knowledge, the anesthesia pain fellowship has never interviewed a candidate from an outside specialty.
I have no idea what kind of friction must go on with IR, who do cervical discograms, etc.
Before I get accused of misrepresenting facts, I was not involved in any of these discussions, but this is information that was related to me by some members of the involved parties.
So, this is as deep as Ill delve into it. PM me if you want further details.
Back on track. The interventional training is now good (as opposed to great) and as described above, is through the VA, Cook County Hosp, private clinics or outside electives.
As stated above, there is a lot of elective/selective time, which is potentially advantageous not only for the future sports/spine/pain doc, but also for the resident who wants to be good at outpt Neurorehab as a new Physiatrist out in practice.
After PGY-2, 24 months definitely not a long time, and it can be tough cram everything you want to do in that short of a time period. In my opinion, the ample funding and flexibility in scheduling for conferences/outside education really allows one to intensify the 24 months of focused training before entering private practice. During PGY-4, while I was doing all the sports/spine/pain stuff, I had a classmate who was off at several other institutions doing all things Peds related.
To be honest, had the opportunity been available and my salary raised to fellow level, I would have considered staying an extra year in residency in a 12 month elective or design your own fellowship type of role.
Though not a shining beacon of PM&R research, it is a good if not unique program for those who want focused, efficient, high-yield training that will equip them with a practical/marketable skill set.
A little off topic, but I think Rush could be fertile ground for a motivated, hard-a** Spine Physiatrist to come in and create some kind of monster interdisciplinary spine program. Whomever it would be would need to be skilled in diplomacy, but with some big
cojones, for the above mentioned reasons. Maybe some senior ISIS or ASIPP guy would be up to the task. Sports would be a little more open I would think.
Im sure other university hospital systems have similar political issues. I recall a little U Mich mini-spat on the ISIS board a while ago (Ligament
) and attended a recent Medtronic implant course where one of the lectures was done by a U. Mich pain faculty neurosurgeon (Dr. Sagher) who made a few comments alluding to as much (funny, the program director for the Rush pain fellowship was instructing me during that same course. Wouldnt that have been awkward if I had introduced myself as a former Rush PM&R resident?). Nevertheless, it seems U of Mich is able to consistently provide its residents with great interventional training. Perhaps they should be a model for other programs. We have model systems for TBI and SCI. How about a model system for non-operative spine care?
Physiatry, for all our wonderful bedside manner, communication skills and team spirit, can definitely use a few more ***holes who can get things done.
