Question

[Snowflake318]

Hey guys,

I am a 4th year applying to PMR who has got interviews at strong programs, strong board scores, good grades, published research in the field, and strong letters. Because I am interested in ruling out another more competitive field, I am taking 2.5 electives in the other more competitive field and have only done a Pediatric PMR elective (although I have informally spent a lot of time on the adult side within and outside that elective).

Do you guys think that only having one PMR elective in Peds PMR will look really bad? Is there any way to explain that I have not lost interest in PMR even though I only took the one elective and a bunch in another field?

Thanks a lot!

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[PMR 4 MSK]

Interviewers, including the Chair, the Residency Director, and any other attendings they can guilt into interviewing you, are most concerned with whether you really want to do rehab. You got good grades, scores etc - great, you're in as long as you convince them that rehab is your life goal.

However, if they sense that PM&R is your backup plan, you stand a good chance of falling to the bottom of their ranking - they don't want to see you bailing out when a position in derm or whatever opens up somewhere.

I'd consider phrasing it like this, when they ask you about it: "I know I want to do PM&R, and also enjoy peds, so I wanted to combine the two. I only had time for 1 elective in PM&R. I also have had significant exposure to the field outside of this elective." And then tell them when they ask what that experience is. When asked about the other fields, say how they relate to PM&R and how they'll prepare you better for it.

But #1 - don't Bull**** them. They've interviewed plenty of strong candidates for whom PM&R is their back-up plan. Hell, even as a resident, when I'd have lunch with interviewees, I could sniff them out. Practice this interview with others, and have them throw some hard questions at you about doing these other electives, and why you're not going into the other field (which is?). Fumbling, backpeddaling or stalling on answers will get you every time.

 

[dc2md]

I'd say if the other "competitive field" is ortho, then you have some argument. If it's derm, rads, ophtho, then you're screwed. I wouldn't believe you were truely sincere about liking PMR.

 

[Snowflake318]

I'd say if the other "competitive field" is ortho, then you have some argument. If it's derm, rads, ophtho, then you're screwed. I wouldn't believe you were truely sincere about liking PMR.

Thanks for your advice...kinda what I suspected. The "competitive field" is in the derm, rad, optho type group.

I'm pretty sold at this point on pmr, but its kinda too late to change my electives around...just have to think things through well and present myself as good as I can, I guess.

 

[Llenroc]

I'd say if the other "competitive field" is ortho, then you have some argument. If it's derm, rads, ophtho, then you're screwed. I wouldn't believe you were truely sincere about liking PMR.

How so? I know a lot of Orthopedic surgery contenders apply to PM&R as a backup (historically at least, perhaps not so much these days), but the two fields are nothing alike.

I'd say something like Dermatology is much more similar to PM&R, because it's clearly within the spectrum of Medicine rather than Surgery and involves small procedures.

Not that I endorse applying to PM&R as a backup. I just think people who couldn't get into Orthopedic Surgery because of mediocre scores or were too physically weak/cowardly to work the hours required and went into PM&R thinking it was the next best thing are clearly deluding themselves because PM&R has about zero in common with the day to day work of Orthopedic Surgery.

 

[Ludicolo]

How so? I know a lot of Orthopedic surgery contenders apply to PM&R as a backup (historically at least, perhaps not so much these days), but the two fields are nothing alike.

I'd say something like Dermatology is much more similar to PM&R, because it's clearly within the spectrum of Medicine rather than Surgery and involves small procedures.

Not that I endorse applying to PM&R as a backup. I just think people who couldn't get into Orthopedic Surgery because of mediocre scores or were too physically weak/cowardly to work the hours required and went into PM&R thinking it was the next best thing are clearly deluding themselves because PM&R has about zero in common with the day to day work of Orthopedic Surgery.

Really? I think you're reaching here...

Some PDs can see an aspiring orthopod applying to PM&R as a backup, given the common ground in the MSK system, spinal injuries, minor procedures such as injections, bracing, and casting. Certainly someone shooting for a surgical specialty can't be accused for choosing a specialty based on lifestyle considerations. I'll agree that the day to day work is different, but the nature of what PM&R and ortho see/treat is very similar.

OTOH - There is not much overlap in pathophysiology between derm and rehab. Maybe dermatomyositis? More significantly, there is a perception, right or wrong, that some people apply to derm primarily for lifestyle considerations. You can't deny that some people apply to PM&R for that reason as well. I don't begrudge the lifestyle issue - it is very important to all of us. But it should not be the primary reason for choosing a specialty. Someone primarily seeking a good lifestyle could be viewed as a possible resident who looks to leave early, shirk responsibility, etc. PDs also are looking for people who will enjoy their work. They want people who are in rehab for the right reasons.

Obviously derm is way more competitive than PM&R, and candidates will be applying to back up specialties. I would argue that IM or FM have more overlap with derm than PM&R. Why wouldn't they choose those as back ups? An astute interviewer will challenge the derm/PM&R candidate. Better have a good answer, and your track record hopefully will back that up.

 

[dc2md]

I agree with Ludicolo regarding ortho's similarity to PMR.

And on the topic of applying to multiple specialties, or PD during this years interview season has been saying that the stats say 50% of all candidates are applying to more than one specialty (aside from prelim and transitional programs of course). The good news for the candidates is, we don't know what those other specialties are. I could ask them all, but I'm really not looking to bust someones balls on interview day.

 

[PMR 4 MSK]

One of my classmates in PM&R was an ortho from England who could not get into an ortho residency, PM&R was his back-up, and became his career. He is an excellent physiatrist, and was a definate asset to the program. He would have gladly dropped PM&R for ortho, but as an IMG, it wasn't going to happen.

There is a great deal of overlap b/w our fields - 90% of the pts I see could just as easily been seen by ortho, but my practice is biased that way.

 

[ShrikeMD]

Interviewers, including the Chair, the Residency Director, and any other attendings they can guilt into interviewing you, are most concerned with whether you really want to do rehab. You got good grades, scores etc - great, you're in as long as you convince them that rehab is your life goal.

However, if they sense that PM&R is your backup plan, you stand a good chance of falling to the bottom of their ranking - they don't want to see you bailing out when a position in derm or whatever opens up somewhere.

I'd consider phrasing it like this, when they ask you about it: "I know I want to do PM&R, and also enjoy peds, so I wanted to combine the two. I only had time for 1 elective in PM&R. I also have had significant exposure to the field outside of this elective." And then tell them when they ask what that experience is. When asked about the other fields, say how they relate to PM&R and how they'll prepare you better for it.

But #1 - don't Bull**** them. They've interviewed plenty of strong candidates for whom PM&R is their back-up plan. Hell, even as a resident, when I'd have lunch with interviewees, I could sniff them out. Practice this interview with others, and have them throw some hard questions at you about doing these other electives, and why you're not going into the other field (which is?). Fumbling, backpeddaling or stalling on answers will get you every time.

Amen to the above.

Even though my ability to "sniff" out individuals who are using PM&R as a "back-up" is probably not as good as PMR4MSK, my central advice would be for you to pursue the professional goal that you believe would give you the greatest professional satisfaction.

BTW, by all means, take the PMR rotation, preferably in a good, well-regarded teaching program. You shouldn't need two rotations. You may find that the "more competitive" field is professionally less satisfying to you.

 

[Snowflake318]

Amen to the above.

Even though my ability to "sniff" out individuals who are using PM&R as a "back-up" is probably not as good as PMR4MSK, my central advice would be for you to pursue the professional goal that you believe would give you the greatest professional satisfaction.

BTW, by all means, take the PMR rotation, preferably in a good, well-regarded teaching program. You shouldn't need two rotations. You may find that the "more competitive" field is professionally less satisfying to you.

Thanks so much for all the good, thoughtful replies. To tell a bit more about my situation...i knew a lot about pmr, so I decided to do a couple rotations in option number2 to make sure I was picking the field that was right for me. Seemed like the best appproach at the time, but doing a couple rotations in another lifestyle field ha some obvious downsides when applying to pmr.

 

[Llenroc]

Really? I think you're reaching here...

Some PDs can see an aspiring orthopod applying to PM&R as a backup, given the common ground in the MSK system, spinal injuries, minor procedures such as injections, bracing, and casting. Certainly someone shooting for a surgical specialty can't be accused for choosing a specialty based on lifestyle considerations. I'll agree that the day to day work is different, but the nature of what PM&R and ortho see/treat is very similar.

OTOH - There is not much overlap in pathophysiology between derm and rehab. Maybe dermatomyositis? More significantly, there is a perception, right or wrong, that some people apply to derm primarily for lifestyle considerations. You can't deny that some people apply to PM&R for that reason as well. I don't begrudge the lifestyle issue - it is very important to all of us. But it should not be the primary reason for choosing a specialty. Someone primarily seeking a good lifestyle could be viewed as a possible resident who looks to leave early, shirk responsibility, etc. PDs also are looking for people who will enjoy their work. They want people who are in rehab for the right reasons.

Obviously derm is way more competitive than PM&R, and candidates will be applying to back up specialties. I would argue that IM or FM have more overlap with derm than PM&R. Why wouldn't they choose those as back ups? An astute interviewer will challenge the derm/PM&R candidate. Better have a good answer, and your track record hopefully will back that up.

Maybe, but I just don't see that many people who decide which organ system they like best and then apply to a field based on it. I would guess most people decide early on in their third year if they want something that involves the operating room, call, coming into work at 6 a.m., etc. Or if they want something in the spectrum of medicine, whether they want to stick to primary care or specialize. And if specialize, then something with procedures, or not? Or if you dislike patient care entirely you go with Radiology, Pathology, etc. I would say the vast majority people don't have any great fascination or interest in one particular organ system, and they're at least somewhat flexible about which systems they'll deal with.

For example, the neurologic system, the bones/muscles, and the gastric system are very different. But I knew a lot of people who decided between Orthopedic Surgery and Neurosurgery (and for many it had less to do with which system they liked best, and ultimately more to do with lifestyle), or Orthopedic Surgery and General Surgery (for some the decision was based on board scores). On the other hand, I didn't know a single Neurology applicant who was even remotely interested in Neurosurgery. Nor did I see any overlap between the IM gunners going for future GI vs. doing General Surgery instead, even though General Surgeons can tailor their practice to be somewhat like GI if they focus on scopes and clinic.

And I doubt this is a recent development. I had 3 uncles who wanted to be surgeons. One wanted Ortho and got it. The other two wanted General Surgery, but neither could get it so one went into Ortho and the other Neurosurgery (this was decades ago when there happened to be a big craze for General Surgery at the time).

I'm going into PM&R, but I could easily see myself in Cardiology, Heme-Onc, or even Dermatology. Orthopedic Surgery? Not so much.

 

[topwise]

On the other hand, I didn't know a single Neurology applicant who was even remotely interested in Neurosurgery.

Really? I know at least three people who were debating between neurosurg and neurology. (All of whom picked neurology.)

 

[PMR 4 MSK]

Really? I know at least three people who were debating between neurosurg and neurology. (All of whom picked neurology.)

Let me think, do I want 4 years of 8 am - 5 pm, M-F with periodic call, followed by many years of an easier schedule, or 7 years of 36 hour days, no life outside the hospital, psychologic brutality, followed by many years of the same or worse?

Do I want $10K/year Malpractice, or $500K? Do I want to be sued once or twice in my career, or every other month?

Do I want $200K/yr salary and the ability to spend it, or $1M/yr, with a spouse +/- ex-spouses to spend it for me?

I've seen many pre-meds and M1s and M2s talk about the debate b/w the 2 fields, but I can't magine any M3 or 4 who has seen the fields even remotely have a hard time deciding which field suits them. They often co-treat, see a lot of the same patients, but their residencies, training and lifestyles are so vastly different that the only ones who are unsure about which of the two fields would be better for them are people who have never seen them in action.

 

[Snowflake318]

I'd say if the other "competitive field" is ortho, then you have some argument. If it's derm, rads, ophtho, then you're screwed. I wouldn't believe you were truely sincere about liking PMR.

Just wanted to make sure people aren't getting discouraged by these sorts of comments. Although I haven't matched to PM&R yet I have gotten interviews at great programs who have told me that I should have my pick of where I want to go. Most programs have noted the other field that I was interested in, but after I explained "why PM&R" to them, they seemed fine with things. I will certainly get a better sense of whether or not having lots of rotation in another field hurt me.

I think that PM&R is truly interested in whether people are interested in the field, so if you have a reasonable explanation and at least some evidence that you are interested in PM&R I think you should be alright.

To say that just cause you are also interested in derm/rads/optho and decide to do PM&R that you are not sincere about PM&R is a bit unfair to PM&R. I mean those fields aren't sooo much better than PM&R, just different...and more lucrative. To say that you can't be undecided between PM&R and derm is certainly selling PM&R short.

 

[evajaclynn]

To say that you can't be undecided between PM&R and derm is certainly selling PM&R short.

That's not the impression I got of the point dc2md was trying to make. Sounds like they are just saying that ortho has more in common overall than does derm. Thus, it would be harder to explain to a PM&R program the difficult decision between two fields that are quite different and to be able backup your genuine interest in PM&R.

I see in no way how this argument is selling PM&R short. I would choose PM&R over derm anyday.

 

[7phoeniX]

Interviewers, including the Chair, the Residency Director, and any other attendings they can guilt into interviewing you, are most concerned with whether you really want to do rehab. You got good grades, scores etc - great, you're in as long as you convince them that rehab is your life goal.

However, if they sense that PM&R is your backup plan, you stand a good chance of falling to the bottom of their ranking - they don't want to see you bailing out when a position in derm or whatever opens up somewhere.

I'd consider phrasing it like this, when they ask you about it: "I know I want to do PM&R, and also enjoy peds, so I wanted to combine the two. I only had time for 1 elective in PM&R. I also have had significant exposure to the field outside of this elective." And then tell them when they ask what that experience is. When asked about the other fields, say how they relate to PM&R and how they'll prepare you better for it.

But #1 - don't Bull**** them. They've interviewed plenty of strong candidates for whom PM&R is their back-up plan. Hell, even as a resident, when I'd have lunch with interviewees, I could sniff them out. Practice this interview with others, and have them throw some hard questions at you about doing these other electives, and why you're not going into the other field (which is?). Fumbling, backpeddaling or stalling on answers will get you every time.

Is there such a thing as doing too many PM&R rotations? I'm dead certain that I want to do it. I've put some well-researched thought into the prospect. I'm now just trying to determine what type of PM&R program would best fit my interest. The problem is....I have 1.5 months of experience (OMSI & II) but find everything interesting, and not one particular aspect of the field more or less intriguing. I've set up a general outpt Rehab, Paeds rehab for my OMSIII rotations, and intend to do at least another two or three more (braininjury, sports/occu, inpt) during early OMSIV. Am I overdoing it? The thing is, I don't feel as though I am missing out on experiences because I'm required 22 months of 4-week rotations to graduate, and several electives during my fourth year (I'm planning rads, neurosx/othosx and pain mgmt to get some more experience toward residency). Is there such a thing as being too focused?

 

[PMR2008]

I think there is such a thing as too many PM&R rotations. You should find a program that gives you the opportunity to excel and get exposed to all the sub fields of rehab (U of Washington, RIC, Kessler etc). You will have ample time to find your interest once you start. A month of outpatient and peds might be too much. I did a month of PM&R as a MSIII which was broken into 2 weeks of inpatient, 1 week of outpatient and a week of Peds. I shadowed a pain doctor for a few days as well. It have me a very broad exposure to all the fields. It also made me shine during my 4th year audition electives. I would suggest setting up 2 PM&R electives during your 4th year preferably at programs that you want to match at. Set the electives during late summer and early fall so you can get a letter/interview out of the electives.
At the same time do electives that supplement and complete your rehab knowledge. As a 4th year I did neurosurgery, orthosurgery, neurology, rheumatology(lots of injections), radiology and urology(you deal with a lot of bladder issues in inpatient rehab). In your intern year you will get enough medicine but try to brush up on radiology, neurology and ortho.
Personally I think it is a good thing to be focused. I have learnt enough medicine in my intern year and I was able to take care of my patients in my inpatient rehab elective as an intern.

 

[7phoeniX]

I appreciate the feedback. I suppose that I will reevaluate my elective choices, now. I heard that uro was a good elective to consider, so thank you for reminding me of that. Apologies for the many questions: How many programs should one consider applying to--on average. I heard 8 interviews was a comfortable number to have. What do you think about looking into programs that have a VAMC? I heard that these programs offer some interesting training. All in all, I'm not looking for a 'big name' but 'big potential' and 'big hands-on-education'. I want to go where the program is hungry to make a name for itself, and pushes its residents to excel, not just go through the motions. I can learn that stuff from any old book. I'd like to go where there are people thinking outside the box, and not necessarily business as usual. PMR seems to have the potential to be a dynamic and progressive field. And I cannot wait to jump in!

 

[PMR2008]

The number of programs you should apply to depends on the type of programs you are applying too and how competitive of a candidate you are. I would say have a PM&R attending, PD or resident read your CV, PS etc and have them advice you. 8 is considerend a safe number statistacially for american medical graduates (MD's). Probably a little more for DO's and a lot more for FMG's.

All the information you need can be found here

http://www.nrmp.org/data/index.html

big potential' and 'big hands-on-education' usually means "Big Name".

I appreciate the feedback. I suppose that I will reevaluate my elective choices, now. I heard that uro was a good elective to consider, so thank you for reminding me of that. Apologies for the many questions: How many programs should one consider applying to--on average. I heard 8 interviews was a comfortable number to have. What do you think about looking into programs that have a VAMC? I heard that these programs offer some interesting training. All in all, I'm not looking for a 'big name' but 'big potential' and 'big hands-on-education'. I want to go where the program is hungry to make a name for itself, and pushes its residents to excel, not just go through the motions. I can learn that stuff from any old book. I'd like to go where there are people thinking outside the box, and not necessarily business as usual. PMR seems to have the potential to be a dynamic and progressive field. And I cannot wait to jump in!

 

[7phoeniX]

One more question:
Most of my electives are scheduled after December, and I've noticed several programs don't allow visiting students to come through June, July or August. I have 12/20-1/14 available...Is this just too late to try for a rotation in PMR, or should I just use it for Rheum, etc?

Thank you again for your time!

 

[PMR2008]

One more question:
Most of my electives are scheduled after December, and I've noticed several programs don't allow visiting students to come through June, July or August. I have 12/20-1/14 available...Is this just too late to try for a rotation in PMR, or should I just use it for Rheum, etc?

Thank you again for your time!

Is this for time period during your 4th year? If so its most definitely too late to get a letter of recommendation (Most important reason to rotate) but it is still possible to get a interview out of the rotation. Most programs interview until the end of January. But since that is the time period that you will be interviewing in as well you will have to miss a lot of time from the rotation. That could hurt your chances at that particular program and possibly not get a strong LOR. I would suggest doing a month of radiology or vacation during that time period so you can focus on your interviews.