RIC - Inpatient vs Outpatient

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RunKid11

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I'm trying to figure out my rank list, and still more undecided than I'd like to be. I've narrowed my choices to RIC, Washington, Colorado, and UCLA (I like the West Coast). I'm interested in outpatient MSK, and I'd like to do a fellowship in sports following residency.

All of the places I mentioned seem like fantastic places to train, with a ton of great faculty and residents. I've read in various places that RIC is a program focused on inpatient rehab and that outpatient training is not their strength. This sentiment has been expressed both online and in person along the interview trail. I'm a little confused by these assertions because they don't seem to fit with what I can glean from the interview day and in reviewing their clinical rotations and academic curriculum. Unless I’m misunderstanding their materials, it seems that RIC residents complete just over a year of inpatient and outpatient each, and then have a great deal of flexibility with elective time to pursue their own interests. In going there, I could do six extra months of sports that I couldn’t do at a place like UCLA or Colorado, where elective time seems to be far more limited (not to disparage these places at all - I think they're great). RIC also has a weekly sports conference and ultrasound didactics, as well as numerous opportunities for sports coverage. They seem to match 3-4 people into sports each year, with a few more going into pain.

I’m saying all of this not to promote RIC, but rather to preface the question – what am I missing? I’m worried that I’m misinterpreting the rotation schedule or the didactics, or that I’m misconstruing the coverage and fellowship opportunities. I actually liked UW, Colorado, and LA a little better on the interview day, but the opportunities at RIC seem to be slightly ahead of those other places. I've heard from many people that I may change my mind and decide to do inpatient rehab. I respect the perspective that others further along in training can provide, but I seriously doubt this will happen. I've had plenty of exposure during medical school to inpatient medicine, in a variety of contexts, and I am very confident in saying that I don't like it. In fact, if inpatient medicine were the only option for practicing physicians, I'd look for job opportunities outside of clinical medicine because I find it so unappealing. I'm reticent to rank highly a place that has a reputation solely for inpatient rehab, and so I'm hoping to get some clarity regarding the program.

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I interviewed at all of those places, and--though I'm biased because I prefer inpatient--I definitely did not feel that outpatient at RIC was lacking in any way and certainly seemed as strong as at the other programs. If anything, I think UW tended to be a bit more inpatient heavy and traditional.

(A tangent: my sense re: UCLA was that it's the place to be if you're sure you want to practice in LA after residency, because they put a big focus on networking and getting their residents jobs in the area.)
 
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I'm going to have to agree with luckystar. If you want to practice in CA and you don't want to do academic physiatry...then LA is a no brainer as long as 1) you believe you will receive the training that you need in practice/fellowship and 2) you believe that you are a good fit for the program and that it is a good fit for you.

RIC and UW undoubtedly would provide a strong education...but would it be enough to offset you leaving CA and potentially losing out on those connections? Probably not.
 
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Actually, I don't even buy that going to RIC or UW over UCLA would put someone at a major disadvantage if they wanted to go back anywhere in California other than LA specifically. Those residents went pretty much wherever they wanted after.

But I got the impression that the residents at UCLA both wanted to *train* in SoCal and *stay* in SoCal. Enough so that I felt like a bit of an outsider, anyway.
 
When I interviewed at RIC back in 2010, i was told to look elsewhwere if I wanted to focus on outpatient/MSK type of practice. I work closely with a recent grad from RIC and he seems to echo this sentiment.

UCLA would be a great place for this type of training, very heavy on this type of practice actually. If you want to stay in SoCal, I would go there over UW or RIC. I am a SoCal native and it would have been my top choice if I wanted to stay in CA. I end up leaving for a east coast program because I felt the need to leave CA at that juncture in time. I am now finishing up here and eager to return home. My only advice would be to consider a possible change in focus during training and making sure the program provides a broad experience. I initially wanted to do primarly MSK/procedural work and shifted my career goals to a more inpatient field. A program like UCLA is not as inpatient heavy.

Again, to reiterate, you will get a great education at any of the programs mentioned above. If names are important to you, and sometimes they can be, then by far UW and RIC will carry more weight. That being said UCLA is a great program with a great group of docs running it.
 
I'm a SoCal native and my Pmr mentor works in la jolla (San Diego area). I want to end up in San Diego in the future. Here was his response to me regarding location of training.

" However, I think at this stage of the game, get your credentials / education at the best place you can. You will never learn more at any time in your career than you will in Residency. The job market is serendipitous at best so the networking only goes so far.
I say follow the education and a job in a place you want to live will follow."

My top 3-4 will likely be a mix of RIC, mayo, harvard, upmc
 
I'm a SoCal native and my Pmr mentor works in la jolla (San Diego area). I want to end up in San Diego in the future. Here was his response to me regarding location of training.

" However, I think at this stage of the game, get your credentials / education at the best place you can. You will never learn more at any time in your career than you will in Residency. The job market is serendipitous at best so the networking only goes so far.
I say follow the education and a job in a place you want to live will follow."

My top 3-4 will likely be a mix of RIC, mayo, harvard, upmc

Yeah...but I don't believe that level of education always correlates to program reputation. If you want to do outpatient PM&R, there are plenty of programs that offer top notch educations. The reputable programs are often that way because of their affiliation with large rehab hospitals and their inpatient practices. I believe that having as many tools in your toolbox is a good thing, but there also has to be some focus on what you want to accomplish with your training.

If the OP wants to do outpatient or work in a VA-like setting...I don't think that those other places would be able to provide a significantly better experience. Mayo doesn't even have a VA (though of course their outpatient is elite...no question). I am also willing to say that reputation could be overrated if you have staff members who aren't looking out for you and if you feel like you are alone in the process.
 
" However, I think at this stage of the game, get your credentials / education at the best place you can. You will never learn more at any time in your career than you will in Residency. The job market is serendipitous at best so the networking only goes so far.
I say follow the education and a job in a place you want to live will follow."

I'd have to agree with this. That's why I think Mayo is the best choice regardless of whether you know you don't want to do MSK/US.

Not sure why everyone is in love with Spaulding this year -- I found everyone I met there to be uppity and haughty. I'm thnking Mayo will, again, be the most competitive to match into this year. Then probably Spaulding > RIC > UW / Stanford / Columbia Cornell. Anyone else's thoughts?
 
I'm a PGY3 resident at RIC going into sports medicine. RIC's program is well-balanced for inpatient/outpatient exposure even without considering all of our elective time. With 5 months of elective/selective blocks, we have plenty of opportunities to further tailor our training to suit each our of preferences and professional goals.
 
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RIC
pgy2: all inpatient
pgy3: half in, half out
pgy4: living the life!

the residents are self-motivated rockstars and get top notch jobs, and the best fellowship positions

having the academic credentials helps a lot.
 
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I'd have to agree with this. That's why I think Mayo is the best choice regardless of whether you know you don't want to do MSK/US.

Not sure why everyone is in love with Spaulding this year -- I found everyone I met there to be uppity and haughty. I'm thnking Mayo will, again, be the most competitive to match into this year. Then probably Spaulding > RIC > UW / Stanford / Columbia Cornell. Anyone else's thoughts?

Agree with you by and large. Couple exceptions are I thought harvard was quite welcoming on interview day. Also, I think UPMC is a very underrated program and will be part of the super 6 very soon
 
I did my residency at RIC and fellowship at UCLA -

in terms of RIC - i feel that I got a very solid MSK/pain training because of all the electives I was allowed to do - sure PGY2 is inpatient heavy and when you interview - you mostly meet PGY2s because the PGY3s and 4s are out doing their thing - By end of PGY3 year I knew what I wanted to do and what was lacking from my training thus far so I set up my electives to prepare me for practice. I spent two months doing pain (including tons of interventional experience), a month with a MSK and neuroradiologist learning how to read MRIs, spent some time learning MSK ultrasound, etc. I also spent a month doing ortho(some of my classmates did a rheumatology rotation which was excellent) which was helpful since I work in an ortho group now - learned basic ortho spine, foot/ankle, hand, etc. I learned efficiency, how to multitask, how to market myself (Joel Press gives a great talk on this topic), and polished my work ethic, which has benefited me tremendously in my practice.

UCLA has a great fellowship - I do know that their residents were competing pretty hard for the pain fellowship and there were years that they did not take any from their own residency (like my year) and there were years when they took two. There's also tremendous competition to get a SoCal job and many residents have gotten less than ideal jobs just to stay in the area. The alum network in SoCal is good and the PD will try her hardest to pull strings to help you get a job but it is just a really saturated tough market and the climate is not very favorable to start your own gig or find a good private practice job that is not going to take advantage of you.

I got a lot of procedural skills at UCLA - but in terms of fund of knowledge - the basic MSK/sports/ortho/pain clinical knowledge and acumen - that mostly came from my RIC training. Anyone can learn how to stick a needle in something but it takes that fund of knowledge to know what procedure to do when, why, and why not.

The other thing about going to a larger older program like UW, RIC, Kessler, Mayo, Baylor, and the like - is the alumni base and the "name" faculty that is connected. In PM&R, pain, and MSK/sports, everyone knows everyone - so having the right person write a LOR or make a phone call for you can go far. It only takes attending the AAPMR alumni reception to understand the power of a large alumni network. I got approached by several RIC alums with SoCal opportunities after my fellowship. I actually didn't love SoCal so didn't stay in the area.

So that goes to say there is no one right answer for everyone.
 
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I don't know how having elective during PGY4 year would help sports medicine applicants that much as most application goes in in July August if that's the set up at RIC. It is ideal to have elective toward the end of PGY3 for sports medicine applicants.

Sports medicine is in essence advanced MSK medicine. Ideal candidate for sports medicine fellowships should have mastered most of basic diagnosis and anatomy in MSK medicine before applying to the fellowships. One does not necessarily have to have sports medicine experiences as this is rare to have an extensive exposure to sports topics during the residency.

If one wants to be competitive for sports, go to a place that will let you take command of physical examination and procedures (not just observed), have access to good research projects, and/or have successful matching track record for sports. RIC has done great. Matched Utahx2, Spauldingx2, RIC, UC Davis over past two cycles. UW also matched one to St. Louis and one to RIC during recent two cycles. I don't know much about Colorado but I believe last UCLA match was over 3 years ago to UC Davis-not sure I would necessarily call this a recent match. Alternatively, UCI has matched one to Cleveland Clinic and one to Mayo Clinic over 2 yrs from what I heard since we are talking about California.
PMR sports is very competitive esp for those top tier programs.
It's important to know the process but sometimes it is good to see the end product (recent match success) as a parameter to gauge your own chance... Good luck!
 
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Agree with you by and large. Couple exceptions are I thought harvard was quite welcoming on interview day. Also, I think UPMC is a very underrated program and will be part of the super 6 very soon

I think UPMC is approaching super 6 on account of the faltering of Baylor (namely) and Kessler. Of course Kessler name still caries a lot of weight, but it was noticeably weaker compared to the other "super 6" I interviewed at (Mayo, Spaulding, UW and RIC)
 
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I think UPMC is approaching super 6 on account of the faltering of Baylor (namely) and Kessler. Of course Kessler name still caries a lot of weight, but it was noticeably weaker compared to the other "super 6" I interviewed at (Mayo, Spaulding, UW and RIC)

Can anyone comment on the procedural opportunities at Baylor or Kessler? Still trying to put together my ROL...
 
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