bulldogtor

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    I am a PGY3 resident in PM&R and I have wanted to do a spinal cord injury (SCI) fellowship for some time now because I feel like I am able to really connect and make a difference in the lives of my patients. I recently started our pediatric rehab medicine (PRM) rotation and I am absolutely loving it. Everyone seems to be happy and making a difference in the life of a child feels amazing. Since I have to decide and apply for a fellowship very soon, I would really like some advice.

    Pros of doing an SCI fellowship:
    - I feel like I can connect with my patients and make a positive impact. I loved my SCI patients.
    - If I am unable to get a job in an academic setting seeing mostly/all SCI patients, I can always get a job in a general rehab hospital.
    - More training in procedures for spasticity management.
    - Opens the doors to an inpatient SCI attending position.

    Cons of doing an SCI fellowship:
    - May not increase salary.
    - I'll have to move to a different state for one year (since my current program does not have an SCI fellowship).
    - If I am really interested in doing inpatient SCI, the positions are mostly at academic hospitals and I am not sure if there is a demand for more attendings.

    Pros of doing a PRM fellowship:
    - Opens the doors to an inpatient peds attending position.
    - I get to work with kids every day. Peds hospitals, the staff and the patients are so uplifting and positive.
    - I can still work with patients with SCI, which I love.
    - There is a fellowship opportunity in the state where my wife and I would like to settle, though I am unsure how competitive it is and there is no guarantee I will match to that fellowship (and get a job there afterwards).

    Cons of doing a PRM fellowship:
    - 2 years long. We'll have to move to another state for 2 years where I will be the main breadwinner, unless I can get the fellowship in the state we want.
    - Unclear demand/job market/security and unsure if I will be able to obtain a job where I would like to live.
    - Call schedule as a fellow and as an attending seems tougher compared to SCI, but I'm not 100% sure about this.
    - Likely no salary increase (my wife says this is important since we are sacrificing time and if we are looking to start a family very soon)

    My wife is supportive but since she will be leaving her job for at least 1 year while we move somewhere for me to do pursue a fellowship, she also wants me to consider more practical things like job availability, demand, salary, call schedule, etc. Any thoughts on these things or the pros/cons I listed above? I am trying to speak to as many folks as I can from other hospitals, too, so I can get a more clear picture. Thank you very much in advance.
     

    j4pac

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      I consider where you would like to practice.

      If you are not in an acedemic center...you may not need an SCI fellowship to achieve the same scope of practice. And of course, the more training the better...but I think that you could leave residency and be a competent adult inpatient rehab doc.

      On the other hand, I think that Peds rehab is probably better suited from someone that is fellowship trained. There just isn't as much Peds exposure in residency (except at a rare program like U Wisc). And not to mention that parents expect their child to be tended to by someone with Pediatric training.

      If you plan to work at a major academic center you will likely need to be fellowship trained in either. As a tie breaker I'd probably go with fastest route to making money...SCI.
       
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      j4pac

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        Thanks for the reply! Any thoughts on how the demand and job outlook/competitiveness compares between the two?

        I'm only a second year so I haven't gotten that far. But I go to a super-6 program and therefore have lots of co-residents in the application process to fellowship. According to our Peds fellow and the few co-residents Peds bound there appears to be a pretty healthy job market for Peds. Not as many people want Peds because you potentially make less than a generalist with needing two more years of training.

        On the other hand, the SCI jobs are typically at academic centers. Academic placement jobs tend to be more competitive. The people I know who want to get into SCI intend to work at academic centers and be apart of the research scene as well. The residents who want inpatient but don't care about going to an academic center typically just go straight into practice without fellowship. They tend to make about the same money without the need to lose about $100000 by going to fellowship.
         

        bulldogtor

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          Thanks! I am interested in going to academics, more for the hospital setting and teaching aspects than the research aspect. From what I imagine, the job market for academic peds would be bigger than the job market for academic SCI, right?
           

          j4pac

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            Thanks! I am interested in going to academics, more for the hospital setting and teaching aspects than the research aspect. From what I imagine, the job market for academic peds would be bigger than the job market for academic SCI, right?

            From what I've heard...yes. But again...I'm getting second hand information that I'm not sure is completely accurate. It would be better to ask someone like a program director who has a better understanding of historical trends.
             

            RangerBob

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              I see many more SCI job listings than those for peds. However, if you go into peds you will definitely find a peds rehab job--not too many people apply for those. Most PM&R residents just aren't interested in peds. The problem is since it's such a small field it can make it very hard to work where you want. SCI already generally ties you to larger-ish metropolitan areas, but peds jobs are generally only available in even larger ones and are mostly concentrated at academic medical centers and at Shriners hospitals. There are still lots of community rehab centers with SCI positions, as well as the entire VA system.

              When talking about academic positions, I've noticed more listings for SCI than peds--however, I'm also specifically looking out for SCI. In general peds is just a smaller field--there are fewer positions, but there are also far fewer applicants. Many peds positions are also just unfilled
              and can take years to fill due to the difficulty in finding interested/qualified applicants.

              I think your first step is to figure out which (if any) fellowship you want to do. You should only do a fellowship if you need it to do what you want to do. (ie, I'm interested in VA SCI--so I'm doing a SCI fellowship). Both fields are not all that popular so if you want to do a fellowship and apply to enough programs you should definitely get in somewhere, unlike sports and pain where I think only 45% of those who apply very broadly will match somewhere. Applications/interviews were all pretty low stress. I submitted my applications ~July. I couldn't afford to fly out for 4 separate interviews, so I was able to schedule them all at ASCIP in Sept. Rank list was due late Sept, matched early Oct. I imagine peds would be as low-stress as well, maybe even lower stress since they're always so nice!

              I would argue both fields have good job outlook. Most physiatrists just don't want to go into either field, so if you're fellowship trained and open minded on where to live, you'll have a job. However, I am not sure that I will be able to get an all-SCI job in my geographical region of choice upon finishing fellowship. There just aren't as many jobs so you're waiting for people to retire or for a new job to be created.

              Do talk to someone with more experience in peds PM&R than us. I don't think anyone on SDN is doing peds PM&R, so if you want the most accurate info possible, I would contact a peds PM&R fellowship director. If you have a peds physiatrist at your program, that would be a good start as well (but keep in mind, the peds fellowship director will know what kind of jobs there are because every year one of their fellows goes out and gets one!).
               

              scifiMD

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                As an academician, I would feel better with an SCI fellowship trained SCI doctor for my patients. I mean, I know neurorehab (do CVA myself) but SCI is a different beast. I would say take the fellowship route - I don't think it's too competitive in SCI. Peds can vary - sometimes very hard, sometimes not as competitive, just depends on the year. I would say it's easier to get an academic SCI spot than an academic peds spot - a lot of places recruit from within so if you are on their "like" list you'd have a possibility. Private peds jobs are likely easier to come by - but like a previous poster stated, peds jobs usually = less pay than the grown up sector.

                I also have a general word of warning about SCI medicine - at some institutions you may be the one burdened with spill-over from the "general" section - MS (which is appropriate), GBS/AIDP/CIDP (also appropriate), sometimes amputee. You just need to be comfortable with that possibility.

                You probably should reflect on what is the worst case scenario (for you) for both of those fields. I absolutely cannot deal with "nonaccidental head trauma" patients - it breaks my heart and I have homicidal thoughts towards the "non accident" caregiver involved. Peds oncology is also too rough for me. Sometimes you will get a string of those "non-accidents" and it is a sad sad week (I cover inpatient consults at times for our peds doc). I honestly can't think of a deal breaker for me in the SCI world but I have had some oppositional defiant people who then got paralyzed and will NOT do any protective care for themselves - no pressure relief and end up like swiss cheese, refusing ISC and then septic all the time, etc - like they have a death wish.

                hope this rambling at least adds some things to think on
                 

                bulldogtor

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                  I see many more SCI job listings than those for peds. However, if you go into peds you will definitely find a peds rehab job--not too many people apply for those. Most PM&R residents just aren't interested in peds. The problem is since it's such a small field it can make it very hard to work where you want. SCI already generally ties you to larger-ish metropolitan areas, but peds jobs are generally only available in even larger ones and are mostly concentrated at academic medical centers and at Shriners hospitals. There are still lots of community rehab centers with SCI positions, as well as the entire VA system.

                  When talking about academic positions, I've noticed more listings for SCI than peds--however, I'm also specifically looking out for SCI. In general peds is just a smaller field--there are fewer positions, but there are also far fewer applicants. Many peds positions are also just unfilled
                  and can take years to fill due to the difficulty in finding interested/qualified applicants.

                  I think your first step is to figure out which (if any) fellowship you want to do. You should only do a fellowship if you need it to do what you want to do. (ie, I'm interested in VA SCI--so I'm doing a SCI fellowship). Both fields are not all that popular so if you want to do a fellowship and apply to enough programs you should definitely get in somewhere, unlike sports and pain where I think only 45% of those who apply very broadly will match somewhere. Applications/interviews were all pretty low stress. I submitted my applications ~July. I couldn't afford to fly out for 4 separate interviews, so I was able to schedule them all at ASCIP in Sept. Rank list was due late Sept, matched early Oct. I imagine peds would be as low-stress as well, maybe even lower stress since they're always so nice!

                  I would argue both fields have good job outlook. Most physiatrists just don't want to go into either field, so if you're fellowship trained and open minded on where to live, you'll have a job. However, I am not sure that I will be able to get an all-SCI job in my geographical region of choice upon finishing fellowship. There just aren't as many jobs so you're waiting for people to retire or for a new job to be created.

                  Do talk to someone with more experience in peds PM&R than us. I don't think anyone on SDN is doing peds PM&R, so if you want the most accurate info possible, I would contact a peds PM&R fellowship director. If you have a peds physiatrist at your program, that would be a good start as well (but keep in mind, the peds fellowship director will know what kind of jobs there are because every year one of their fellows goes out and gets one!).

                  Thank you so much for the thoughtful response and the reassurance!

                  "Most physiatrists just don't want to go into either field, so if you're fellowship trained and open minded on where to live, you'll have a job. However, I am not sure that I will be able to get an all-SCI job in my geographical region of choice upon finishing fellowship. "
                  - That is what I have to accept. In the end, if I have a job doing what I love, then I can compromise on the geographical area.

                  I will definitely talk to more folks. It's reassuring to here that you've seen more academic positions for SCI than peds, because whenenever I see job postings, they are usually just for pain or for general rehab, with a few peds positions sprinkles here or there. I haven't seen an SCI position in a while.
                   

                  bulldogtor

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                    As an academician, I would feel better with an SCI fellowship trained SCI doctor for my patients. I mean, I know neurorehab (do CVA myself) but SCI is a different beast. I would say take the fellowship route - I don't think it's too competitive in SCI. Peds can vary - sometimes very hard, sometimes not as competitive, just depends on the year. I would say it's easier to get an academic SCI spot than an academic peds spot - a lot of places recruit from within so if you are on their "like" list you'd have a possibility. Private peds jobs are likely easier to come by - but like a previous poster stated, peds jobs usually = less pay than the grown up sector.

                    I also have a general word of warning about SCI medicine - at some institutions you may be the one burdened with spill-over from the "general" section - MS (which is appropriate), GBS/AIDP/CIDP (also appropriate), sometimes amputee. You just need to be comfortable with that possibility.

                    You probably should reflect on what is the worst case scenario (for you) for both of those fields. I absolutely cannot deal with "nonaccidental head trauma" patients - it breaks my heart and I have homicidal thoughts towards the "non accident" caregiver involved. Peds oncology is also too rough for me. Sometimes you will get a string of those "non-accidents" and it is a sad sad week (I cover inpatient consults at times for our peds doc). I honestly can't think of a deal breaker for me in the SCI world but I have had some oppositional defiant people who then got paralyzed and will NOT do any protective care for themselves - no pressure relief and end up like swiss cheese, refusing ISC and then septic all the time, etc - like they have a death wish.

                    hope this rambling at least adds some things to think on

                    Thank you very much! When you say it's easier to get an academic SCI spot than an academic peds spot, are you referring to a fellowship spot or an attending spot? From what I have seen and heard, it appears that SCI attendings don't usually leave their positions once they get them, so the jobs may be harder to acquire.

                    What you said in regards to worse case scenario is something that has been bugging me, too. I originally wanted to do general peds when I first applied for medical school but decided I would be too frustrated and affected with non-accidental trauma. I would of course be dealing with that a lot more with peds PM&R. We have been hit with a few peds oncology patients with spinal metastases this past week and it's really saddening. Explaining the meaning of an ASIA exam and answering questions regarding the chances for recovery is extra tough when talking to the parents of young children with aggressive cancers.

                    I figure if I do SCI, at some institutions I will end up seeing patients with GBS/AIDP/CIDP/MS/TM, as well as spillover from amputee/general trauma/cancer, but that will just keep me well-versed in different areas. As long as I am able to see mostly SCI as inpatient and in clinic, then the fellowship will be worth it.
                     

                    HufflepuffTX

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                      If anyone could also connect me with people with whom I can speak to about these things, that would be awesome. Thanks!

                      Hi Bulldogtor, I'm a pgy-4 who recently matched into PRM. This was a more competitive year than usual, but everyone ultimately ended up matching. Jobs in PRM are plentiful, but are limited geographically (usually larger cities, academic institutions, associated with residencies). I have seen some PRM folks start their own practice, or join with a larger group of pediatricians, Peds Neuro, or Peds ortho. I haven't heard much about PRM salaries, other than the rumor that Peds will always make less money, but I guess I'll have to wait and see.

                      My residency program has both SCI & PRM fellowships. The last 2 cord fellows both moved on to take SCI Medical Director jobs, making very respectable money ($250-300K), but are in locations that they didn't prefer. They chose to work there for the money, with hopes of moving closer to home in a few years after paying off loans.

                      As an aside, academic jobs typically pay less money, regardless of subspecialty. The benefits can sometimes balance the discrepancy, but sometimes not.

                      If you'd like to talk more about Peds, or fellowship apps, you can email me or PM me :)
                       

                      RangerBob

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                        I will definitely talk to more folks. It's reassuring to here that you've seen more academic positions for SCI than peds, because whenever I see job postings, they are usually just for pain or for general rehab, with a few peds positions sprinkles here or there. I haven't seen an SCI position in a while.

                        I don't want you to get the wrong impression-- I've seen more SCI academic positions than peds ones, but I haven't really seen tons of jobs for either. Most jobs out there are general/pain/MSK. However, I have seen enough SCI jobs (at universities and the VA, as well as some community-based hospitals) that I feel confident I'd find an SCI position if I opt to do only SCI. But like I said, that may mean not being as close to my family as would be ideal.
                         
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