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Stanford PM&R prgram

Discussion in 'PM&R' started by mrmed, Apr 25, 2004.

  1. mrmed

    mrmed Member
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    Has anyone heard anything about stanfords program? Is is "up and coming"? Is it considered malignant? Does it have good clinical teaching?
     
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  3. axm397

    axm397 SDN Moderator
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    I interviewed at Stanford and liked it enough to rank it rather high. I have heard rumors; however, that it is malignant. The call schedules did seem a bit tougher - and the fact that you go to all the acute SCI admissions - was something I did not see at any other pM&R programs. I really liked the faculty members I interviewed with. I thought Dr. Date was very straightforward and nice. I loved Dr. Teraoka - he was excellent - funny, energetic, and approachable. Dr. Lew was also a good teacher. I did not meet any PGY2s on the interview day - so I cannot comment on their schedule. They have a hard working mentality as a whole - probably less laid-back than the other California programs. They just recruited a Harvard-grad pain management doc for their fellowship director, which may strengthen their fellowship program.

    It's easy to label programs as "up and coming" and I have hard that label applied to many programs. I think the truth will be revealed as time goes by. You also have to take into consideration that as the applicant pool gets more competitive, the residency programs are going to also change in quality.

    Let me know if there are specifics you want to know about the program.
     
  4. GQPMR

    GQPMR Fellow
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    I can tell you the real story behind the program at Stanford. I rotated there during my 4th year. You may think this is a disgruntled view of the program, but it is the truth and in no way reflects my issues with this program. The interview applicants attended is very decieving, since they only show their best sides.

    While I rotated there almost every PGY-3 and PGY-4 asked me why I wanted to go there and that I should be cautioned of the problems that they face day to day. The PGY-2s had just started and were just happy to be in the PM&R program after their grueling intern year, but many of them have since been subjected to these same issues as well. First of all, the program will prepare you for a life in general PM&R. If you are looking for a focus, such as musculoskeletal, spine, sports med, pain management, EMG, you will be sorely dissapointed as almost anything you want to be comfortable with you will need to complete a fellowship for.

    The spine rotation is OK, but because they take a fellow each year for interventional spine, you will take a back seat to them for injections/procedures. Basically all you will do most of the time is wheel your patient in from pre-op waiting area and take a H&P on them on injection days.
    The sports med rotation with Dr. Fredrickson, the Stanford athletes' doc, is supposedly a good rotation, although you have to show extreme interest in sports med to get along with him. If you think you are interested in this you must be in touch with him from the beginning of your PGY-2 volunteering for various sports clinics while doing other rotations, otherwise your relationship with him is nothing more than employee/employer situation. The unfortunate things is that either of these rotations will only be available to you during your senior year and the kicker is that you can't do both... You have to choose either a sports rotation or a spine rotation, unless you become chief resident and when handing out schedules to everyone, you just happen to find time to give yourself both.

    They offer fellowships for both sports med and interventional spine. None of the residents there at the time were interested in doing the spine fellowship at Stanford, although many of them were being told to apply. They were all looking elsewhere... All of the seniors were tired of the faculty there, even though the new interventional spine director from Harvard (who just graduated from his fellowship) just started, they just did not want to be subjected to another year with the rest of the faculty. The sports med fellowship although open to the PM&R residents and run by Dr. Fredrickson, who is PM&R faculty, has never to this date accepted a PM&R graduate into the program. They mainly take FP grads to fill this position and this year the PM&R chief resident who had geared her whole resident life experience towards sports med, did research and was told multiple times she had a good chance at the sports fellowship was finally told that they were not going to offer the fellowship this year. So she took a sports med fellowship elsewhere.

    Another moot point from the residents were there EMG experience. Many of the residents have complained that they haven't gotten the requisite 200 EMGs by the end of their residency. There were some seniors who had 60 EMGs recorded starting their senior year with hopes to getting more. Not sure if this has changed as many of them were worried about not being proficient at it.

    As far as SCI/TBI at Santa Clara Valley Medical Center, you will see acute SCI as they come in and you will be screwing the halos in with yoiur attending. This can be exciting as well as intimidating since mostly neurosurgeons do this elsewhere. They also have a separate unit called the Rehab Trauma Center (RTC), where the patients are usually on vents due to there C1-3 frx. Also very interesting as things can get crazy quickly, basically a medical stable rehab ICU if you will. The attendings here can be a mixed bag, some are willing to teach, while I would say a majority do not teach unless asked. There are a couple of good attendings there, but recently one of the better attendings left to pursue a another opportunity. They also were down an attending in SCI and have since just hired someone who finished her fellowship at RIC (I think). But I believe they are still looking for another attending for the one that just left. You do not get much autonomy here and the attendings here do not like to function without a resident, so unless you are done with patients, dictation, admitting, etc... you do not get to go off to lecture or grand rounds lecture. Unfortunately, lectures and teaching are not protected time. The only day that I witnessed, which offered any sort of protected time was a lecture that was given on Wed mornings at 7-9 AM. Otherwise the grand rounds/journal club/dinner lectures were only free to go to unless all of your work was done and the attending did not have to finish it. You also could be paged during lectures if something were needed on any of your patients.

    As far as attendings go, my favorites were by far Dr. Teraoka and Dr. Singleton. Dr. Teraoka's attitude was wonderful and he allowed almost total autonomy of the patients with you as a resident. Dr. Singleton, a rheumatologist and PM&R doc, was the most down to earth and provided the most clinical teaching from all of the faculty I was around. I would have to say that most of the other attendings I was suspect about... There is very little camaraderie between faculty and residents and no one is willing to get your back if you come under hot water for any reason. Alot of the faculty at the VA were very hard to work with based on residents' comments.

    Basically you do mostly inpatient rotations your first year and a half and then start doing more outpatient rotations and hopefully if you're lucky or chief resident your senior year is mostly outpatient rotations. The other thing is that there is not elective time, so you only get what they have to offer as far as rotations. And since there is no current chairperson, the PD is acting as both, so its hard for her to address both resident's issues and run the program at the same time, as well as teach and run her own clinics. I was told multiple times by residents to have as little contact with her as possible (take that for what it is worth).

    Caution, there is a huge bias against DOs in this program. I witnessed multiple times when a couple of DO students rotated there, that attendings would talk all sorts of things behind their backs. They take the sacrificial one DO per class to state they hold no bias towards DOs. In fact, the DOs that were there were made to wear MD after their names on their white coats. I asked one of them why and they stated because the higher ups at Stanford don't want any affiliations with the DO name in any program there.

    You can make your own judgements on what the program is like, but if you want to stay in CA, there isn't much choice for alternatives as the other programs have similar issues. My personal feelings are that if you want a good education with a good working environment, you should look elsewhere outside of CA for that in PM&R. Good luck and let me know if there are any more questions...
     
  5. arch

    arch Member
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    Hey guys, thanks for these information rich responses. It is very helpful since I'm contemplating a 4th yr elective in a few months at this program and subsequently applying.

    as far as board scores, research, AOA, etc. Do you know what Standford is/was looking for in their candidates?
    :confused:
     
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  6. GQPMR

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    There is nothing concrete that they are interested in from what I remember from my interview and time there... They tend to keep that pretty secretive based on what residents state. The residents took us (medical students) to the side one day and stated don't get caught up with what you hear from faculty or how you think they may be thinking about you, because more than often the medical students read too much into comments made, letters of recs they recieve, etc... Obviously with the increase in apps in PM&R these last two years, good grades, good board scores, AOA, and research may become criteria for them to consider you even if you rotate there. Good luck...
     
  7. mrmed

    mrmed Member
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    If you had to rank them again would you rank them high? Do the residents get along, in terms of comraderie? Does their program typically fill? Have any of the residents left?
     
  8. GQPMR

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    If I am not tied to geographic areas, this program would definitely not be in my top choices as far as rank goes. This also goes for all of the other CA PM&R programs as well. You must on the other hand decide that for yourself, some people are tied to geographic areas and my advice would be to research all the programs before making commitments. Although, I have noticed alot of recent grads from other programs practicing in CA than those produced by these PM&R programs... So a choice to train elsewhere does not hinder your opportunities in CA. In fact, since most PM&R docs know the better programs are elsewhere, when you mention Stanford, Davis, UCLA, UC Irvine, Loma Linda... most people cringe and say, "so what." The only people who may be impressed by those names are the layperson (sp?) who don't know anything and possibly docs outside of PM&R.

    As far as camraderie goes, the only class that had any sort of closeness was the PGY-2 class. Both the PGY-3 and 4 classes had many issues, so camraderie was not that great.

    This program fills every year, although both the PGY-3 and 4 classes are a mix of original residents and transfers into the program because residents dropped out or transferred elsewhere. From what I remember the PGY-3 class had one resident drop out just this past December and two the year before. All three have been replaced, one from another program and the other two by transfers from different specialties. The PGY-4 class had two drop out and were replaced by two transfers from other specialties. So there is a fair amount of movement into and out of the program. The reasons all vary as to why these residents left...
     
  9. axm397

    axm397 SDN Moderator
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    Heard the same thing about DO-unfriendliness at Stanford. I met some excellent DO candidates at Mayo who got interviews at Spaulding, RIC, etc but NOT Stanford or Columbia/Cornell. The word among the DO students seems to be that they are not DO-friendly.

    Also, confirm rumor about SCI attending from RIC - She is definitely going to be an asset to Stanford.

    I think the recent hiring of new faculty members shows the PD/aPD's committment to improving, BUT young faculty members mean less experience...
     
  10. J-rod

    J-rod Junior Member
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    I am a DO and received interviews at both Stanford and Columbia/Cornell. I just don't want any DO student to feel intimidated about applying to any program because they came from an osteopathic school. It is unfortunate that so many DO students base their decision about which programs to apply to on "DO friendliness" or whether there are DO faculty or residents at that institution. As I believe, and I'm sure most of you also believe, there are good/bad DOs,MDs,FMGs. Although PM&R is getting more competitive, there are still opportunities for each of these groups in the best residency programs. Talented DOs have entered all of the top programs.

    MDs and DOs receive pretty much the same training and I think most programs understand this.

    J-rod
     
  11. drvlad2004

    drvlad2004 Senior Member
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    I have no idea about the DO unfriendliness of Stanford but, while doing a dreadful PM&R elective at NYU, I do remember another DO student from CA who did an elective at Stanford. She didn't have high regards about the program. Their PM&R department does not get much respect within the hospital system.

    As far as Cornell-Columbia, they may be somewhat DO-unfriendly. Regardless, two classmates from NYCOM matched into the program this year. It is considered maybe the best program in NYC, but it has some major drawbacks (i.e. NO elective time, rough call schedule, rotations far out in White Plains and Morristown, NJ in which you need a car, and an inflexible PD). As a DO, you can certainly get into Cornell-Columbia with good credentials. However, I think that there are many "name" programs that aren't cracked up to what they're supposed to be.
     
  12. axm397

    axm397 SDN Moderator
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    Agree with the "name" comment by drvlad. I found many "name" institutions definitely rode that coat tail a bit too much. There were also older PM&R "name" institutions that have let themselves go in terms of quality - and also riding on the coat tails of their history.

    It's definitely tempting to look at a good "name" and let your ego influence your decision. I was certainly moved... Especially when attendings and PDs contribute to that "air of superiority".

    And I really didn't mean to discourage DOs from applying to certain programs. Just passing along what I heard on the interview trail... Obviously, if you are a qualified applicant, you will get interviews from most of the better programs regardless of your degree type, gender, race, etc.
    We had a discussion on this multiple times in this forum.

    Anyways, I give kudos to GQPMR for sharing his/her experience. It's definitely valuable to us since we really can't rotate at every institution... :thumbup:
     
  13. tari

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    I'm a current resident at Stanford PM&R. Here are some facts:

    - 100% Board passage rate. Whether this is because we're Stanford and it's just the selection process or it's because our 18-month curriculum (you hear everything twice) is entirely taught by attendings and done during protected time is speculative. The numbers speak for themselves. Ask this on the interview trail.

    - 100% acceptance to fellowship of choice, if one so chooses. Again, is that because of the Stanford name/reputation (remember that these are PM&R fellowships, so it's not just the average layperson or uninformed programs that can be easily impressed with a name) or because the residents have proven to be well-trained over the years is up for speculation. Ask this on the interview trail.

    - Call is one day a week, one weekend a month. All home call. Attendings get concerned and tell you to "go home" if you stay at the hospital too long (past 2PM) on the weekends.

    - One of our outgoing and one of our incoming chiefs are DO's. There is no bias based on type of schooling. We do get great applicants and the process is more competitive. Our lab coats are issued with either "Stanford University" or "SCVMC" on them. If you want stitching, you can get your own. I wore an old coat that had my name and "Orthopaedic Surgery" and no one batted an eye.

    - I have never been turned down to do a procedure when I demonstrate that I understand the anatomy, the potential risks and their treatment. Staff here and everywhere like it when a resident shows initiative.

    - Contrary to what some have said without having been here for an extended amount of time, the PM&R section at Stanford is very well respected by the other specialties here. The trauma teams call us to evaluate spinal cord injuries because our exams and recommendations are more reliable and comprehensive than either Neurosurgery or Orthopaedics. In my personal experience, the attendings on the other services would rather get report from me than their own residents because of our quality control.

    - EVERY program has one or two quirky staff that make you wonder whether they have Axis II diagnoses. I've been through a surgical internship, orthopaedics residency, and another PM&R program that closed down due to lack of funding. I know from experience that this is a universal phenomenon. We're adults and we cope with others' eccentricities. Overall, I have found our staff to be accessible, very knowledgeable, and supportive of our goals. (Yes, we're getting Susie Kim. We're very excited!)

    - We get protected vacation time and are encouraged to schedule a few days off each quarter. They are extremely supportive of maternity/paternity leave with the caveat that any time over 6 weeks will have to be made up at the end, e.g. if you take 8 weeks, you will make up two weeks at the end.

    - Moonlighting is allowed. The staff tell you where there are opportunities and don't mind as long as it doesn't interfere with your clinical duties.

    - Intensity: At the "Valley", our hours are a little longer, because of the types of patients we get. The staff stay just as late and will sometimes show up before us to see patients. It's a team effort. There is the RTC where we take acute non-operative spinal cord injury admissions. It's rare and we usually know well in advance.

    - Morale: No matter where you go, it will be a bit of a crap shoot whether you like your fellow residents or not. Our class is very close, which is different from the graduating seniors. We intend to pass along the tradition.

    - The residents who have left have done so because of personal reasons (significant others out of state, want to change specialties, etc.) There will always be a couple disgruntled residents at every program in every specialty. It usually isn't anything inherently malignant (except at UW), but some people just essentially unhappy and nothing will make them happy.

    I wish you all good luck finding a position that matches your goals, lifestyle, and personality. If you don't like Stanford, we'll still fill our spots with qualified candidates. When it comes down to it, our stats are better evidence than anecdotal experience that can be colored by personal bias for whatever reason.
     
  14. Touch

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    XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
     
    #13 Touch, Feb 29, 2016
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  15. studerman

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    It seems a lot of people I met on the trail ranked them #1 as well.

    I don't know about "the top," but they are def going in the right direction. Their residents were definitely very happy and motivated, as you mentioned, and the PD was awesome.

    Interesting to calculate out with all the "perks" ($3k moving, $6k housing, $1k cell phone, etc) and salary that your net is more than other places, like Uwash and Mayo. (Disclaimer I used $1,200 for Mayo housing and $2,500 for Stanford).

    Glad you liked them; hope you match there.
     
  16. gamrag

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    Nice weather always makes for happy people. Now if you go to a place with nasty weather and people are still happy, then you know you've discovered a gem. Just saying...
     
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  17. RangerBob

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    I've found Minnesotans tend to be the nicest people I've ever met. To be honest I think it's partly because of the weather--when you live in a place like North Dakota, Minnesota, Wisconsin, etc., then you never know when you're going to need a neighbor's help to shovel out your car or driveway, check on a relative, etc. And certainly in the past there might be times your home collapsed in a winter storm, etc. I think that's a big reason why communities in the Midwest are more close-knit and friendly. Maybe that and we don't have fences? (That was a really weird concept moving from the SF area!)

    It's nice to hear Stanford is on the up--I felt that way when I interviewed there as well. I'm also not sure if they'll ever be the top program but it wouldn't surprise me to hear their name mentioned with other top programs someday. Regardless, "top" program is really in the eye of the beholder. We're not considered a top program yet almost everyone that matched here ranked it higher than RIC or other "top" programs. Ultimately you just have to go to the top program for you, and I thought Stanford had a ton to offer when I rotated and then interviewed there.

    It's also quite nice to hear that Stanford finally has some housing allowance! When I applied I think the path residents got almost 10k in housing stipends, but the PM&R residents didn't get anything. I think the medical school and Department of Orthopedics is now finally making an effort to boost the PM&R program. And I think having Dr. Kennedy as the PD probably has a lot do do with the program advancing more.

    Best of luck with the match.
     
  18. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    13 years later. Is it still "up and coming" or has it risen?
     
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  19. Disciple

    Disciple Senior Member
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    Drs. Smuck and Kennedy had been running the PMR spine fellowship there. Interesting to hear that they're now running the residency program. I would be happy about that were I a resident there and had spine/sports or MSK aspirations.

    Both are early/mid-career I think, and involved quite a bit in SIS, NASS and AAPMR.

    Back in the day, PASSOR and the I-Spine movement started out of there. Stanford is also involved with the development of the regenerative medicine literature (primarily Ortho Dept.---but since PMR there is a division of ortho...)

    Contrast that to UCSF where there is pretty much no PMR presence.

    Alot of innovation comes out of the bay area/CA. I could see Stanford becoming a shining hub for PMR in the western states.

    drusso, you should invite them to the SIS beer summit in July.

    Or not, depending on what you think will happen there.:laugh:
     
    #18 Disciple, Mar 6, 2016
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  20. awesomepossumMD

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    Hi!

    I am a graduating Stanford PM&R resident going into Dartmouth Pain Medicine Fellowship. In general I love our program and definitely feel like we are a top program and only improving (biased opinion haha). I honestly believe we have an amazing balance between teaching, quality of life, and some of the best attendings in our field. Bay Area living is awesome - just on the expensive side but we are also some of the highest paid residents. Our PD is Dr. Kennedy who is not only an amazing teacher and renowned in the spine world, but also leading our program to be stronger every year. Just in these 3 years I have been in the program, I have noticed significant improvement and our feedback is taken seriously. I can honestly say all of my PGY4 co-residents are super happy we picked this program - we all got into our top choices for fellowship or job.

    Additionally, as a residency, we definitely excel on a national level. Our residents have held the Vice President and President positions on the AAPM&R Resident Physician Council for the past 4 years straight. We also have residents on committees with the AAP and SIS, and we consistently have residents conducting some of the best research presented at the national meetings.

    Also as a side point, we get to be part of Stanford and the Silicon Valley, which has advantages. If you like Sports Medicine, you get the opportunity to work with top Division 1 athletes. Or if you like teach, becoming a TA for one of the Stanford classes our program runs. If you have an interest in technology, join your fellow residents in a Stanford BioDesign class - last year they got clinical time off for it and presented their projects to a panel of biotech VCs. One resident started his own company and got ventured back, while another does part time work for a top-consulting group. Others moonlight for attending experience (and money). While others take part of solid research that our department and Stanford offers.

    What prompted me to get on and check SDN is that during our yearly review, it was mentioned that there were some old posts about our program that is not reflective of the way things are now. Our program is rigorous, and expectations of residents are high, but DEFINITELY not malignant. I don't think any resident ever has gone over duty hours, and rarely have I ever heard anyone feeling overwhelmed. There is tremendous support from our attendings and from the program in general. In the time I was here, we did have one person leave the residency but that individual went to a completely different field (to my knowledge, it didn't have anything to do with not liking our program)

    Lastly, I wanted to try to answer some specific questions about financials (since I get asked this quite a bit by med students)

    Bay Area living can be expensive. Here are some of the hidden gems that people have discussed already about Stanford Residency. Don't quote me on these numbers as they might change

    - $3k moving bonus which is one time
    - $500/ month housing stipend (every month every year)
    - 2.5K education stipend (annual)
    - $400 healthy steps / year (FSA healthcare spending)
    - Amazing insurance (no co-pays)
    - Salary is already very competitive (probably among top, if not the top)

    For Stanford PM&R specifically, I think the best financial piece is moonlight - several of our resident moonlight and do very well. My co-resident made an extra 60K a year, each year (mainly because we work typically at most 1 weekend call a month, and it even decreases to less weekend calls each assending PGY year). There are ample moonlight opportunities but they do require a drive sometimes.

    Rent can be VERY affordable if you choose to co-live / roommate situation (thought it is hard to do if you have a family). For example rent with utilities in a large private room in Palo Alto can be <$1,300. Hope that helps! Happy to answer any questions!
     
    #19 awesomepossumMD, May 31, 2017
    Last edited: Jun 5, 2017
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  21. Dr. Bruce Banner

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    where can you find such apartment for <1,300??? I hope it's not around sketchy areas. lol

     
  22. Carolinapm&r

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    I'm writing this with the caveat that my residency was a few years ago. That said, with the exception of a few wonderful Physicians I had the pleasure of learning from, I can confidently say that the rumors are true. Stay away from this program, it was as malignant as they said. The main issue was that residents we're treated as cogs in a machine, you were put where you were needed, never mind what you wanted to learn, or what your wishes were when you're interviewed when you told them what specialty of pm&r you wished to pursue.

    I knew residents who never touched an EMG machine until their pgy4 year. Some of them never stepped foot on Stanford University campus except for meetings and lectures, because it was convenient for the program to keep them at the Palo Alto VA or at Santa Clara Valley Medical Center for their entire 3 years. If you were extremely lucky, knew the right people and had the chance to speak with him, you might be able to work with dr. Fredrickson at a sports medicine rotation, but the odds were slim. The bottom line is you were not treated as an adult, and a future colleague, but rather as a tool to be placed where they need the labor.

    I cannot speak for the current Residency program director, but the director before him, Dr Jeffrey Teraoka, who was just an attending when I was there, was one of my favorites. He was kind, understanding, and wonderful to learn from. Before him,the medical director, dr. Elaine Date, was, in short, not a very likeable person. We were told to watch out for her when she was in a bad mood, and she regularly brow beat residents in front of patients. I knew a resident who did the program a favor and switched rotations at the last minute because of a personality conflict between one attending and another resident. This switch, however, involved that accommodating resident driving all the way up to St Mary's Hospital in Northern San Francisco instead of a less stressful, less expensive commute to the Palo Alto VA, when that resident was trying to save up money and have a little extra spare time to study for USMLE part 2. The resident asked as a favor, since they were nice enough to do this for the program, could they have a rotation that was closer to home and that was not known to take up a great deal of time next time around, so that they might be able to prepare for the exam, and was told no problem.

    When the next rotation came out, they again put that resident at a far away location on the spinal cord injury unit, which, while excellent, is very stressful and leaves you exhausted at the end of the day. This resident spoke to the program director, who said, after stating she would see what she could do, sent a group email out to several who worked with that Resident, including the head of spinal cord injury, saying that this Resident was being extremely defensive and unappreciative of the efforts they had made, essentially stabbing them in the back. To no one's surprise, that resident transferred soon after, with several fellow residents telling that person they wished they could do the same.

    Dr. Klima at the VA was a joy, Dr. Henry Lew was also a nice guy. Dr. Englander would definitely keep you on your toes and make you work hard, and could be a little OCD, but you left his rotation a much better position than when you entered it. Dr Berlly on the SCI rotation was a hack who only cared about stuffing as many beds as possible, and had no problem giving you 7 or 8 trainwreck admissions late at night while he slept in his bed ( at least one of the other attendings I worked with thought he was a jerk). Many of the other attendings on the s c i unit work, however, great to learn from.

    During my time there, the majority of the residents did not like the program, they were simply there because most wanted to work on the west coast, and the Stanford named had a lot of weight to it. I sincerely hope they have cleaned up their act and start treating residence like adults whose wishes should be honored when they interview, instead of indentured servants to be chastised and told " you'll go where we tell You, now shut up and deal with it." Best advice I can give you is go to forms like this, speak to current and former residents and get as much information as possible. I had no inclination that this was anything but a wonderful place to be for three years in my interview. Boy, was I proven wrong.

    *I am putting a necessary addendum to my initial posting, my apologies for not stating this earlier: This was all a few years ago; the person who responded to my post has stated that at least most of these issues have been resolved, and I'm glad if so. If there's one lesson I can impart, it's this: DO NOT base your residency selection based solely on what a program tells you - always talk to former residents and look at forum boards like this to see what life is like when they're done trying to impress you to join.
     
    #21 Carolinapm&r, Sep 23, 2018
    Last edited: Sep 25, 2018
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  23. drg123

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    Dr. Kennedy, the most recent PD, is at Vanderbilt now. What is the current status of the Stanford PM&R program. Sounds like the past was pretty miserable, but things have gotten better. Any current residents here to chime in?
     
  24. RangerBob

    Physician 5+ Year Member

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    I rotated at Stanford as a med student back when Teraoka was PD--he was a really nice guy. I thought highly of my experience, but I also had minimal MSK/sports interest and did not work at all with any of the attendings mentioned above that the poster had negative experiences with. I do think some residents complained about lack of EMG experience, as well as interventional procedures (there's a fellow, so it seemed like they did most of the cases-- this is a problem at many programs that have a fellow).

    I was primarily interested in inpatient and focused there more when I rotated at Stanford (and spent all my time at the VA and SCV--both were great experiences). The units get lots of great cases. I don't recall any resident feeling they got too many admissions. I don't know how the above poster got 7-8 admissions. That is a lot unless you're not managing any patients on the unit. I never got that many admissions as a resident or fellow (max was probably 4).

    In hindsight, I feel my inpatient attendings in my residency and fellowship where more invested in the residents, but I still really liked the Stanford attendings. It seemed like the residents were fairly happy, but they definitely worked hard. They weren't as happy as residents at UCLA, but there aren't too many programs with residents that happy.

    When Dr. Kennedy took over I figured the program would improve further, as he was a really, really dedicated attending and as a student it was great working with him. It's too bad to hear he left. I never met the current PD.
     
  25. PM&Rspine

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    Current resident here. Whoever "Carolinapm&r" is, they are a troll.

    "my residency was a few years ago" ... Dr. Date left for private practice about 15-20 years ago. A whole lot has changed since you left...

    "theythe again put that resident at a far away location on the spinal cord injury unit, which, while excellent, is very stressful and leaves you exhausted at the end of the day." ---> What does this even mean??? Why are the tenses changing?

    The statements in the argument just don't make sense, and are not worth arguing. They imply that some residents get to rotate at certain sites, whereas others do not, which is absolute insanity. There aren't any programs in the country like that to my knowledge.

    Stanford has more early EMG exposure than most programs, and every resident has plenty of experience at the end of their PGY 2 year, and way over 300 by the end of their PGY 4 year.

    The program is extremely balanced with an inpatient slant early in residency, and an outpatient slant late in residency. SCVMC, which is the main inpatient site, has state of the art, subspecialized inpatient units, and is the major referral center for all vent dependent high cervical SCIs in the area. The Brain Injury unit is equally impressive, and SCVMC is one of the few hospitals where PM&R is probably the most successful and respected department.

    The rotations at Stanford proper are guaranteed, and everyone works with Dr. Fredericson (this is how it is spelled). The MSK experience at Stanford is unparalleled. Most residents leave the program with 100+ ultrasound guided peripheral injections (residents doing the injections, not just watching, and they perform every injection in the Malanga ultrasound text), 150+ fluoroscopic Spine injections (with ample opportunity for the residents to do them if they are interested), and early exposure to PRP, BMAC, fat graft injections, and other emerging technologies.

    Unfortunately, I think the disgruntled poster was not able to rotate at Stanford ever, for unclear reasons...

    I just cannot fathom why someone would post something so long after finishing residency, but I can definitively say that nothing in their post is accurate anymore, and I really question if it ever was...



    PS: "Dr. Klima at the VA was a Joi," ... what?
     
  26. btp

    btp

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    Hey guys,

    Current Stanford PM&R resident here. I glance at the SDN forums every now and then and saw this thread, and I figured I'd provide some up-to-date info.

    My co-residents and I love the Stanford program. The camaraderie is fantastic. We have happy hours and house parties, play pick-up sports, and have lots of free time during the week to pursue activities we enjoy (on most rotations, we're rarely at work past 5pm). Our attendings are friendly, supportive, and very willing to teach. Our program has been so responsive to our feedback that it was surprising for me to read about carolinapm&r's experience. I've heard that there were more malignant attendings in the past who have all left, and in no way would I ever think of the Stanford program as malignant now. I think it's one of the most well-rounded and supportive programs to train in. I think it's safe to say that many of my co-residents and I couldn't imagine being happier anywhere else.

    Every resident completes the same rotations by the time they finish residency. Here's a quick summary by year:
    • PGY2: the most inpatient-heavy year but still lots of EMGs. PGY2s spend about half their time at the VA and half their time at Santa Clara Valley Medical Center (SCVMC). There is exposure to a wide variety of inpatient TBI/stroke/SCI cases. At SCVMC, the team census is usually between 9 and 13, and we usually get probably 1 admission per day on average. I've gone multiple days without admissions, with an occasional rare instance of 3 admissions per day. For what it's worth, SCVMC was just ranked #1 in California and #15 in the nation for acute rehab facilities. At the VA, we do EMGs on Tuesday and Thursday afternoons. We also get exposure to prosthetics/orthotics and acupuncture. During one of our VA rotations, we also work at Stanford in sports and MSK clinic with Dr. Fredericson.
    • PGY3: about half inpatient and outpatient. For the outpatient experience, you do about 200 EMGs this year at Stanford and the VA. You also do interventional spine at Stanford. On my rotation, I watched about 20 injections, helped out with 30 injections, and performed about 30 injections on my own. The spine fellow hadn't arrived yet, and I would assume these numbers would've decreased otherwise. I also saw multiple collegiate and pro athletes for sports injuries. The chief of our PM&R department is Dr. Matt Smuck who does tons of research and is regarded as one of the leaders in the interventional spine world. This year, you also do pediatrics at Stanford, SCVMC, and Children's Hospital of Oakland. Inpatient mostly consists of SCI and consults at SCVMC.
    • PGY4: mostly outpatient including sports and interventional spine at Stanford. Inpatient mostly consults of VA polytrauma, consults at Stanford, and St. Marys (a private practice hospital in San Francisco).
    Other things:
    • There are opportunities to provide game coverage for Stanford varsity athletics with the sports fellows and also teach a sports medicine class to Stanford undergraduates and med students.
    • If you are interested in healthtech, there is no better place to train. Our PD is highly supportive of residents taking the 6-month Stanford Biodesign Innovation Course which teams you up with Stanford grad students in law, medicine, and engineering to work on medical device innovation, prototyping, and bringing things to market.
    • Our previous PD, Dr. Kennedy, left in the spring to become the PM&R chair at Vanderbilt. He was awesome and improved the program vastly. Our new PD, Dr. Levin, has picked up where Dr. Kennedy left off, and many of us haven't noticed a significant difference. Dr. Levin is very approachable, easy to talk to, and is also well-connected in the PM&R world.
    For more details about the program, check the Stanford PM&R website.
     
  27. j4pac

    j4pac PM&R resident
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    Try again
     
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  28. Carolinapm&r

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    Dear PM&Rspine:

    First off, I'm glad that the program has undergone a retooling - as I said, it's been a while. Rest assured I did attend this program (I used to love to go to Strait's Cafe on El Camino Real and the one near St. Mary's Hospital, for example) I have better things to do with my time than slander a program just because I was bored. It's also beneath my dignity to speak badly of a person or place just because I feel like it. I would agree that that's the true definition of a troll. Apparently you're of a later generation than I am, and some (needed) reforms have taken place, for which I am glad. There was a time not long ago when PM&R programs were very loosely organized, and it was a crap shoot as to what you learned where depending on where you went.

    At the risk of getting into a war of words (not my intention at all), the arguments posted make perfect sense. It was a malignant program, and many residents of my era who went through would attest to that. Rotations were NOT guaranteed, you were put where the program felt you were needed, that's it. If you expressed an interest in a specialty at interview, you were told "of course, no problem," but you ran the risk of being treated like a pariah if you complained that you weren't getting what they promised, and you still might wait until your PGY-4 year to get there (like I said, one guy was in his last year before he did an EMG rotation). As mentioned, I knew residents who all but lived at SCVMC doing TBI and SCI over and over again, and chances to get in with Dr. Fred were rare at best. If you doubt me, please read some of the posts from previous years. You came in at a much better time than I did.

    The intention of my post was to state that if things have not changed, then this was a program to avoid. I'm glad things are different now. And there were many wonderful attentings (Dr. Teraoka, Dr. Wallbom, Dr. Singleton - God rest his soul). The comment about Dr. Klima was a typo, which is why it didn't make sense to you. He was another of the good ones. The area and the weather are beautiful, the cost of living is ridiculous (I seriously hope they raised the residency salary - we were barely getting by with what they paid us), and the Junipero Serra freeway drive to San Fran and Muir Woods on the weekends stand out as some of my best memories. Had I gone through the residency you did, I imagine my post would have had a much different slant to it.
     

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