Switching into PM&R - off cycle

[physicianunknown]

Hello everyone, I have a question about switching into PM&R. My situation is as follows. Currently in the middle of PGY3 year in a specialty that is high acuity and with direct patient exposure in critical care settings. However, now I am coming towards a fork in the road and unsure of what the best course is. I have been told that my contract will not be renewed, but that I will have support transitioning into another field which may be more suitable. There are no professionalism issues. I have credit for 1 year of internal medicine internship. PM&R is a field that I have had some / not minimal exposure to, but in which I currently have no connections. My PD has said they will help find a rotation in PM&R at a nearby institution that I can do in the spring.

The question I have for you guys is, I am off cycle with respect to the match and there is no time left this year. In any case, it seems most successful applicants go on > 10 interviews. My step scores are above average for Step 1 and Step 2. My only shot for next year seems to be via the rotation that has yet to be scheduled. Also, since almost all PM&R spots match, there won't be a chance to SOAP into a PGY2 position. I also know that I must be working clinically the following year in order to remain competitive. So I will need to look for other options in the interim. How should I go about doing this? The best case scenario is there is a spot for me. More likely I may make a good impression and get a couple of letters, and prepare for the match the following year. Thanks in advance.

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[Burnted_out]

Hello everyone, I have a question about switching into PM&R. My situation is as follows. Currently in the middle of PGY3 year in a specialty that is high acuity and with direct patient exposure in critical care settings. However, now I am coming towards a fork in the road and unsure of what the best course is. I have been told that my contract will not be renewed, but that I will have support transitioning into another field which may be more suitable. There are no professionalism issues. I have credit for 1 year of internal medicine internship. PM&R is a field that I have had some / not minimal exposure to, but in which I currently have no connections. My PD has said they will help find a rotation in PM&R at a nearby institution that I can do in the spring.

The question I have for you guys is, I am off cycle with respect to the match and there is no time left this year. In any case, it seems most successful applicants go on > 10 interviews. My step scores are above average for Step 1 and Step 2. My only shot for next year seems to be via the rotation that has yet to be scheduled. Also, since almost all PM&R spots match, there won't be a chance to SOAP into a PGY2 position. I also know that I must be working clinically the following year in order to remain competitive. So I will need to look for other options in the interim. How should I go about doing this? The best case scenario is there is a spot for me. More likely I may make a good impression and get a couple of letters, and prepare for the match the following year. Thanks in advance.

That's rough man, middle of PGY-3? What field are you in? Any way to rescue your current position? As you mention, for the past 2 years I think PM&R has filled all its positions, and has become more competitive in recent years - probably because many people now go into pain/sports fellowships. Anyhow, spots do open here and there, but obviously your best option is to go through the match. PGY2 spots are not that common. Why no look into preventine/occupational med? Low acuity reasonable schedule. PM&R is more forgiving than other specialties, but again given the increased competitiveness as of late, it might be a challenge. Rotating at a place will be important though, and getting a PM&R letter will be important too. If you can talk to PDs, try to make connections, be able to explain "why" PM&R, what PM&R does, etc.

 

[physicianunknown]

So the more I think about it, the more confusing it gets. Since PM&R matches only advanced positions, even with a rotation scheduled at this institution in the spring, there shouldn't be any open spots there for next July 1st unless someone matching at the institution this past March opted out (is that allowed?) now during PGY1 year. I would also not be participating in this year's match, and SOAPing also wouldn't work since there are probably no leftover spots available. But the program will be matching in March a full class to start in 2020. Even if I then go through the match the following year 2019 - 2020, that would mean I can only start PM&R in 2021. In that situation, I could have finished some other residency like you mentioned like preventive medicine/occupational medicine, which takes only 2 more years from next July, and be able to work as an attending by July 2021. Am I working through this logically? Thanks.

 

[Burnted_out]

So the more I think about it, the more confusing it gets. Since PM&R matches only advanced positions, even with a rotation scheduled at this institution in the spring, there shouldn't be any open spots there for next July 1st unless someone matching at the institution this past March opted out (is that allowed?) now during PGY1 year. I would also not be participating in this year's match, and SOAPing also wouldn't work since there are probably no leftover spots available. But the program will be matching in March a full class to start in 2020. Even if I then go through the match the following year 2019 - 2020, that would mean I can only start PM&R in 2021. In that situation, I could have finished some other residency like you mentioned like preventive medicine/occupational medicine, which takes only 2 more years from next July, and be able to work as an attending by July 2021. Am I working through this logically? Thanks.

If you went thru the match this year although it’s likely late, even with no rotation it’s feasibe that you could get some sort of interview. If not you are right it would be 2 years from now. If I were you I would no do that. I would apply out of the match for something like occupational medicine, do 2 years and get a job, it’s not competitive, pretty chill, and a reasonable job market. I think their Match process though is December so I would start contacting programs now. So places have January starts and they vary. PM&R might take more work.

 

[j4pac]

There are typically a handful of physician only slots in ERAS. Those match as usual in March, but then you’d start that July instead of the following July for advanced programs. The downside is that there are far fewer physician only spots (typically less than ten). Every once in a while those positions get listed outside of the match on this forum.

You’re in a tough spot. You are now carrying a significant red flag and the majority of programs will be apprehensive that history will repeat itself. I’ve been here a long time, so I couldn’t tell you how many people I’ve seen on the main board or ones I’ve mentored who have either not matched or been reprimanded by their residency program and they’ve been given counsel that they should go into PM&R. Honestly, it’s pretty bad counsel, and it stems from ignorance about our specialty. PM&R isn’t necessarily “easier” than any other specialty. The rate of burnout is amoung the highest in medicine and there are certainly reasons for that. And PM&R is competitive. It’s rare for a position to go unfilled. When positions don’t fill its typically because the program didn’t rank enough applicants, and it had nothing to do with lack of demand.

So you have to ask yourself how you are going to match into PM&R, when program directors know that they will have no problem filling their programs without applicants with significant red flags. The answer is that you’d have to go above and beyond the average PM&R applicant along with some luck. I’m not saying this to discourage you...I just want you to know what you are up against so that you can make a good informed decision. If you aren’t set on PM&R, I’d consider a less competitive specialty.

 

[Burnted_out]

There are typically a handful of physician only slots in ERAS. Those match as usual in March, but then you’d start that July instead of the following July for advanced programs. The downside is that there are far fewer physician only spots (typically less than ten). Every once in a while those positions get listed outside of the match on this forum.

You’re in a tough spot. You are now carrying a significant red flag and the majority of programs will be apprehensive that history will repeat itself. I’ve been here a long time, so I couldn’t tell you how many people I’ve seen on the main board or ones I’ve mentored who have either not matched or been reprimanded by their residency program and they’ve been given counsel that they should go into PM&R. Honestly, it’s pretty bad counsel, and it stems from ignorance about our specialty. PM&R isn’t necessarily “easier” than any other specialty. The rate of burnout is amoung the highest in medicine and there are certainly reasons for that. And PM&R is competitive. It’s rare for a position to go unfilled. When positions don’t fill its typically because the program didn’t rank enough applicants, and it had nothing to do with lack of demand.

So you have to ask yourself how you are going to match into PM&R, when program directors know that they will have no problem filling their programs without applicants with significant red flags. The answer is that you’d have to go above and beyond the average PM&R applicant along with some luck. I’m not saying this to discourage you...I just want you to know what you are up against so that you can make a good informed decision. If you aren’t set on PM&R, I’d consider a less competitive specialty.

Filling all of our spots does not intrinsically mean that it’s more competitive than other specialties.
Derm and Ortho don’t typically fill and are far more competitive than PM&R. Sure it has gotten more competitive than before without a doubt. Our program had more than 500 applicants per our coordinator the last year I was there so yes plenty of applicants. But not impossible. But overall I would agree with you that OP should try to find something else. Perhaps also leaving without being dismissed would be ideal. Sometimes programs can be benign and allow that.