Top Programs, but not in name

[cubsfan]

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So starting to think about different programs with interview season underway...do people out there have opinions based on that "program" and not the name? For example, if comparing the big 6 or so (arbitrary):
Harvard
RIC
UMich
Kessler
UW
Baylor

If these were renamed programs A, B, C, D, E, F---any opinions on the program itself???

FYI--I do not have interviews at all of these programs--this is more for a comparison point

 

[aspiring_painMD]

So starting to think about different programs with interview season underway...do people out there have opinions based on that "program" and not the name? For example, if comparing the big 6 or so (arbitrary):
Harvard
RIC
UMich
Kessler
UW
Baylor

If these were renamed programs A, B, C, D, E, F---any opinions on the program itself???

FYI--I do not have interviews at all of these programs--this is more for a comparison point

I think aside from the name themselves, all of these are considered top programs. Maybe U-Mich isn't mentioned as much. But I did interview at all the programs except U-Mich, so I won't comment on it. When ranking these places, you always need to think of what you are ranking it with respect to. Is it inpatient or outpatient, is it the research residents do, or is it the ability to attain certain fellowships. Almost no one in rehab will do every single subspecialty of cards, pulm, burn, TBI, pain simultaneously in their future practice. So if you don't know what you want to do, pick the one with the most breadth or flexibility, since the faculty at these places are probably all going to be great teachers.

In terms of overall breadth, flexibility to do what you want to do
1 Spaulding (most well rounded, unmatched number of electives)
2 RIC (again very well rounded, quite a few electives)
3 UW
4 Kessler (too few electives, esp outside of Kessler)
5 Baylor (too inpatient focused)

I would say strictly in terms of structured didactics and faculty teaching:
1 RIC & Kessler tied(both a lot of didactics/board review)
2 UW
3 Baylor
4 Spaulding (strong faculty, but structured didactics not quite there yet)

For research opportunities and supported by faculty:
1 RIC (most amount of research going on)
2 Spaulding (lots of research requirements, journal)
3 UW
4 Baylor (suprisingly I have heard residents complain of how hard it is to find a research mentor here)
I don't know where Kessler fits in honestly.

Then the next and most important question is what about the field I think I'm going to go into? If its EMG training or EMG fellowship you want to pursue, Mayo is best. It is also the only program I am aware of that teaches EEG also. If its anesthesiolgy based pain management, then Harvard has the best track record of matching its residents. If its SCI, then Kessler and Baylor are probably the top programs. If its stroke, RIC has tremendous faculty like dr roth, dr harvey, dr bogey, along with cutting edge research in stroke. If its professional teams sports you want to do, UW has Dr Herring who works in pro football. If you have no idea what the heck you want to do, then pick Harvard and you can keep taking electives until you find your niche.

 

[Disciple]

It is also the only program I am aware of that teaches EEG also.

Of what use is that to a Physiatrist?

 

[nvrsumr]

Just a couple thoughts on U of M.

Smaller program, 6 per year, so we get a little less exposure than some of the other excellent programs listed.

Well rounded program(short but intense inpatient with excellent MSK, Spine, EMG). Electives generally are done only at U of M but my PGY2 year we had 3 residents do 1 month international electives(Africa and India).

2 months of protected research time without clinical duties, except home call or weekly continuity clinic if applicable. We had 15 posters at this years AAPMR-more than any other program in the country(this is my personal observation from the meeting).

All four of the PGY 4s who applied to pain management fellowships were accepted to ACGME accredited programs. None accepted one of U of Ms 3 PMR pain ACGME accredited spots. This maybe the best placement total in the country, especially considering they were all outside spots.

Best of luck.

 

[Finally M3]

Not going to toot your own horn?

For the OP; I would probably insert Mayo's program in place of UMich. However, like nvrsumr said, we are a very strong program. We're just not consistently mentioned in the 'elite' programs.

 

[cubsfan]

Wow--thanks for the great replies...

 

[arik79]

why does everyone associate matching with an acgme pain managment program, automatically equal the strength of a resident. now there are reduced numbers of pmr acgme programs, but there are close to 80 anesthesia programs and many are weak. so i wouldn't rush to judgement on the acgme. Not doubting your program, or any program for that matter, but you want to look at comprehensive programs as well as match rates and where they went.

 

[Finally M3]

why does everyone associate matching with an acgme pain managment program, automatically equal the strength of a resident. now there are reduced numbers of pmr acgme programs, but there are close to 80 anesthesia programs and many are weak. so i wouldn't rush to judgement on the acgme. Not doubting your program, or any program for that matter, but you want to look at comprehensive programs as well as match rates and where they went.

I'm not going to list where our grads got offered/going, because it's not my story to give, but they are all pretty 'strong' programs.

And I agree, pain isn't the be-all end-all regarding rehab. But for some applicants (and about 50% of grads per the last 'Physiatrist' survey) it's definitely an interest.

 

[axm397]

I'm not going to list where our grads got offered/going, because it's not my story to give, but they are all pretty 'strong' programs.

And I agree, pain isn't the be-all end-all regarding rehab. But for some applicants (and about 50% of grads per the last 'Physiatrist' survey) it's definitely an interest.

probably the best thing to look at is whether all the people who wanted to do fellowship got one of their top choices - since fellowships come in all flavors even within "pain". (i.e. musculoskeletal, sports, pain, spine, acgme, non-acgme, etc.)

As there have been discussions in the past there are some excellent non-acgme fellowships in pain/msk/spine and different people have different priorities so ACGME accreditation may not be as accurate an indicator as whether people got what they wanted. (Of course, that's hard to find out)

I think in general if you go to one of the top to top-mid tier 10-15 PM&R programs in the country, you'll do fine.

 

[njdevil]

Although your comments are well intended, I disagree with quite a few comments. Your direction of: if you want this than this is too general and does not fit the bill. For example, yes Kessler is reknowned for SCI but there residents get the fellowships they want despite not having electives. They also have very strong MSK/sports exposure with two fellowships coming from there faculty. I am not a Kessler resident. I am just stating an example.

What is too much elective time? Is a lot elective time saying that they are flexible or do they not have enough different clinical settings to accomdate well rounded training.

Anyway, advice on the board should always be taken with a grain of salt (you get what you pay for), but there are some glaring generalities with all of these statements.

I think aside from the name themselves, all of these are considered top programs. Maybe U-Mich isn't mentioned as much. But I did interview at all the programs except U-Mich, so I won't comment on it. When ranking these places, you always need to think of what you are ranking it with respect to. Is it inpatient or outpatient, is it the research residents do, or is it the ability to attain certain fellowships. Almost no one in rehab will do every single subspecialty of cards, pulm, burn, TBI, pain simultaneously in their future practice. So if you don't know what you want to do, pick the one with the most breadth or flexibility, since the faculty at these places are probably all going to be great teachers.

In terms of overall breadth, flexibility to do what you want to do
1 Spaulding (most well rounded, unmatched number of electives)
2 RIC (again very well rounded, quite a few electives)
3 UW
4 Kessler (too few electives, esp outside of Kessler)
5 Baylor (too inpatient focused)

I would say strictly in terms of structured didactics and faculty teaching:
1 RIC & Kessler tied(both a lot of didactics/board review)
2 UW
3 Baylor
4 Spaulding (strong faculty, but structured didactics not quite there yet)

For research opportunities and supported by faculty:
1 RIC (most amount of research going on)
2 Spaulding (lots of research requirements, journal)
3 UW
4 Baylor (suprisingly I have heard residents complain of how hard it is to find a research mentor here)
I don't know where Kessler fits in honestly.

Then the next and most important question is what about the field I think I'm going to go into? If its EMG training or EMG fellowship you want to pursue, Mayo is best. It is also the only program I am aware of that teaches EEG also. If its anesthesiolgy based pain management, then Harvard has the best track record of matching its residents. If its SCI, then Kessler and Baylor are probably the top programs. If its stroke, RIC has tremendous faculty like dr roth, dr harvey, dr bogey, along with cutting edge research in stroke. If its professional teams sports you want to do, UW has Dr Herring who works in pro football. If you have no idea what the heck you want to do, then pick Harvard and you can keep taking electives until you find your niche.

 

[Disciple]

why does everyone associate matching with an acgme pain managment program, automatically equal the strength of a resident. now there are reduced numbers of pmr acgme programs, but there are close to 80 anesthesia programs and many are weak. so i wouldn't rush to judgement on the acgme. Not doubting your program, or any program for that matter, but you want to look at comprehensive programs as well as match rates and where they went.

Let's stop confusing medical students more than they already are.

Unlike specialties such as IM or Ortho where reputation would likely facilitate entry into all things associated with those two specialties, reputation in Physiatry will not necessarily facilitate career goals in a one-size (or program) fits all manner.

For all these applicants focused on future careers in interventional pain management, the rep of your PM&R residency matters little. All that is necessary is a combination of the below factors to varying degrees.

1. The reputation of your hospital system
2. Flexibility of your program, #of selectives and outside electives (experience and audition rotations)
3. Relations with the gas department (with which to rotate, collect LORs and help out with research), even better if they have an attached pain fellowship
4. Your program housing one of the few surviving accredited PM&R pain fellowships (self explanatory)

In not so many words, it's as simple as that. All of the above information can be obtained during interviews and/or through correspondence with residents you will meet.

I've met a good number of Physiatrists who are anesthesia pain fellowhip trained (through the same hospital system as their residency or at a gas program they were able to rotate at) who either trained at poor PM&R residencies or had virtually no MSK training/injection experience during residency.
It didn't matter. The circumstances were favorable for them and they were able to achieve their objective.

On the other hand, I've had the unfortunate experience of interviewing at gas fellowships that had become cold to the idea of taking Physiatrists (as stated by those interviewing me) due to past poor experiences with PM&R fellows that were "stellar" on paper but frustrating failures when it came to wielding a needle and performing minor surgery.

The majority of the anesthesia pain guys that I've interacted with in the past 2 years (academic and private practice) have no idea what PM&R residency curriculum entails. But, it goes both ways.
An example from the AAPMR conference in Hawaii while making the rounds at the job fair and stopping at several of the academic booths:
(Conversation going well)
PM&R recruiting prof: Who's your PD?
Me: Dr. X
PM&R prof: Who?
Me: I'm in an anesthesia pain fellowship
PM&R prof: Oh, he's an anesthesiologist, I wouldn't know him then (followed by dismissive look)

If you're interested in one of the popular MSK or Sports/EMG fellowships or a career in such, it's not too hard to figure out what PM&R programs to shoot for.

Same goes for those interested in TBI, SCI or Peds research. They're a rare find these days, but they're out there. My former co-resident (whom I hold in high esteem for her abilites) was one.

The way things are you're unlikely to find a program that can provide everything for all residents. Not now, and with the current attitude of the ABPMR and PM&R academics, not in the near future. In fact, there are few programs with all or even most of the above. What compromises are you willing to make? Decide honestly what you really want and plan accordingly.

 

[axm397]

obviously, students should consider their own career goals when ultimately deciding on a residency program. I agree with disciple that there are many factors to consider and that reputation of your program alone will not guarantee a successful fellowship match. But I do have to respectfully disagree with disciple about whether the reputation of your program matters at all. I think there are still enough PM&R based pain and PM&R friendly pain programs that the reputation of your program (and more importantly the alumni connection/history of your program) is a consideration.

if you survey the top 10-15 PM&R programs, you will find that most if not all of their senior residents managed to match in one of their top choice pain/MSK/sports fellowship programs. there's usually a good variety of fellowships they choose to pursue including anesthesia based pain, PM&R based pain, academic pain, sports, MSK, non-acgme pain, etc. There are still some quality traditionally PM&R ACGME and non-ACGME pain programs out there and even anesthesiologists know "name" PM&R pain/MSK people. For example, Joel Press is well known outside of the PM&R circle because he was president of NASS and has published the "couch potato" work out book. Norman Harden, who is a Neurologist by training but is an active attending in the PM&R department and researcher at RIC is known internationally for his work with CRPS.

Dont' get me wrong, I don't think you can "ride" a PM&R program's name/reputation - you definitly need to work harder than an average anesthesia resident to land a pain spot. If pain is the only goal then anesthesia may be better for you. Most ppl I know who are going into pain from PM&R chose to go the PM&R route because of philosophical reasons on what kind of pain physician they wanted to be.

Although it was disappointing to see the low numbers of PM&R applicants on the recently released NRMP report, the top PM&R programs still are very competitive. We have ppl from top med schools like harvard med, duke, etc, several AOAs per class, etc. etc. Those people will look good on paper regardless of what program they choose to go to in PM&R and they will do well applying to fellowships. So need to consider those factors as well.

People will have different opinions based on their own experiences. Forums like this are great for getting a good variety of opinions on different topics. I wouldn't take anyone's opinion including my own as the absolute truth.

 

[drusso]

The lesson to take away from all this is that it's the *INDIVIDUAL* that matters more than the *THE PROGRAM.* Don't choose a program based upon what you might want to do for a fellowship. That's silly. Things change. Interests change. People change.

You want to be a physiatrist, right?? Then, choose a PM&R program that is "balanced" in the sense that it provides adequate exposure to all the facets of the field: Inpatient, outpatient, MSK, EMG, and interventional procedures. Choose a program that is "progressive" in the sense that it has an eye on where the field is heading (MSK medicine, Ultrasound DX and TX, Trauma Medicine and Neurorehabilitation) and not where it "has been."

Having said that: If your goals are specifically focused on Interventional Pain Medicine you should prepare yourself in specific ways. You need a set of defined experiences that include exposure to anesthesia-based pain management, rudimentary axial spine procedures, basic airway management and peri-operative medicine. Most of these experiences can be obtained through the combination of elective experiences in your internship and residency. Most "top programs" offer sufficient elective experiences to accomodate this. Ask at your interviews...

Finally, there are pro's and con's to training outside your specialty of origin. Having trained in an anesthesia-based program, I can tell you that institutional reputation and anesthesia department reputation probably matter more than PM&R-specific reputation. Predictably, the converse is true within physiatry. In *THE LONG RUN* it really doesn't matter. Everyone ends up doing the same procedures. Someday, there might not even be pain fellowships. There may be an autonomous residency in Pain Medicine. As the field advances and evolves, it seems to be cleaving itself from anesthesia, physiatry, and neurology.

Focus on the "here and now." Try to get into a good, balanced program that you like and see yourself staying for three or four years. The other details will work themselves out on their own...