what pmr does aside from pain?

[amyl]

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trying to decide between anes and pmr before a pain fellowship. talked to the pmr at my home hospital today and he said practicing pain as one or the other won't matter...more a matter of what i wanted to do in residency -- work in the OR (go anes) or round on patients, rehab stroke patients, casting and splinting, etc (go pmr). how much time in pmr residency is devoted to this stuff?😀

 

[Brooklyndo2.1]

trying to decide between anes and pmr before a pain fellowship. talked to the pmr at my home hospital today and he said practicing pain as one or the other won't matter...more a matter of what i wanted to do in residency -- work in the OR (go anes) or round on patients, rehab stroke patients, casting and splinting, etc (go pmr). how much time in pmr residency is devoted to this stuff?😀

ive met a couple of anesth residents who wanted to do pain switch to rehab because they felt they werent learning what they wanted to be leaarning in aneth....

 

[mehul_25]

Truthfully speaking as a physiatrist I honestly feel that we have a better fundamental knowledge base preparing us for the practice of pain medicine. Certainly that is not intended as a blanket statement as there are many many excellent pain doctors with anesthesia backgrounds. Regardless an anesthesia residency will insure a much easier road to an accredited pain fellowship.

 

[Brooklyndo2.1]

from my little experience I feel like you would get more run of the mill pain exposure (i dont specifically mean injections or official pain patients) than in anesth. This is, in my mind, because from what I understand most gas residencies focus on operative and acute post op pain management, as well as sedation, etc... but I never looked into anesthesia seriously so I could be horribly wrong.

 

[axm397]

trying to decide between anes and pmr before a pain fellowship. talked to the pmr at my home hospital today and he said practicing pain as one or the other won't matter...more a matter of what i wanted to do in residency -- work in the OR (go anes) or round on patients, rehab stroke patients, casting and splinting, etc (go pmr). how much time in pmr residency is devoted to this stuff?😀

I think if pain is your focus and you are thinking about PM&R because you think anesthesia is too competitive for you, then I think you will be in for a rude awakening. Good quality PM&R residency programs are just as difficult as anesthesia programs and you kind of need to match into a good residency program to get a good fellowship.

You can look up our residency training requirement on the ACGME website to answer your question on "how much time in pmr residency is devoted to this stuff?" If you are looking for a stepping stone into pain, I think you will be miserable in PM&R. We do at least 12 months of inpatient rehab - yes, that means rounding on patients. We also do consults, EMGs, musculoskeletal/sports, and other outpatient months. We don't usually do the casting and splinting unless we are doing a P&O (Prosthetics and Orthotics) rotation.

If you are looking to learn about disability, function, quality of life, and pathologies related to nerve, bone, and muscle, then PM&R is right for you. If you want to learn to do procedures (intubate, start lines, etc.), work in an OR, and learn about critical care/post op care, then anesthesia is for you. You should think about what attracts you to pain then go from there.

 

[Disciple]

trying to decide between anes and pmr before a pain fellowship. talked to the pmr at my home hospital today and he said practicing pain as one or the other won't matter...more a matter of what i wanted to do in residency -- work in the OR (go anes) or round on patients, rehab stroke patients, casting and splinting, etc (go pmr). how much time in pmr residency is devoted to this stuff?😀

Depends on the program (highly variable). If you want to learn sports med, EMG, non-surgical Ortho stuff, MSK Ultrasound (at a select few programs at the moment) then do a PM&R residency. If that stuff doesn't interest you then do an Anesthesia residency (your chances for a "pain" fellowship will be much higher) or go to a PM&R program that is hooked up with the gas department or with outside electives that can be used for anesthesia pain rotations (doesn't have to be a good program, so long as the aformentioned provisions are met).

 

[amyl]

I think if pain is your focus and you are thinking about PM&R because you think anesthesia is too competitive for you, then I think you will be in for a rude awakening. Good quality PM&R residency programs are just as difficult as anesthesia programs and you kind of need to match into a good residency program to get a good fellowship.

thanks for the advice. it is not necessarily that i think anes is too competitive, just that i think my app might be stronger at a pmr program. in my understanding pmr is more DO-friendly. i was also part of a research project with a neurologist treating TBIs and CP kids, etc.

you picked up correctly on my vibe -- would much rather be in the OR than rounding on stroke patients...thanks for putting in black and white what i knew down deep inside anyways

 

[JEB4]

Disciple, you mentioned that a select few programs are doing MSK ultrasound. Would you mind listing the ones you're aware of? Thanks!

 

[axm397]

Disciple, you mentioned that a select few programs are doing MSK ultrasound. Would you mind listing the ones you're aware of? Thanks!

RIC has Dr. Paul Lento doing MSK ultrasound. Dr. Marciniak also does some MSK ultrasound but more in conjunction with EMGs. Dr. Fitzgerald does ultrasound to look at pelvic MSK issues.

 

[Disciple]

Disciple, you mentioned that a select few programs are doing MSK ultrasound. Would you mind listing the ones you're aware of? Thanks!

RIC and Mayo.

At Wash U if you rotate with Heidi Prather she has one now.

At my residency we rotate with Larry Frank and he got one last year.

That's all I'm aware of at this time.


This technology hasn't quite fully caught on yet, so you don't really need formal training. Just go to a course, there are several good ones and then start practicing (if you can get your hands on a machine).

It's becoming a hot technology in PM&R. I just attended a course last month. Several of the progressives were there (Lagattuta, Falco, Fortin).

 

[Disciple]

You can look up our residency training requirement on the ACGME website to answer your question on "how much time in pmr residency is devoted to this stuff?" If you are looking for a stepping stone into pain, I think you will be miserable in PM&R. We do at least 12 months of inpatient rehab - yes, that means rounding on patients. We also do consults, EMGs, musculoskeletal/sports, and other outpatient months. We don't usually do the casting and splinting unless we are doing a P&O (Prosthetics and Orthotics) rotation.

There are four likely pathways to pain and I'm not sure any of them are any less "miserable" than any of the others.

e.g. I personally can't say that rounding on patients is any worse than doing OB call (more call in general for that matter) or sitting through 12 hours cases while getting yelled at by academic surgeons or doing detailed psychological assessments on patients with personality disorders.

If someone is dead set on going into pain, I think he or she should pick the base specialty that will provide the extra skill set they are interested in and not based on avoiding rotations that they don't like.

 

[amyl]

not wanting to avoid rotations i don't like at all. its just that if for some reason in four years i don't want to do a pain fellowship (so much can happen in four years) I want to be happy with what I will be doing without the fellowship. For me I think that is the OR.
I also lack confidence in some of my physical medicine skills (OMM) -- seems like the kind of thing you either have a feel for or not.

 

[Disciple]

Fair enough.

I don't like to discourage bright med students interested in pain from looking into PM&R. During residency I hated rounding as well, but was able to make it through without wanting to kill myself. When I wasn't doing the inpt stuff the rest was thoroughly enjoyable.

There are really four practical routes to pain, and each of those specialties has specific things that are unappealing about them. If you can't make a clear decision based on that, then base it on the postives each specialty has to offer.

Good luck with your decision.

 

[mehul_25]

Jefferson residents have a month long rotation with Dr. Nazarian who incidently teaches Jefferson's MSK U/S course and is very well know in the MSK U/S community