top 3 reasons: Best and Worst things about being a Physiatrist.

Best -
1) EMG's - Diagnostic, usually no follow up as most are referrals, pays well.
2) Injections, when they work well
3) Helping someone disabled by pain or impairment to get more functional

Worst -
1) Patients who are convinced they just need vicoden and nothing else
2) Personality disorders - they're attracted to pain docs like moths to flames
3) Egotistical docs in other fields who know nothing about PM&R but put it down anyway.

I'm in private practice.

oreosandsake said:

Another way to put it would be to ask, "what do you love most about your job, and what is the least pleasurable part of your work."

hoping to get some feedback from residents/attendings.

Also, please include the type of practice you are involved in. academic, private, etc

thank you. 🙂

Click to expand...

1. Field draws people into it with good personalities, humor and overall insight into overall life, not JUST medicine.
2. Depth and breadth of clinical work, from instant gratification with successful injections to long-term rehab
3. Its fun!

1,2,3. None

Academic outpatient practice.

Love most:
1) Teaching. Helping baby docs take their first steps and watching them blossom into competent, hopefully outstanding physiatrists provides me with a lot of vicarious enjoyment and personal fulfillment.
2) Agree with the EMGs. For me, this was the point of residency where it all came together. Better understanding of anatomy and pathophysiology. Mastering the neuromuscular history and examination, generating a differential diagnosis (yes – actually diagnosing!) and performing a procedure that either confirms your diagnostic acumen – or tells you to get a clue.
3) Outpatient practice. No weekends. No call. ‘Nuff said.

Least pleasurable:
1) Lack of awareness of the field. I’ll admit it gets tiring explaining to patients, new doctors every July, what it is we do. It is nice though when patients (and doctors) ultimately say, “I wish I had known about your specialty sooner.”
2) Patients with a pathologic sense of entitlement. They want everything done for them immediately, but are not willing to help themselves. Demanding specific pain medications. Mad at you and the world even though they don’t follow through with your recommendations. These people don’t do well within the rehab care model. OTOH - watching truly motivated patients and family improve and regain functional independence, and when they express their gratitude – priceless.
3) Paperwork.

great thread- any others?

frankly can't stand inpatient rehab. Far too much internal medicine and honestly general outpatient rehab is primary care for the disabled. Also don't like wound care.

What do I like?
EMG
MSK
Pain

haha hey Gauss... what thread is that quote from "busterbones" from??

stgeorge said:

You are not really a doctor.

Click to expand...

profound, you want a cookie?
oh and piss off

oreosandsake said:

Another way to put it would be to ask, "what do you love most about your job, and what is the least pleasurable part of your work."

hoping to get some feedback from residents/attendings.

Also, please include the type of practice you are involved in. academic, private, etc

thank you. 🙂

Click to expand...

Speaking from the perspective of a private-practice neurorehab/BI (inpt/outpt) doc:
Love:
1. Interesting work (neuroimaging, managing neuromedical complications, spasticity/motor impairment intervention)
2. Helping people deal with devastating circumstances (come on, that should count for something, even among my outpatient MSK colleagues)
3. Developing my own learning curve to take care of patients better the next time that problem shows up.
3a. Publishing a cool paper sharing something about what I have learned to my other colleagues in the field.

Hate:
1. Paperwork (disability forms, insurance forms, etc.)
2. Maladaptive family dynamics
3. Paperwork (BTW, did I mention how much I hate the paperwork?)

oreosandsake said:

followup Q if you dont mind... So, you are in private practice but do a bit of research/observation and published what you learned in your private practice? (that's really cool)

what % of your day would you say you spent on paperwork? I'm sure paperwork is something that should be expected in all fields of medicine, but is there a greater amount in physiatry?

thank you

Click to expand...

Q: What % is spent on paperwork (ie disability & insurance forms, outpt orders, etc.)?

A. Hard to say, because I hate it so much, I delegate as much as I can to my nurses & nurse practitioner. Still, there are ALWAYS more forms and letters, always. I know of BI specialists who refuse to fill them out, primarily because of how odious a task it is for them. Please remember that I speak only for myself, a BI-specialist, and I don't know whether my angst regarding the endless disability forms is applicable to other branches of physiatry (or even other BI physiatrists.).

As for the pvt practice/research, it is admittedly not a common combination, but it can be done, particularly with motivation, discipline, some computer skills, excellent help (e.g., nurse/NP, secretarial), COLLABORATORS (esp neuropsychology-key!), and a supportive rehab hospital/administration. A small but effective critical mass of collaborators, particularly with influence/connections on the clinical team, can get a lot of fun stuff accomplished together.

Shrike, I saw that you said you were in private practice and also were able to publish. How are you able to obtain the funding? Do you find it any more difficult conducting research in a private practice setting?

ShrikeMD said:

Speaking from the perspective of a private-practice neurorehab/BI (inpt/outpt) doc:
Love:
1. Interesting work (neuroimaging, managing neuromedical complications, spasticity/motor impairment intervention)
2. Helping people deal with devastating circumstances (come on, that should count for something, even among my outpatient MSK colleagues)
3. Developing my own learning curve to take care of patients better the next time that problem shows up.
3a. Publishing a cool paper sharing something about what I have learned to my other colleagues in the field.

Hate:
1. Paperwork (disability forms, insurance forms, etc.)
2. Maladaptive family dynamics
3. Paperwork (BTW, did I mention how much I hate the paperwork?)

Click to expand...

I'm very interested in the neurorehab aspect of PM&R and am always looking for people who are practicing outside of the academic setting. Would you mind sharing a little more about your practice (logistics, patient population, day to day routine, etc.) Did you complete fellowship training, and if so, where? Please feel free to PM me. Thanks!

MSKalltheway said:

Shrike, I saw that you said you were in private practice and also were able to publish. How are you able to obtain the funding? Do you find it any more difficult conducting research in a private practice setting?

Click to expand...

In my administrative contract with the hospital, I negotiated a pilot project fund for start-up dollars. It would help pay for a medical student or assistant to help with some retrospective studies. Funding was not the biggest hurdle, however. (Funding is important, but I am primarily clinical, and my clinical practice/inpatient practice serve as settings for most of my publications.)

For what it is worth, my experience suggests that an important key to productivity is the synergy that can be realized by identifying compatibly-minded collaborators within the clinical setting where I work (preferably ones who can write and know their areas of interest/literature well. For me, this usually involves the neuropsychologists, but for colleagues in the pain "arena", this could involve a pain psychologist, a Ph.D therapist, or even a physician in a different field, such as an anesthesiologist.)

As for the difficulty of conducting research in a private practice setting vs. an "academic" setting, I think most academic settings should have resources that would allow a motivated individual to conduct research more easily than in pvt practice. That being said, if your chair works you to death seeing patients, provides no administrative support, and you have 2 young children at home, I wouldn't expect to publish much. Further, my situation is a bit unique, as our rehab hospital has its own IRB, and has a small research dept. Most do not. We have a gait lab, most rehab hospitals do not. Hence, I have resources most colleagues in private practice settings do not have. If you are in an "academic" setting, you may have an IRB that is comprised of what I call "thought police"; individuals who make it very difficult to get research done because they erect obstacles to investigation even before it starts. Big turn off. I have a reasonable IRB. It isn't a rubber-stamp entity, but if they have questions/concerns regarding something I propose to do, they are reasonable in the subsequent negotiations, and they don't make me wait forever for an answer.

Bottom line: Research can be done in pvt practice rehab settings & hospitals, but it helps to have collaborators and some help from the administration. Conversely, while academic settings should have an advantage with regard to research opportunity, this is not necessarily the case.

ShrikeMD said:

If you are in an "academic" setting, you may have an IRB that is comprised of what I call "thought police"; individuals who make it very difficult to get research done because they erect obstacles to investigation even before it starts. Big turn off.

Click to expand...

👍 Our IRB is the bane of my, and many of my colleagues, existence. Don't like them. Not a whit.

Reasons I like PM&R
1) I like helping people with chronic conditions/disabilities, great patient experiences.
2) Not a bad lifestyle in outpatient.
3) Epidemiologically, there is an increasing need especially for quality MSK and pain care as the population ages. I feel I'm working on problems that are going to very important to healthcare. I envision a day when pts with back pain see a physiatrist or sports med FP first, before getting a referral to ortho or chiropractor.


Reasons I sometimes dislike my field:
1) The glaring lack of Level 1 evidence in most fields of PM&R, especially musculoskeletal. Many of the splints, physiotherapy, steroid injections we do are based on very few studies. (This is why I plan on future clinical research.) Some fields are further along (ie spine >> hand arm vibration syndrome), but regardless we have very far way to go.
2) There are some attendings (esp in community, non-academic settings) who do not keep up with the latest developments in neurology or internal medicine, and are practicing outdated medicine.
3) lack of recognition from other fields

1) What you do really helps people.
2) Hours/no call.
3) Relatively low stress problems.

1) 'What the heck is a physiatrist' from docs and lay people.
2) Jack of all trades, master of none in many cases.
3) 'What the heck is a physiatrist'. Did I mention that?

Good:
1. Interesting with broad range of possible employment opportunities (maybe only FM and IM have more)
2. Lifestyle and lifestyle
3. Laid-back, team approach to medicine with good patient and staff relationships

Bad:
1. Narc seekers
2. Sometimes frustratingly slow improvements with possibility for zero improvement and the subsequent questioning of 'what am I really doing here?'
3. Explaining your specialty to OTHER DOCS . . . although many are wishing they had made the same choice after I talk to them for a bit