PM&R vs Neuro for outpatient neurology

[JSW1123]

Hi all,

I am interested in working with neurological diseases of the outpatient variety (a large range, obviously, but still does exclude a lot of things), and PM&R came onto my radar relatively recently as a pathway to reaching this goal. To be honest, it seemed weird to me that there is a pathway to work in neurology, in the setting and with the diseases that I want to work with, that doesn't involve going through a neurology residency.

I posted a thread in the PM&R forum to find out more, and it really does seem like this is the case.

In short: I like the idea of a thorough physical exam being necessary for diagnosis, I like diagnosing, and I don't want to feel like a "rehab coordinator." From speaking to PM&R people, it sounds like there is, magically, a way to get there without the grueling neuro residency. Neurologists, do you disagree? Do you think that is ridiculous? I would love to hear perspectives from this side of the fence!

Thanks in advance!

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[curiousneuro]

Hi there - welcome! I read through the thread that you included in your post briefly, and there are a lot of great points.

At the end of the day, it probably boils down to that neurology is about the diagnosis and medical management of neurologic conditions, which PM&R is focused on rehabilitation and mobility, but NOT primarily the diagnosis.

For example - a patient will come in with new neuro sx, we'll see them, diagnosis a stroke, make acute tx decisions, workup, management, and arrange for them to be evaluated by PM&R for continued mobility assessments. PM&R will assess the patient and work on a plan to get that patient more mobile and improve their functional recovery....however, they have little to no input on the diagnosis and management of their stroke.

Does that make sense? Two sides of the coin, but very different jobs. I love and appreciate what our PM&R folks do, but that's just not my jam.

 

[sloh]

Hi all,

I am interested in working with neurological diseases of the outpatient variety (a large range, obviously, but still does exclude a lot of things), and PM&R came onto my radar relatively recently as a pathway to reaching this goal. To be honest, it seemed weird to me that there is a pathway to work in neurology, in the setting and with the diseases that I want to work with, that doesn't involve going through a neurology residency.

I am PM&R. I would recommend you go into Neurology if those are your goals in the outpatient setting. Unless you’re in academia or are lucky enough to have a very niche practice that is also financially sustainable, the practice setting you’re looking for is very rare in PM&R.

 

[xenotype]

Hi all,

I am interested in working with neurological diseases of the outpatient variety (a large range, obviously, but still does exclude a lot of things), and PM&R came onto my radar relatively recently as a pathway to reaching this goal. To be honest, it seemed weird to me that there is a pathway to work in neurology, in the setting and with the diseases that I want to work with, that doesn't involve going through a neurology residency.

I posted a thread in the PM&R forum to find out more, and it really does seem like this is the case.

In short: I like the idea of a thorough physical exam being necessary for diagnosis, I like diagnosing, and I don't want to feel like a "rehab coordinator." From speaking to PM&R people, it sounds like there is, magically, a way to get there without the grueling neuro residency. Neurologists, do you disagree? Do you think that is ridiculous? I would love to hear perspectives from this side of the fence!

Thanks in advance!

PM&R are not diagnosticians. They fix people who already have problems that need a lot of work- like a spinal cord injury and terrible spasticity. 'Coordinating rehab' means EMG guided botox, ordering the right braces to keep them walking, close communication with their PT on how the botox and braces are doing, and dealing with joint disease that pops up as well. They don't diagnose parkinsons disease, and their neurological exam is not going to be as good as a master neurologist as it does not have to be. They are better at keeping people moving than neurologists (and getting them moving again) and have clinics better set up to facilitate this. It is a very different job than neurology even if we both do EMGs, botox, etc and see the same exact patients.

If you like diagnosis, you should do neurology. The residencies are the same length. If you don't like acute illness, the hospital in general, and want to work less PM&R is much better set up for that from the beginning. The pay will probably be very similar at the end of the day on an hour per hour basis.

 

[sloh]

They fix people who already have problems that need a lot of work- like a spinal cord injury and terrible spasticity. 'Coordinating rehab' means EMG guided botox, ordering the right braces to keep them walking, close communication with their PT on how the botox and braces are doing, and dealing with joint disease that pops up as well. They are better at keeping people moving than neurologists (and getting them moving again) and have clinics better set up to facilitate this.

I'll also add that outside of academia, the patient population the OP expressed interest in makes up a very small sliver of outpatient panels. In the outpatient setting, it's a lot of chronic pain.

 

[xenotype]

I'll also add that outside of academia, the patient population the OP expressed interest in makes up a very small sliver of outpatient panels. In the outpatient setting, it's a lot of chronic pain.

Yes excellent point. Outside of headache patients it is fairly easy to extricate yourself as a neurologist from chronic pain patients if you don't want to be involved. Not so much in PM&R. The flip side is that PM&R is a little easier entry point into interventional pain if that is one's thing. Not impossible from neuro though, just requires more planning ahead.