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[doodleman]

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[HeftyGo37]

Definitely a difficult decision and it sounds like you would find a happy life as an attending with either path. With your strong interest in TBI, SCI, and disability, it may be worth considering the relative aspects of each residency you would enjoy the "least." Perhaps that might be epilepsy, headache, movement disorders, MS, for Neuro? and perhaps that might be the musculoskeletal, sports, and pain medicine for PM&R? Think about which you would probably tolerate less during residency. I will say that it seems that more and more PM&R applicants seem to be taking a greater interest in the MSK/sports/spine/pain side of things, and you would be highly appreciated and revered for your strong neurorehab interest (especially among PDs). I have not heard of the disrespect for physiatrists that you mention, but I do think there is significant regional variance with how well other physicians know about/consult PM&R. Patients absolutely love PM&R docs and those relationships are one the most attractive things about the field. I don't think any doc who regularly works with well-trained physiatrists would ever think of them disrespectfully.

Also, one important thing that you may not have heard of because it is not common is that PM&R residents can do fellowships in neurocritical care. At University of Michigan PM&R, a resident has matched into highly-esteemed neurocritical care fellowships each of the past 2 years (scroll to the bottom of this link). People | Physical Medicine and Rehabilitation | Michigan Medicine

 

[JBM16BYU]

I'll throw in my 2 cents as well, as someone who pursued a residency in PM&R followed by a Neurology-based Neuromuscular Medicine fellowship. There are definitely differences between the training in both specialties, but there is quite a bit of overlap in patient population. From my experience, on the neurologic disease side of things, Neurology tends to participate more in the acute aspect of neurologic conditions and the initial work-up, diagnosis, and medicinal management of these conditions, while PM&R tends to participate in the long-term management of the patient's rehabilitation needs, spasticity, pain, bladder/bowel management, DME, wheelchairs, and other quality of life aspects. Both sides have their pros and cons, just depending on what you are interested in. You received great advice above which I would keep in mind while thinking about this decision. As well, like was mentioned, PM&R can do fellowships in neurocritical care (a newer development), brain injury medicine, spinal cord injury medicine, neuromuscular medicine (99% of these fellowships are in Neurology departments), and even more specific non-accredited fellowships in advanced spasticity management or multiple sclerosis rehabilitation. There will be regional variation on how PM&R is viewed by other physicians and hospital systems. Patients love their PM&R physicians and you do get the opportunity to build lasting relationships with your patients as you help them throughout their lives.

 

[specepic]

Do you like to diagnose? Neurology
Do you like to treat? PM&R

I was also torn between these 2 specialties. I felt like a lot of neurology was spending a lot of time figuring out the diagnosis then telling the patient the diagnosis then telling him there was not a lot we can do about it

PM&R seem to be more about coming up for creative solutions for difficult to treat issues