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- Thread starter doodleman
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Im neither of these specialties but have a few thoughts that may/may not help:
1) PMR doesn’t get disrespected in the hospital. That’s because in 3+ years at my current institution I’ve never actually seen one of our PMR docs in the hospital. Ever. Im in a sub specialty of my own field that gets ragged on by others, and it’s hard to care when you’re out the door hours before all the people talking crap. My guess is the PMR docs aren’t crying into their Wednesday happy hour cocktails either.
2) diagnosis gets insanely easy really fast. Perhaps my only gripe about medicine - I thought it was going to be more puzzles and complex thinking. Nope. Diagnosis pretty obviously 98% of the time. Assume that part will become routine and no longer interesting over time.
3) beware the inherent student bias. Students tend to get bounced around to the most interesting cases/services/clinics, especially in a good teaching hospital. You’ll have fellowship trained docs with tertiary level referrals for everything. There’s zero chance your actual practice will be like that because nobody’s is. You’ll have lots of interesting stuff, but lots of routine cases as well, not to mention admin work. Those are the days you tell students to go hang out with your partner who’s got some interesting stuff happening. Try and get a sense of the totality of a given attendings day/week.
4) when in doubt, always go with best lifestyle. Never heard of any doc being unhappy because his lifestyle was too good.
5) diagnosis being easy was a letdown, but the difficulty of management has more than made up for it. You like the diagnostic aspect of Neuro, but think about the mgmt aspect as well. That’s really what your day ends up being.
1) PMR doesn’t get disrespected in the hospital. That’s because in 3+ years at my current institution I’ve never actually seen one of our PMR docs in the hospital. Ever. Im in a sub specialty of my own field that gets ragged on by others, and it’s hard to care when you’re out the door hours before all the people talking crap. My guess is the PMR docs aren’t crying into their Wednesday happy hour cocktails either.
2) diagnosis gets insanely easy really fast. Perhaps my only gripe about medicine - I thought it was going to be more puzzles and complex thinking. Nope. Diagnosis pretty obviously 98% of the time. Assume that part will become routine and no longer interesting over time.
3) beware the inherent student bias. Students tend to get bounced around to the most interesting cases/services/clinics, especially in a good teaching hospital. You’ll have fellowship trained docs with tertiary level referrals for everything. There’s zero chance your actual practice will be like that because nobody’s is. You’ll have lots of interesting stuff, but lots of routine cases as well, not to mention admin work. Those are the days you tell students to go hang out with your partner who’s got some interesting stuff happening. Try and get a sense of the totality of a given attendings day/week.
4) when in doubt, always go with best lifestyle. Never heard of any doc being unhappy because his lifestyle was too good.
5) diagnosis being easy was a letdown, but the difficulty of management has more than made up for it. You like the diagnostic aspect of Neuro, but think about the mgmt aspect as well. That’s really what your day ends up being.
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Concur that I've never seen a physiatrist in a hospital, so you can scratch that off your con list. They have OTs and PTs for that lowly inpatient stuff. Looking like you have a lot more cons about neurology, but that might be my bias. Definitely second that diagnoses get easy fast, regardless of specialty. My goodness is that ever the case for neurology. It's mostly strokes, not Marchiafavabignami syndrome. Your job just isn't going to be House every day even if it feels like that in med school.
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I'm baffled you two have never seen a physiatrist in the hospital--do you not have an attached rehab unit or a consult service?
We were very involved in acute care consults in residency. Trauma, neurosurgery, neuro called us all the time for consults. As an attending, docs call me up all the time to get their patients to rehab.
I've never felt disrespected by anyone based on my specialty choice. And I've never personally heard of another physiatrist feeling disrespected by another purely because of their specialty choice. Sometimes certain folks are just jerks and disrespects everyone.
But true, I don't cry my way on my way to Wednesday happy hour. I'm smiling on my way home to see my family instead. 🙂
We were very involved in acute care consults in residency. Trauma, neurosurgery, neuro called us all the time for consults. As an attending, docs call me up all the time to get their patients to rehab.
I've never felt disrespected by anyone based on my specialty choice. And I've never personally heard of another physiatrist feeling disrespected by another purely because of their specialty choice. Sometimes certain folks are just jerks and disrespects everyone.
But true, I don't cry my way on my way to Wednesday happy hour. I'm smiling on my way home to see my family instead. 🙂
We consulted PM&R on like every other pt for our attached rehab unit when I was on IM as an intern (thank the LORD I'm not IM), and I didn't see them once.
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Definitely do NOT have an attached rehab unit for our acute care hospital. I'm sure our offsite SNF has physiatrists all over the place. In terms of a consult service, yes...there's an outpatient consult service where the patient will see a physiatrist or there's PT/OT inpatient. I literally just checked the EMR and there actually IS a consult present for a PM&R physician, but when you click it, it advises you to place a PT consult instead.
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LOL, yeah, it wasn't at all uncommon when we called the trauma (or whoever) service to clarify the reason for a consult we'd get a "oh, I thought you were PT, sorry, we just want PT to eval the pt and see if they can go home."
It sounds like you have no inpatient PM&R consult service, which is common. PT/OT can see the patient and usually have a good idea if the patient is a good acute rehab candidate vs SNF or home.
Outpt PM&R is very different than inpatient, but regardless you won't see them entering the hospital any more often than an outpatient psychiatrist or dermatologist.
Well, that's a lousy consult service. They should be either talking to you or calling you as any good consultant would. Unless literally all your consult is for is for dispo recs (acute rehab vs SNF vs home), but even then typically the referring team wants an answer sooner than later and hospitalists are too busy to keep checking the chart for new notes on every patient.
Pivoting back to the OP--have you ever rotated through PM&R? Neuro is often a required rotation but not PM&R. I had an academic idea of what I'd like, but when I actually rotated though specialties certain ones just felt like a better fit. And hence how I ended up in PM&R.
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