After 1 month of PM&R rotation...

[Dr. Bruce Banner]

I like neurology better

---

Members don't see this ad.

 

[RangerBob]

Glad to hear you are enjoying your rotation! I felt the same way about the psych aspect, and also found psych more rewarding in PM&R than on my psych rotation (which I also enjoyed).

Inpatient PM&R manages all the medical aspects of patients while they're in rehab. Some physiatrists will order consults for any minor medical problem, others handle just about everything themselves. I call the hospitalist or a specialist consult if things are getting tenuous/serious.

In addition to the medical stuff, we manage neurogenic bowel/bladder, spasticity, pain (in more comprehensive and sustainable way than other inpatient physicians), and other complications that arise in the rehab patient population, like autonomic dysteflexia, etc.

The one-liner I like is we specialize in the diagnosis and treatment of people with disabling conditions.

 

[Tigerhawk77]

To preface, I’m still a doctor. I recognize and treat life-threatening conditions every day. But in terms of the rehabilitation component so often questioned, I will tell a parable:

“What does a sommelier even do?” asks the coal miner.

“They don’t even make the wine. I can sit around and drink. That’s not a job. My job is a real job.”

The coal miner goes back to the mine, working a physical job for 14 hours. It’s dark, it’s unsafe, and it’s miserable. But to him it feels like a real job.

The sommelier goes to the vineyard. He drinks, he travels, he writes about his craft. He can’t believe he’s getting paid to do this. Sure, anyone could do this at first but so few people do. As he hones his craft, fewer and fewer people can do what he does. He develops a sense of the subtleties and science of wine criticisms. His opinion becomes very valuable. Once he let the “real job” concern go, he was a free man. And the world rewarded him handsomely.

Don’t mistake work discomfort with work value. My job is fun, interesting, and pleasurable. My clinics are full, my beds are full. Some people think I add value.

 

[claner1]

To preface, I’m still a doctor. I recognize and treat life-threatening conditions every day. But in terms of the rehabilitation component so often questioned, I will tell a parable:

“What does a sommelier even do?” asks the coal miner.

“They don’t even make the wine. I can sit around and drink. That’s not a job. My job is a real job.”

The coal miner goes back to the mine, working a physical job for 14 hours. It’s dark, it’s unsafe, and it’s miserable. But to him it feels like a real job.

The sommelier goes to the vineyard. He drinks, he travels, he writes about his craft. He can’t believe he’s getting paid to do this. Sure, anyone could do this at first but so few people do. As he hones his craft, fewer and fewer people can do what he does. He develops a sense of the subtleties and science of wine criticisms. His opinion becomes very valuable. Once he let the “real job” concern go, he was a free man. And the world rewarded him handsomely.

Don’t mistake work discomfort with work value. My job is fun, interesting, and pleasurable. My clinics are full, my beds are full. Some people think I add value.

This is beautiful.

 

[cluelessme7]

To preface, I’m still a doctor. I recognize and treat life-threatening conditions every day. But in terms of the rehabilitation component so often questioned, I will tell a parable:

“What does a sommelier even do?” asks the coal miner.

“They don’t even make the wine. I can sit around and drink. That’s not a job. My job is a real job.”

The coal miner goes back to the mine, working a physical job for 14 hours. It’s dark, it’s unsafe, and it’s miserable. But to him it feels like a real job.

The sommelier goes to the vineyard. He drinks, he travels, he writes about his craft. He can’t believe he’s getting paid to do this. Sure, anyone could do this at first but so few people do. As he hones his craft, fewer and fewer people can do what he does. He develops a sense of the subtleties and science of wine criticisms. His opinion becomes very valuable. Once he let the “real job” concern go, he was a free man. And the world rewarded him handsomely.

Don’t mistake work discomfort with work value. My job is fun, interesting, and pleasurable. My clinics are full, my beds are full. Some people think I add value.

So well put. There is a reason why PM&R used to be called/is called the hidden gem of medicine. There are other fields where you may be contributing more directly to a patient's well-being, managing all medical/surgical aspects etc. in exchange for your own physical/mental well-being. If I am able to play a role in taking care of others, whatever it may be, but also have time + money to enjoy my life, travel, spend time with my family, I would call that quite an amazing set up, and pretty much unheard of in medicine. Its akin to why specialties such as Derm have become so competitive. Overseeing care done by the team, talking to patients that are usually very appreciative, working sane hours with minimal emergencies, and getting paid pretty well--Its rare to see a PM&R doc burnt out, whereas 9/10 docs I saw during core clerkships were at the verge of quitting.

 

[DMBandFan86]

Depends what PM&R doctors you are working with. Some IPR centers admit directly to a medicine service and PM&R gets consulted. Other IPR centers the PM&R does the admission and consults specialists when needed. Even then, some PM&R docs consult medicine with any minor issue (chronic cough, stable BP's, etc) while other PM&R docs manage higher level care.

Where I work I sometimes end up treating complex medical problems including infections, acute anemia, sepsis, HTN, edema, CHF. When I consult a hospitalist they usually don't do much and I am still paged about all the medical issues. I am comfortable with it and get consultants to help when I need them. This set up is definitely more time consuming and stressful. At the same time, I also work with docs that spend very little time with the patients and just sort of wave at them and move on.

On the consult side there are places where PM&R only does disposition planning. Other places, PM&R will do consults for TBI, SCI, MSK-related complaints, neurological complaints, back pain, baclofen pumps and EMG's among others. It depends where you're working. At some institutions PM&R isn't all that well established/respected and that is where you will mostly see consults for disposition planning. At other institutions we get consulted to help manage problems on the medical floors and in the ICU.

There is a reason PM&R is so confusing to students and even other physicians. The scope of practice is very broad and treated differently everywhere you go.

 

[cgk]

So well put. There is a reason why PM&R used to be called/is called the hidden gem of medicine. There are other fields where you may be contributing more directly to a patient's well-being, managing all medical/surgical aspects etc. in exchange for your own physical/mental well-being. If I am able to play a role in taking care of others, whatever it may be, but also have time + money to enjoy my life, travel, spend time with my family, I would call that quite an amazing set up, and pretty much unheard of in medicine. Its akin to why specialties such as Derm have become so competitive. Overseeing care done by the team, talking to patients that are usually very appreciative, working sane hours with minimal emergencies, and getting paid pretty well--Its rare to see a PM&R doc burnt out, whereas 9/10 docs I saw during core clerkships were at the verge of quitting.

Are you saying that PM&R, for all your a fore mentioned reasons has become ultra competitive? Can a D.O. student with USMLE 210/ COMLEX 450 scores have a REALISTIC shot at a residency spot in PM&R?

 

[DMBandFan86]

It is a competitive field. I don't think it is 'ultra' competitive.

Your comlex score is below average. In PM&R, the board scores mostly get you screened into the applicant/interview pool (based on program specific cut-offs); so since it is below average your score is going to limit you in getting interviews. After that, your overall application takes over so I recommend that the rest of you application is impressive if you want to match into PM&R. You also need to interview well and make a good personal impression. Board scores come back to haunt you if you are head-to-head with another applicant and all they have is your board score to set you apart If you haven't taken step 2 then showing improvement on your score is key.

Overall, your board scores are going to be more important in matching to preliminary medicine / TY programs. This is especially true to for a DO student applying for ACGME prelim.

So in both aspects your are climbing up-hill more so than your average applicant. Not impossible to match, but somewhat more challenging.