Are you happy you chose PM&R?

[namethatsmell]

I'm a 3rd year med student and PM&R is on my radar--I've done a little bit of shadowing in the field (only inpatient at this point) and I've been following this board for the better part of the last year. I'd like to thank everybody for helping to paint as much of a picture of the field as the internet allows.

Anyway, I saw this topic on another board and found nothing similar/current after searching this forum, so...

Are YOU happy with your career in physiatry? Why/why not?

What's your practice environment like?

Where do you see the field going in the next 10-20-30 years?

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[RUOkie]

I'm a 3rd year med student and PM&R is on my radar--I've done a little bit of shadowing in the field (only inpatient at this point) and I've been following this board for the better part of the last year. I'd like to thank everybody for helping to paint as much of a picture of the field as the internet allows.

Anyway, I saw this topic on another board and found nothing similar/current after searching this forum, so...

Are YOU happy with your career in physiatry? Why/why not?

What's your practice environment like?

Where do you see the field going in the next 10-20-30 years?

1) yes I am happy. In practice 15 yrs. 9/10 days I wake up happy to go to work
2) Generalist-solo practice: Outpt msk medicine, EMG, msk Ultrasound, Non-fluoroscopic injections, some inpt consults, occasional rehab admissions.
3) no effin' idea over the next 5 yrs, let alone 30

 

[PMR 4 MSK]

1 most of the time
2 group, multi-specialty, mostly ortho
3 10 years - vane attempts to keep inpatient rehab alive
20 years - complete abandonment of inpatient rehab
30 years - resurrection of inpatient rehab
40 years - other specialities finally figure out what we do
50 years - patients finally figure out what we do
60 years - Physiatrists finally figure out what we do

 

[RUOkie]

what do we do again?

 

[DrFreshair]

🙄 It seems a lot of frustration here......

1 most of the time
2 group, multi-specialty, mostly ortho
3 10 years - vane attempts to keep inpatient rehab alive
20 years - complete abandonment of inpatient rehab
30 years - resurrection of inpatient rehab
40 years - other specialities finally figure out what we do
50 years - patients finally figure out what we do
60 years - Physiatrists finally figure out what we do

 

[caedmon]

...No frustration here

1) Yes. As with any job there are days that can be tough.
2) Work in a large Neurosurgery/physiatry group. Business hours. No call. Do interventional spine, EMG, MSK including ultrasound.
3) You never know. Could die, could thrive. With some of the new studies out showing that PM&R saves money in the long run for spine patients, it is a big opportunity for us to grow. I know in my group we get a lot more patients who we take care of as surgery isn't approved.

 

[deleted185747]

I am a senior PM&R resident with a pain fellowship all lined up for next year. Today, as part of my sports medicine rotation, I was able to scrub in and help with a total knee arthroplasty, high tibial osteotomy and arthroscopic meniscectomy. I had way more fun today than doing PM&R clinic... Ortho is pretty sweet 😍

 

[SSdoc33]

I am a senior PM&R resident with a pain fellowship all lined up for next year. Today, as part of my sports medicine rotation, I was able to scrub in and help with a total knee arthroplasty, high tibial osteotomy and arthroscopic meniscectomy. I had way more fun today than doing PM&R clinic... Ortho is pretty sweet 😍

then be an orthopedic surgeon

i agree that id like to see orthopedic patients rather than an SCI with a million systems to cover, but holding a retractor for 3 hours while the orthopods dont notice you are alive doesnt seem like much fun to me.


i am very happy with my choice of PM&R. we have a bit of an identity crisis, but if you swallow that, its a good field. best part about it? i get to spend time with my family, earn a decent paycheck, and am never on call. whats not to like?

 

[bronx43]

I am a senior PM&R resident with a pain fellowship all lined up for next year. Today, as part of my sports medicine rotation, I was able to scrub in and help with a total knee arthroplasty, high tibial osteotomy and arthroscopic meniscectomy. I had way more fun today than doing PM&R clinic... Ortho is pretty sweet 😍

Agree with SSdoc. You aren't gonna be doing cases in the OR with the orthopods. You'll be covering clinic and other non-OR duties. Maybe if you love ortho surgery that much, you can wait until the ortho fever dies down and apply for a residency spot. Highly unlikely in the short term, but stranger things have happened.

 

[deleted185747]

I'm back with an update:

The day after my fun day of drilling, coring, and plating joints I was going to come in extra early for another surgery. Well I slept in turns out I like sleep more than surgery

 

[lobelsteve]

Some of us PMR guys spend 2-3 days a month in the OR, and 5 days a week in clinic/fluoro suite. We cut people open and look inside. Now it's not like we are removing lamina, but I've popped out an X-stop, some pedicle screws (C-spine and L-spine), and a ton of batteries and wires.


This thread is silly- don't ask the guys actively participating on the internet forum for PMR if they like it. We all love it. Go find the folks who hate their jobs and do inpatient or Peds PMR and get paid less than IM does. They will be the ones telling you PMR stinks.

 

[namethatsmell]

Some of us PMR guys spend 2-3 days a month in the OR, and 5 days a week in clinic/fluoro suite. We cut people open and look inside. Now it's not like we are removing lamina, but I've popped out an X-stop, some pedicle screws (C-spine and L-spine), and a ton of batteries and wires.

Interesting. I understand that if you've done a pain fellowship you can put in pumps and stims--do you remove these things as part of those procedures? Also, are you with a surgeon or are you solo when you implant/remove hardware?

This thread is silly- don't ask the guys actively participating on the internet forum for PMR if they like it. We all love it. Go find the folks who hate their jobs and do inpatient or Peds PMR and get paid less than IM does. They will be the ones telling you PMR stinks.

Heh, I respectfully disagree. The three PM&R docs I've spoken with all love their jobs...and ironically all of them do inpatient. However, all three are attached to academic programs and as a med student it's tough to connect with private practice docs (who might be a little bit more forthcoming about downsides of the field). I made this thread to gain a larger n and learn more about different ways PM&R docs utilize their skills and I think it's been helpful in that regard. I do see your point about this not being the most representative population to draw from, although it's kinda the best pool readily available.

So, if I can tweak one of the questions for you Dr. Lobel (or anybody else who feels like answering): what is the one thing you now know about PM&R that you wish you knew before going into the field?

Thanks to everybody for taking the time to share their thoughts and experiences--it's much appreciated!

 

[philaPMR]

Some of us PMR guys spend 2-3 days a month in the OR, and 5 days a week in clinic/fluoro suite. We cut people open and look inside. Now it's not like we are removing lamina, but I've popped out an X-stop, some pedicle screws (C-spine and L-spine), and a ton of batteries and wires.


This thread is silly- don't ask the guys actively participating on the internet forum for PMR if they like it. We all love it. Go find the folks who hate their jobs and do inpatient or Peds PMR and get paid less than IM does. They will be the ones telling you PMR stinks.

I wouldn't jump to the conclusion that everyone doing outpatient PMR loves their jobs and everyone doing inpatient PMR hates their jobs. I do a mix of inpatient and outpatient neurorehabilitation and I love my job. My colleagues who all do both inpatient and outpatient feel the same way I do. As has been said many times before, PMR is a vast field. If you are interested in outpatient work but are stuck doing inpatient rehab, you will be unhappy. If you want to take care of hospitalized patients, lead an interdisciplinary team, form a connection with your patient and their families as they recover from devastating injury, and then assist them through the entire continuum of their recovery (months to years) but are stuck in a job seeing outpatients every 15 minutes, then you will be unhappy.

find what part of the field you like, go get that job, and you'll be fine.

 

[jopo]

This thread is silly- don't ask the guys actively participating on the internet forum for PMR if they like it. We all love it. Go find the folks who hate their jobs and do inpatient or Peds PMR and get paid less than IM does. They will be the ones telling you PMR stinks.

At the beginning of my third year I found a PM&R physician to shadow for a day... she definitely did not enjoy her job and almost blatantly told me to pick another specialty. That day we did botox injections on a toe walking kid, consulted on a 13 yo with painful diabetic neuropathy (recommended lyrica and moved on), and then saw a few kids in clinic for FU. I convinced myself that she has just given up being a real doctor and has lost perspective of what she can offer to patients.

Here is an example of what I mean by that last sentence: On another day I saw an adult patient with her who was on metformin but who did not currently have a pcp. Her metformin dose was way to low and when I presented the patient and recommended an increase of dose she said that was out of the scope of practice for PM&R (which I disagree with since I believe all specialist are first a physician and then their speciality, any intern can handle a metformin increase, and this lady did not have a pcp so it's not like there would be too many cooks in the kitchen). Also, it seemed that the PT and brace making guy were better at assessing the patients needs and she was just there to go through the motions and sign the paperwork. She also commented that everyone just want to go see ortho anyway...

I found another physician at the same hospital and he too was not excited about the field, I did not spend much time with him so I don't know why he is not happy. Maybe it is just the hospital and the niche they have there (which is not a niche, people know of them but they are very peripheral and even placed in a side building with PT away from everyone else).

I guess I'm just posting to say that my real life interactions, n=2, are far from what is seen of this forum. I'm planning to get a little more exposure to the field, but if the real life interaction don't improve I'll be going into interventional rad or rad onc.

 

[namethatsmell]

I guess I'm just posting to say that my real life interactions, n=2, are far from what is seen of this forum. I'm planning to get a little more exposure to the field, but if the real life interaction don't improve I'll be going into interventional rad or rad onc.

Hey jopo--not sure where you're located, but if there's a PM&R residency program anywhere near you I recommend trying to shadow/chat with some of those docs. I've done so in two different cities and the attendings (n=3) I've interacted with are mostly or totally in love with the field (they all do mostly inpatient). The programs I was at are competitive so the residents were quite bright/motivated and shared some interesting reasons for going into the field--actually, one of the residents had already completed an ortho residency but later decided that he wanted to be a physiatrist. I was pretty much set on another field, but these interactions are making me strongly consider PM&R.

 

[Louisville04]

Here is an example of what I mean by that last sentence: On another day I saw an adult patient with her who was on metformin but who did not currently have a pcp. Her metformin dose was way to low and when I presented the patient and recommended an increase of dose she said that was out of the scope of practice for PM&R (which I disagree with since I believe all specialist are first a physician and then their speciality, any intern can handle a metformin increase, and this lady did not have a pcp so it's not like there would be too many cooks in the kitchen). Also, it seemed that the PT and brace making guy were better at assessing the patients needs and she was just there to go through the motions and sign the paperwork. She also commented that everyone just want to go see ortho anyway...



I guess I'm just posting to say that my real life interactions, n=2, are far from what is seen of this forum. I'm planning to get a little more exposure to the field, but if the real life interaction don't improve I'll be going into interventional rad or rad onc.

I think if the physiatrist changed the metformin dose, she would be responsible for further changes as well continued diabetes management. I wonder how that patient didn't have a PCP and was on metformin?

I work at a VA and the majority of musculoskeletal problems are sent to physiatry unless surgery is clearly indicated. Since orthopedists are very expensive to hire, physiatrists are sort of like the gatekeepers in the VA.

I think interventional radiology and radiation oncology are excellent choices $$$ 🙂

 

[padresp]

For what it's worth, I'm a PGY-2 PM&R resident who had a career prior to going back to med school. I definitely see the world in shades of grey and not black/white. I have definitely come to the realization that it's not the field in which they enter that makes the person happy.

Everyone who has completed college, med school, residency, whatever... think back to someone who was happy when it all began. Far more often than not, those are still the people who are happy. The people who were miserable and uptight are still the same way. Saying that, what I didn't realize is that certain personalities are drawn to certain fields. Surgery selects surgeons; surgery doesn't make surgeons. True, the hours don't help, but it's the personality that dictates the choice of field, then it is perpetuated.

That has been the biggest reason I'm happy with physiatry. The people are more like me than any other field. The mindset, for the most part, is that we don't care what a patient looks like, we don't care (as much) what their diagnosis is, we don't care about our social status, and we don't care if a true cure just doesn't exist. We just care if people are able to live their lives better after seeing us.

Find the field that fits you best and enjoy it.

 

[jopo]

Hey jopo--not sure where you're located, but if there's a PM&R residency program anywhere near you I recommend trying to shadow/chat with some of those docs.

I'm hoping to visit a residency program, but the nearest one is a 3.5 hour drive away so it's been difficult finding time away from my clerkships.

I think if the physiatrist changed the metformin dose, she would be responsible for further changes as well continued diabetes management. I wonder how that patient didn't have a PCP and was on metformin?

I work at a VA and the majority of musculoskeletal problems are sent to physiatry unless surgery is clearly indicated. Since orthopedists are very expensive to hire, physiatrists are sort of like the gatekeepers in the VA.

I think interventional radiology and radiation oncology are excellent choices $$$ 🙂

Yes, and I understand that one may not want to, but the fact that I was told I could not do that for a patient as a PM&R while a pcp was found was a little disturbing esp when one is trying to prevent further disability. Not sure how i feel about being a gate keeper though.

Yes, IR and rad onc do have the potential of $$$, but there are only so many wave runners a guy can buy 🙄

For what it's worth, I'm a PGY-2 PM&R resident who had a career prior to going back to med school. I definitely see the world in shades of grey and not black/white. I have definitely come to the realization that it's not the field in which they enter that makes the person happy.

Everyone who has completed college, med school, residency, whatever... think back to someone who was happy when it all began. Far more often than not, those are still the people who are happy. The people who were miserable and uptight are still the same way. Saying that, what I didn't realize is that certain personalities are drawn to certain fields. Surgery selects surgeons; surgery doesn't make surgeons. True, the hours don't help, but it's the personality that dictates the choice of field, then it is perpetuated.

That has been the biggest reason I'm happy with physiatry. The people are more like me than any other field. The mindset, for the most part, is that we don't care what a patient looks like, we don't care (as much) what their diagnosis is, we don't care about our social status, and we don't care if a true cure just doesn't exist. We just care if people are able to live their lives better after seeing us.

Find the field that fits you best and enjoy it.

True

 

[RUOkie]

Yes, and I understand that one may not want to, but the fact that I was told I could not do that for a patient as a PM&R while a pcp was found was a little disturbing esp when one is trying to prevent further disability.

True

jopo, I saw a lady in my office for back pain 4 months post kyphoplasty. During my PE, I checked her BP and it was 260/145. She was dizzy.

What should I have done? I have not managed hypertension in 15yrs.

What I did was send her to the ER, and then said she NEEDED to see her PCP PRIOR to coming back to see me for her back. By doing it that way, it minimized my exposure to risk, and ensured that she got GOOD medical care. Given my current level of knowlege, I could have offered to manage her BP, but I would have done it poorly. Much like the PCP's who manage acute low back pain with opiates as the first option.

 

[deleted185747]

jopo, I saw a lady in my office for back pain 4 months post kyphoplasty. During my PE, I checked her BP and it was 260/145. She was dizzy.

What should I have done? I have not managed hypertension in 15yrs.

What I did was send her to the ER, and then said she NEEDED to see her PCP PRIOR to coming back to see me for her back. By doing it that way, it minimized my exposure to risk, and ensured that she got GOOD medical care. Given my current level of knowlege, I could have offered to manage her BP, but I would have done it poorly. Much like the PCP's who manage acute low back pain with opiates as the first option.

You did EXACTLY the right thing. SBP >180 with any type of symptom which could suggest end organ damage are admitted to the ICU as "hypertensive emergency" and drips are started to drop the BP asap.

 

[jopo]

jopo, I saw a lady in my office for back pain 4 months post kyphoplasty. During my PE, I checked her BP and it was 260/145. She was dizzy.

What should I have done? I have not managed hypertension in 15yrs.

What I did was send her to the ER, and then said she NEEDED to see her PCP PRIOR to coming back to see me for her back. By doing it that way, it minimized my exposure to risk, and ensured that she got GOOD medical care. Given my current level of knowlege, I could have offered to manage her BP, but I would have done it poorly. Much like the PCP's who manage acute low back pain with opiates as the first option.

I understand that; my main concern was that I was told I could not help a patient lost in the system as PM&R and although I would be willing to take the risk/FU if needed until a pcp was found I still would not be able to do it. This bothered me because her dose was a little more effective than chewing bubble gum and we work in a large hospital where it is easy to set up pcp appointment...they just take a few weeks to get in. Also, metformin is titrated up every two weeks or so; therefore, if I bumped her up 500mg in a few weeks when she gets to see a pcp I've saved them one titration period.

On a side note: Don't some PM&R physicians serve as primary care for quadriplegic/paraplegic individuals?

I apologize for getting this thread off topic.

 

[jopo]

I apologize for getting this thread off topic.

Just to get this back on topic. I just wanted to say that I've met two unhappy physiatrist and I think they are unhappy because just like other unhappy physician they feel trapped in a system where they just go through the motions.

 

[RUOkie]

I understand that; my main concern was that I was told I could not help a patient lost in the system as PM&R
On a side note: Don't some PM&R physicians serve as primary care for quadriplegic/paraplegic individuals?
.

Regarding the first point, I think your assessment of that doctor is correct. He/she feels disempowered, has gotten lazy, and has forgotten why people become physicians in the first place.

There are some SCI docs who act as PCPs for their SCI injured patients, but not many. Especially once they start aging and need routine health maintanance stuff.

 

[PMR2008]

On a side note: Don't some PM&R physicians serve as primary care for quadriplegic/paraplegic individuals?

I have worked with a few but even they end up deferring some of the complicated medial things to the PCP. PM&R is a specialized field and typically during appointments their are many rehab and medical issues that come up. I think it is in the patients benefit to have a PCP who can manage DM, HTN, CAD etc. We are excellent at managing the bigger picture, pain, bowel/bladder, gait/balance, prosthetics/orthotics, msk problems, spasticity etc.

 

[scifiMD]

In response to the main topic: hells to the yeah. The things I hate about being a doctor (paperwork, paperwork, paperwork, insurance AKA the devil, drug seekers, incessant questions from my family members about their medical concerns) are not exclusive to any one field. So on days I hate my job, I hate it for the bureaucracy, not the specialty. And I think those people out there that say "I love going to work every single day!" are either liars or we need to harvest their brain chemicals to make the world's best happy pill for everyone. I have an ongoing argument with my husband about professional athletes and this fact. He thinks these guys probably LOVE EVERY DAY! The games! The practices! They are living the dream!! While I insist that it's still just a job. They probably get up groaning like the rest of us. "It's time to make the donuts."

In response to the medical managment issues: It mainly depends on comfort level in my opinion. I do inpatient stroke rehab (with odds and ends of outpatient things to boot) and I feel like a big portion of my job is internal med. I do more HTN and DM management than most, so I wouldn't have a problem with this. Others, not so much. To each their own--in this broad and varied field, we make our job what we want it to be.

 

[RUOkie]

. I have an ongoing argument with my husband about professional athletes and this fact. He thinks these guys probably LOVE EVERY DAY! The games! The practices! They are living the dream!! While I insist that it's still just a job. They probably get up groaning like the rest of us. "It's time to make the donuts."
.

as someone who has worked with athletes of every level, I can assure you that you are correct. The pros work harder than the amateurs because they have to. But most competitive athletes at all levels have many days that they HATE the training.