Are You Happy?

[Feed Me]

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Are you generally happy and satisfied with your life? Your profession and the type of practice you’re in? On average, how many hours do you put in a week and how many seeing patients vs. finishing paperwork after hours, etc.? Do most of you have families and get to spend quality time with them? With where you’re at now, do you feel like it was worth going through med school to get to this point?

This seems like the perfect specialty for me because it is what I am truly interested in, and I wouldn’t really feel like it was work. In that case, 55 or 60 hour weeks aren’t that bad and still allows for sufficient time outside the office. Is this kind of how any of you feel or is the naivety oozing out of me?

Of course, this all has to be taken with a grain of salt because I need to get more direct exposure to it and go through all my shadowing and rotations with an open mind, but I just can’t see anything catching my interest like this.

Thoughts? Thanks for your help and patience.

 

[RUOkie]

yes I am
60-70 hrs/wk, sometimes as much as 90, or as little as 40.
I see too much of my wife 😛 (she runs the office) but have adequate time to train for shorter length triathlons.

 

[SSdoc33]

satisfied. regular hours. no call.

i also see too much of my wife, but she is trying to lose weight. i kid.

 

[deleted185747]

Anything you do in medicine will feel like work because of the PAPERWORK

 

[Momentum70]

I'm not happy, but I'm a resident and I hear it will get better. Just make sure you get into a good program. Also if they say stuff, get it in writing or you may end up regretting your program decision.

All the physiatrist I know that are finished with residency seem pretty happy though.

 

[PMR 4 MSK]

Physiatrists can work as little or as much as they want. You can choose a job where you are on call 24/7 doing inpt, or no call doing outpt, or both. You can see 5 pts a day or 55.

Happiness comes from getting paid to do what you enjoy. Most Physiatrists are happy. It does not matter how much you make, you are just going to spend it. If you can't be happy with $100K/year, there is something wrong with you. You'll likely make at least twice that, though.

 

[SSdoc33]

I'm not happy, but I'm a resident and I hear it will get better. Just make sure you get into a good program. Also if they say stuff, get it in writing or you may end up regretting your program decision.

All the physiatrist I know that are finished with residency seem pretty happy though.

what program decision? isnt that decision made for you anyway?

i couldnt stand residency. i really like my job now that im out. and honestly, its not just because i make more now.

 

[Feed Me]

what program decision? isnt that decision made for you anyway?

i couldnt stand residency. i really like my job now that im out. and honestly, its not just because i make more now.

That seems to be a common theme from what I have seen on here. I guess I have to ask why is that? And what parts improve when you become an attending to go from not satisfied to content?

 

[RUOkie]

That seems to be a common theme from what I have seen on here. I guess I have to ask why is that? And what parts improve when you become an attending to go from not satisfied to content?

PM&R is a vast field of medicine. There are so many avenues for you to travel in, that you can change your practice so that you do what you love.

10 yrs ago, I was very unhappy with my life. I was in an academic position, and I was TOLD what to do by my section chief. When I tried to expand my EMG practice, I ended up in a meeting with the Neurology chief, who effectively told our chief that they would kill the rehab unit unless I ceased and desisted. I changed jobs.

Then for a while I did a lot of inpatient to help pay bills, and have slowly shifted my practice to what it is now. My wife (who is my office manager) looked at what we are doing now, and said to me last night "You really have your dream practice, don't you?". It took time and patience. But the answer is "yes".

 

[SSdoc33]

That seems to be a common theme from what I have seen on here. I guess I have to ask why is that? And what parts improve when you become an attending to go from not satisfied to content?

the short answer is that most residency programs are mediocre, and do not prepare you for the majority of how most physiatrists practice. mainly, this has to do with inpatient rehab sucking up an inane amount of time and energy. at least this was the problem i had. it went something like this

internship: wow, i am working hard, but i guess thats normal. kind of fun putting to use what i learned in med school

pgy2: ok. lot of what i did last year, just not as high-level. this sucks. what is this emg thing all about? my stroke attending literally cannot speak english. how come i am the only one who bothers to show up for team meetings?

pgy3: hmm another year of inpatient medicine and my attending doesnt seem to even know how examine a shoulder. thats pretty strange. at least i have a month to spend doing the sort of medicine i like.

pgy4: alright, this is a little bit better

fellowship: why the hell didnt i do any of this before. residency blows.

attending: all must kneel to my outpatient spine greatness!!!!

 

[PMR 4 MSK]

the short answer is that most residency programs are mediocre, and do not prepare you for the majority of how most physiatrists practice. mainly, this has to do with inpatient rehab sucking up an inane amount of time and energy. at least this was the problem i had. it went something like this

internship: wow, i am working hard, but i guess thats normal. kind of fun putting to use what i learned in med school

pgy2: ok. lot of what i did last year, just not as high-level. this sucks. what is this emg thing all about? my stroke attending literally cannot speak english. how come i am the only one who bothers to show up for team meetings?

pgy3: hmm another year of inpatient medicine and my attending doesnt seem to even know how examine a shoulder. thats pretty strange. at least i have a month to spend doing the sort of medicine i like.

pgy4: alright, this is a little bit better

fellowship: why the hell didnt i do any of this before. residency blows.

attending: all must kneel to my outpatient spine greatness!!!!

AWESOMENESS! PURE AWESOMENESS!!!

😍

 

[ml2001]

the short answer is that most residency programs are mediocre, and do not prepare you for the majority of how most physiatrists practice. mainly, this has to do with inpatient rehab sucking up an inane amount of time and energy. at least this was the problem i had. it went something like this

internship: wow, i am working hard, but i guess thats normal. kind of fun putting to use what i learned in med school

pgy2: ok. lot of what i did last year, just not as high-level. this sucks. what is this emg thing all about? my stroke attending literally cannot speak english. how come i am the only one who bothers to show up for team meetings?

pgy3: hmm another year of inpatient medicine and my attending doesnt seem to even know how examine a shoulder. thats pretty strange. at least i have a month to spend doing the sort of medicine i like.

pgy4: alright, this is a little bit better

fellowship: why the hell didnt i do any of this before. residency blows.

attending: all must kneel to my outpatient spine greatness!!!!

Hey Dude,
If I could meet you at this moment in time, I would kneel to your greatness. Your response I quoted above is word for word what I would write to the question. I'm just finishing up residency and will be going to an interventional spine fellowship. It is amazing how much bulls**t time I have wasted from my precious life on so called inpatient service in the name of learning. Whatever I learned on the floors, I could have learned in half that time. The other half of it, in my honest opinion, just went into me working like a slave to make money for the rehab hospital.

When you say that inpatient attendings don't know how to do a proper MSK exam of a shoulder, I don't think you are exaggerating. They are soo sub-specialized that I don't want to blame them. The same goes for the MSK attendings who naturally loose touch with what we see on the inpatient side.

It is just that those of us interested in MSK are receiving the short end of the stick as most of the PM&R residencies are inpatient dominant and residents going into MSK don't give a s**t about the inpatient side; hence I feel I have wasted my precious life serving to the financial benefit of the rehab hospital.

Anyways, going back to the original question, I couldn't be happier in the place I'm at in my life. I'm finally going to be doing what I came in to do at the start of PM&R residency. However, I hear from the greats on this forum that it gets boring pretty soon. We shall see in my case if that applies...

-ML

 

[lobelsteve]

SO all we have to do is separate PMR into PM and R.

Like PMR4MSK said.


No more pain fellowships, no more inpatient rehab.

If you are in PM: Sports, spine, occmed, Pain. Return to PLOF or better.
If you are in R: Stroke, SCI, TBI, MD, Peds, P&O. Return to IADL's or close.


Never gonna happen with the money for procedures and lack of current controls for opiates.

How to: Sit Algosdoc, SSDoc, PMR4MSK, me, Rathmell, Rinoo, Grabois, DePalma, and 10-20 others in a room. No weapons allowed.

PM becomes socialized medicine and all docs are employed by the govt. Salary = 90% MGMA for current pain with 3% COLA per year and govt benefits.

No bonus, no chance to be a zillionaire and make $2-5million per year stabbing everything that moves.

But it divides taxonomy to allow 2 things: Interventional procedures are only allowed to be done withing this taxonomy. No more surgeons or IR or weekend warriors. But, outpatient opiates become the sole purview of PM. Exceptions for 3 days ER, 3 weeks post-op and palliative care/hospice. No ability to Rx from anyone outside the taxonomy.

My plan best benefits the US public and would be a huge cost savings to CMS.
Drug companies get dinged, doctors feelings get hurt by not being able to inject without adequate training or Rx without a clue.

I'd have to take a pay cut, but I can make up for it by reviewing cases.

And go.

 

[Prof Moriarty]

pgy2: ok. lot of what i did last year, just not as high-level. this sucks. what is this emg thing all about? my stroke attending literally cannot speak english. how come i am the only one who bothers to show up for team meetings?

pgy3: hmm another year of inpatient medicine and my attending doesnt seem to even know how examine a shoulder. thats pretty strange. at least i have a month to spend doing the sort of medicine i like.

Grrrrreeeaaat.

I'm starting my PGY-2 at a balanced program (50/50 : inpt/outpt) with a strong MSK component, but my upcoming year is still >90% in-patient. Any tips for how to make this more tolerable and get the most out of my education while I'm at it?

 

[lobelsteve]

Grrrrreeeaaat.

I'm starting my PGY-2 at a balanced program (50/50 : inpt/outpt) with a strong MSK component, but my upcoming year is still >90% in-patient. Any tips for how to make this more tolerable and get the most out of my education while I'm at it?

Earbud headphones with wires hidden behind ears.

 

[PMR 4 MSK]

Grrrrreeeaaat.

I'm starting my PGY-2 at a balanced program (50/50 : inpt/outpt) with a strong MSK component, but my upcoming year is still >90% in-patient. Any tips for how to make this more tolerable and get the most out of my education while I'm at it?

Learn to do your rounds, H&Ps and D/C summaries quick, so you have some free time. Then go haunt the EMG clinic or other oupt clinics when you have that time, if they'll let you.

Go down to the PT gym and watch them do their initial evals. PTs and OTs do a lot of interesting things to isolate muscle groups to identify and document specific areas of dysfunction. Then go to the outpt gym and do the same.

We had an attending, a recent grad of our program who came back after fellowship, who led periodic MSK meetings outside of our regular schedule - often 7 or 7:30 am, to learn exam and Hx skills.

Otherwise, read a lot and watch youtube videos of MSK exams. Practice them on other residents or family.

 

[bedrock]

the short answer is that most residency programs are mediocre, and do not prepare you for the majority of how most physiatrists practice. mainly, this has to do with inpatient rehab sucking up an inane amount of time and energy. at least this was the problem i had. it went something like this

internship: wow, i am working hard, but i guess thats normal. kind of fun putting to use what i learned in med school

pgy2: ok. lot of what i did last year, just not as high-level. this sucks. what is this emg thing all about? my stroke attending literally cannot speak english. how come i am the only one who bothers to show up for team meetings?

pgy3: hmm another year of inpatient medicine and my attending doesnt seem to even know how examine a shoulder. thats pretty strange. at least i have a month to spend doing the sort of medicine i like.

pgy4: alright, this is a little bit better

fellowship: why the hell didnt i do any of this before. residency blows.

attending: all must kneel to my outpatient spine greatness!!!!

+1
One of the best summaries of all time.

 

[scifiMD]

For some insane reason, I was one of those residents that loved inpatient rehab. I like taking care of people in the hospital setting. I like that they come in destroyed and go out improved--sometimes back to near normal-->it feels good and patients and families appreciate you for your time/counselling/effort. I love inpatient therapist and I love the teamwork. I guess what I'm saying is that there has to be more of the folks like me out there. We are not all bitching and moaning about residency. Hell, after my hellish intern year (the one month of neurosurgery alone had me suicidal), residency was awesome--a cake walk even!

PGY-1: pure evil q4 call on medicine/neurology, q3 call on ortho sx/trauma sx, brief q2 call (how did that even happen!?!?) on neurosurg

PGY-2: freedom!! sweet sweet freedom!! and I get to do PM&R now? yes, please

PGY-3: other than being back on overnight call for peds rehab months, doing just fine

PGY-4: all EMGs all the time

I'm in academics now and still loving inpatient. The bane of my existence is staffing resident clinic. If I have to see one more back pain patient....arrrgh!!!

Being the attending is great--> you can duck out for an outing with your kid for half the day and still get all your work done due to the indentured servants, oh, I mean residents--I kid, I kid 🙂

For any specialty, paperwork (or EMR work) will kill you. I have friends in rheum, family med, neuro--they are all swamped with it. We all wish for the glory days (which we never had and never will have) when you could just see the patient, help them out, and not have to write or dictate every single thing that happened in the room. Can we just switch to video recording every clinic visit? Let the billers/coders just watch the whole thing and decide what we did or didn't do. Or hell, just have some sort of billing and coding robot in the room with us. They can make a little video game "ding" when we accrue points--> like coins in Super Mario or Sonic rings!

Alright, apparently I've gone manic this AM. My point: PM is great, and R is great too. Just find the part you fit into👍

 

[PMR 4 MSK]

Alright, apparently I've gone manic this AM. My point: PM is great, and R is great too. Just find the part you fit into👍

And also consider this - while you will likely pass written and oral boards just with your residency, after 10 years out in the field, you will have forgotten most of what you don't practice. You will then have to figure out what you need to re-learn to pass the re-certification exam. The more specialized you become, the harder it is.

I found the recert to be much more inpatient-oriented.

 

[Gauss]

I'm in academics now and still loving inpatient. The bane of my existence is staffing resident clinic. If I have to see one more back pain patient....arrrgh!!!

Being the attending is great--> you can duck out for an outing with your kid for half the day and still get all your work done due to the indentured servants, oh, I mean residents--I kid, I kid 🙂

For the residents reading this, this is not at all how practice is outside of academics.

 

[scifiMD]

For the residents reading this, this is not at all how practice is outside of academics.

That's one of the factors that kept me in academics. I had too many friends running solo rehab floors in small town America that were on call 24/7 which required finding locum tenens just to cover their vacations. I'd rather still teach the yout's and take the paycut. Just boils down to what you want to do.

 

[Louisville04]

That's one of the factors that kept me in academics. I had too many friends running solo rehab floors in small town America that were on call 24/7 which required finding locum tenens just to cover their vacations. I'd rather still teach the yout's and take the paycut. Just boils down to what you want to do.

If a hospital has a rehab floor, they will have more than one physiatrist. Even if you are in solo practice, there usually is an agreement with your colleagues for coverage.

Locums tenens is silly for coverage. Why apply for privileges and possible medical license for two weeks of coverage.

24/7 call is somewhat of a misnomer. When I was in residency, a female attending would never do weekend call. Her husband was a physician as well so money was not a factor. Whereas one attending would do a lot of weekend coverage (I think his wife was a homemaker and he had three kids).

 

[RUOkie]

If a hospital has a rehab floor, they will have more than one physiatrist. Even if you are in solo practice, there usually is an agreement with your colleagues for coverage.

Locums tenens is silly for coverage. Why apply for privileges and possible medical license for two weeks of coverage.

24/7 call is somewhat of a misnomer. When I was in residency, a female attending would never do weekend call. Her husband was a physician as well so money was not a factor. Whereas one attending would do a lot of weekend coverage (I think his wife was a homemaker and he had three kids).

You are quite incorrect. There are many hospitals in America with rehab floors and one physiatrist. The current CMS regs make coverage for more than 48hrs difficult because of the "post admission screen". Locums docs for PM&R can make a fortune if they only cover these type units, because there are so few Locums in our field.

 

[Louisville04]

You are quite incorrect. There are many hospitals in America with rehab floors and one physiatrist. The current CMS regs make coverage for more than 48hrs difficult because of the "post admission screen". Locums docs for PM&R can make a fortune if they only cover these type units, because there are so few Locums in our field.

Okay going with your assumption,

What happens if the physiatrist suddenly becomes seriously ill or has a family emergency (i.e elderly parent ill) requiring him to leave town for 1-2 weeks. There is no time to find coverage, what happens to the rehab floor?

I have spoken with locums companies about inpatient coverage, and it definitely is not a fortune.

 

[SSdoc33]

Okay going with your assumption,

What happens if the physiatrist suddenly becomes seriously ill or has a family emergency (i.e elderly parent ill) requiring him to leave town for 1-2 weeks. There is no time to find coverage, what happens to the rehab floor?

I have spoken with locums companies about inpatient coverage, and it definitely is not a fortune.

Internist will cover. Scoop of chocolate, scoop of vanilla

 

[RUOkie]

Okay going with your assumption,

What happens if the physiatrist suddenly becomes seriously ill or has a family emergency (i.e elderly parent ill) requiring him to leave town for 1-2 weeks. There is no time to find coverage, what happens to the rehab floor?

I have spoken with locums companies about inpatient coverage, and it definitely is not a fortune.

We are going through that right now. Physiatrist who has been med director is leaving town. Hospital wants me to be the med director, but I don't have the time or the desire to work with that hospital administration for inpt rehab (lots of bad blood, and I like my current practice too much). I am willing to admit patients though. When I have gone on vacation in past yrs, getting IM to cover was just fine, but apparently the addition of the "post admission screen" by the physiatrist has thrown a big monkey wrench into the situation. Basically, when I'm not available, nobody gets admitted.

Come to rural OK, we can't find inpt coverage, and the hospital is willing to pay.