Can I do PMR and some medicine on the side?

[wjs010]

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Hi, MS3 here. coming down the the home stretch now and realizing 3rd year is almost over. I've had a weird mix of likes/interests these past few years. In college I graduated in kinesiology( I always loved sports, working out, bodybuilding, etc.) and was accepted into PT school..for some picky reasons I decided to defer and give it a lot of thought what I really wanted to do with my career, because I had taken physiology/cancer biology courses in college and really enjoyed it. I ended up finding SDN actually and got lucky enough to find out this PMR thing. I did a lot of reading about it and thought it provided everything I might want. I ended up figuring that I should go to medical school and REALLY see the vast array of options that it would provide, and boy was I right. I loved the first two years of med school. Medicine in general, i really like. I truly enjoy thinking about all the different types of diseases. I am a DO student and went into it thinking it would add to my background, etc. However, I really did not enjoy the OMM stuff. I liked my ortho rotation okay(not surgery, just the clinic stuff). So for the first two years I had my eyes on IM, because of the range of things you can do with it. It's still an option for me. I also liked Rheumatology and dermatology during our coursework. Then, third year came around and i was lucky enough to land a Dermatology rotation early on. I had a lot of fun and loved it. so this also becomes an option. So I have IM, derm, and a vague, naive notion of EM and PMR. PMR sounds great because of my background, but I don't know anything about how practice is like. I will do a rotation in 4th year to see how it is. EM is a required rotation so I will definitely find out how that is.EM worries me because of the burnout scare. I have a feeling I will really like PMR as a whole.

I guess I could have left out that story and just asked what I really want to ask: If I go into PMR, am I forever banished from doing a shift in the ER or a shift in the hospital(or even an urgent care clinic for that matter) doing regular medicine? If I could do that every now and then on the side while doing PMR, that would be me hitting the jackpot. thanks for reading

 

[DoctorPar]

I don't get the impression Urgent Care centers have the most or even appropriately qualified physicians working there... so if you really wanted to, you probably could (although I can't say that with 100% confidence). You wouldn't be able to do shifts in the ER. However, there's a ton of medicine in PM&R. Do you have a PM&R department at your school? Our PM&R docs do everything from inpatient consult service (assessments for stroke, SCI, TBI, amputee, and cancer patients) to purely outpatient follow-up of patients with SCI, TBI, stroke, amputee, etc. We also have a "medically complex" rehab service.... which is just like it sounds like... it's a lot of medicine!

Just to give you an example, if you're doing stroke rehab at an acute rehab center, you're going to be medically managing anticoagulants, anti-hypertensive agents, cardiac agents, (likely) DM meds, as well as neuro stimulants and your bread and butter rehab. If you're doing outpatient management for, say SCI patients, you're managing bowel/bladder, cardiovascular, and pulmonary systems in addition to your bread and butter spasticity and neurological management. I was in a similar situation to you where I liked medicine and I also like sports/msk/neuro. PM&R is where it's at. 😎

 

[wjs010]

I don't get the impression Urgent Care centers have the most or even appropriately qualified physicians working there... so if you really wanted to, you probably could (although I can't say that with 100% confidence). You wouldn't be able to do shifts in the ER. However, there's a ton of medicine in PM&R. Do you have a PM&R department at your school? Our PM&R docs do everything from inpatient consult service (assessments for stroke, SCI, TBI, amputee, and cancer patients) to purely outpatient follow-up of patients with SCI, TBI, stroke, amputee, etc. We also have a "medically complex" rehab service.... which is just like it sounds like... it's a lot of medicine!

Just to give you an example, if you're doing stroke rehab at an acute rehab center, you're going to be medically managing anticoagulants, anti-hypertensive agents, cardiac agents, (likely) DM meds, as well as neuro stimulants and your bread and butter rehab. If you're doing outpatient management for, say SCI patients, you're managing bowel/bladder, cardiovascular, and pulmonary systems in addition to your bread and butter spasticity and neurological management. I was in a similar situation to you where I liked medicine and I also like sports/msk/neuro. PM&R is where it's at. 😎

that sounds encouraging. thanks! I do not have a home anything program (DO school with no attached hospital), but do have opportunities to do rotations in PMR close by. I will try an inpatient one because I heard that is best to get a good feel for PMR. However thus far in 3rd year, I can say I do like clinics more than hospitals...I guess part of my question was because I thought they would already have a PCP who managed their chronic meds, so why would the PMR guy need to? But if I am able do that and stay within medicine while practicing PMR, it sounds pretty clutch. Now I guess its just left to trying the rotation out to see if I like it. I have a feeling I will love the rheumatology side of PMR.

 

[DoctorPar]

Most PCPs don't feel comfortable managing the care of patients a significant portion of PM&R's patients. In many ways we end up using clinic in a PCP manner for a specific set of patients (but also follow-up of those recently in acute inpatient rehab). An away rotation should give you some outpatient exposure too and I think you'll pick up quickly on what I mean. Good luck!

 

[Disciple]

There used to be a few combined IM/PMR residency programs.

 

[ED50]

Can you do a shift in the ER/acute care? Possibly, if you go somewhere rural. Should you as a PMR doc? Probably not. It's really outside your scope and you might be putting your license at risk if there is a bad outcome. By the time you could actually work in an ER which would be as a graduate or at the tail end of residency you are so far from that type of medicine that I wouldn't touch it if I were you. As others have said if you do inpatient rehab you literally can manage most everything you want and then if you don't want to manage it/ aren't comfortable you can consult someone. I have found it a nice balance. If you want to do the ED or acute care/hospital gig I'd just do IM/EM

 

[wjs010]

Can you do a shift in the ER/acute care? Possibly, if you go somewhere rural. Should you as a PMR doc? Probably not. It's really outside your scope and you might be putting your license at risk if there is a bad outcome. By the time you could actually work in an ER which would be as a graduate or at the tail end of residency you are so far from that type of medicine that I wouldn't touch it if I were you. As others have said if you do inpatient rehab you literally can manage most everything you want and then if you don't want to manage it/ aren't comfortable you can consult someone. I have found it a nice balance. If you want to do the ED or acute care/hospital gig I'd just do IM/EM

I don't rly want acute care. I actually like the clinic way more. Thank you. I was afraid that may be the case. Choosing a specialty was easy until third year when I actually exerienced the specialties.


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