For those completely naive about PMR

[daphilster]

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Hi All,

I'm an 2nd year med student starting to explore what I want to be when I grow up. I've always had an interest in physical medicine, since I used to have bad chronic backpain in high school which I saw a physical therapist for.

My question is this, what are the pros and cons on PMR? I've talked to a few docs doing it, but I still don't have a good idea. Here are some of my gatherings so far (correct me if I'm wrong):

Pro:
1) long-term patient contact & relationship building, esp. with trauma or s/p CVA pts.
2) get to do a couple of procedures such as nerve blocks/injections/NCV studies; however, limited in # of procedures you can do
2) relatively clear cut schedule of 9-5 approximately
3) compensation is decent, generally above that of IM and perhaps similar to neurology

Con:
1) You will have to work in close association with a hospital, and depend on other MDs for referrals. I don't know if many PMR MD set up their own private practice. Ironically, the physical therapists I saw in high school had their own practice and I found them in the yellow pages (they ended up being extremely helpful).
2) You DON"T actually do a lot of the physical manipulation or coach your patients directly in doing exercises. Mostly done by hired PTs.
3) Job can be emotionally rough since many pts chronically disabled (spinal cord injury).


One thing I realiize is that PMR is really broad in terms of caring for diff types of pt (ie stroke, sports medicine, backpain, amputees,etc). So can any talk about the good & bad of their experiences or expand upon my pro/con list?

 

[drusso]

Originally posted by daphilster
Hi All,


2) You DON"T actually do a lot of the physical manipulation or coach your patients directly in doing exercises. Mostly done by hired PTs.
3) Job can be emotionally rough since many pts chronically disabled (spinal cord injury).


One thing I realiize is that PMR is really broad in terms of caring for diff types of pt (ie stroke, sports medicine, backpain, amputees,etc). So can any talk about the good & bad of their experiences or expand upon my pro/con list?

You can actually do as much hands-on stuff as you'd like. Manual medicine performed by a physician is a billable procedure.

 

[daphilster]

Oh I didn't realize that. I guess the few PMRs I talked to never really got involved in manual manipulation. That's good to know.

Does anyone else with real experience in the field care to comment about my pro/cons list? I'm trying to find out more opinions on this subject.

 

[Ligament]

the big con is that the inpatient rehab units are very often seen as a dumping ground for other services, and many if not most times they will win.

also, if you only have ambitions of acting as an outpatient only MSK or EMG doc, you will still have to endure months of inpatient PMR training. This can be very trying. However, this issue is certainly not unique to PMR. For example, and OB/GYN who wants to practice only in reproductive endocrinology still has to spend gruelling months on the gyne oncology services and surgerys.

overall, PMR is filled with cool people and lots of cool opportunities for you to specialize. You will help a lot of people that otherwise would be thrown away by the other specialties.

 

[unregistered]

Originally posted by Ligament
the big con is that the inpatient rehab units are very often seen as a dumping ground for other services, and many if not most times they will win.

also, if you only have ambitions of acting as an outpatient only MSK or EMG doc, you will still have to endure months of inpatient PMR training. This can be very trying. However, this issue is certainly not unique to PMR. For example, and OB/GYN who wants to practice only in reproductive endocrinology still has to spend gruelling months on the gyne oncology services and surgerys.

overall, PMR is filled with cool people and lots of cool opportunities for you to specialize. You will help a lot of people that otherwise would be thrown away by the other specialties.

hey ligament, is this why PMR is non-competitive? Because its seen as a dumping ground? I wrote a new thread asking why this specialty seemed so non-competitive in light of its easier hours than medicine and higher pay...

 

[StinkyTofu]

PM&R is a very broad field and the schools that do have a PM&R department usually have students rotating through the inpatient rehabilitation service. I've noticed that most of the students who apply for or consider PM&R usually have greater exposure to an outpatient practice or Interventional Pain Management practice. Also, there are very few PM&R residency programs when compared to other fields and I think lack of exposure also plays a part. To answer your questions from the other thread you posted, the pay is good and the hours are very reasonable. My fellow residents in my program and residents from other programs that I know have had no problems finding a job or a fellowship (whether it is an Anesthesia-based, PM&R-based, or Neurology-based one).

With regards to the comparisons to medicine, it's not like IM is particulary competitive either and the stronger candidates usually view it as a necessary evil to Cards or GI. I remember a couple of years ago when some friends who had just finished residency got the following job offers at Kaiser (large HMO on the West Coast): $95K for FP; 110K for IM; and 150K for PM&R.

In summary, I think there is a lack of understanding with regards to what Physiatrists do, what the training entails, and what we actually get paid. I think that these are some of the reasons that despite the good hours and salary, that it still isn't as competitive as other fields. I think as more students discover the field and the broad range of opportunities, it is becoming more competitive. The majority of medical students that rotate here and the current residents are all interested in an outpatient or Interventional Pain practice. Personally, my hours are great even during residency. On average, I work 40-50 hrs/wk with the longest hours being during my Neuro rotations at MGH. The attendings in my program and in the outpatient clinics that I've worked at also have pretty good hours as well.

 

[Dramkinola]

this thread has been very interesting...
few more questions...
you said the friend done with PM&R got 150K right out of residency... what do you think realistically is his max going to be?
Do any PM&R's hit, say 300K? or is that pretty much it?
and is Pain Management also a separate specialty? or is it a subspecialty of PM&R?
and the anaesthesiology fellowship you talked about changes the patients you see, or treatment modalities how?
Thanks in advance...

 

[seefutlone]

As with any field of medicine, you can make as much money as you are willing to work.

So when you ask about max with PM&R, if you are willing to work the money will be there.

I have heard of an inpt physiatrist at my institution, who grosses over $300K! I think the department head makes over $1mil

So I guess that's your max.

 

[sdntran]

Also, the location where you live is important. If you live in southern California, it is harder to make the big bucks. Nevertheless, I know physiatrists making above 400 K just doing EMG and Nerve Conduction studies day in and day out. The bottom line is this: if you want about 150K - 200K, go academic or work for HMO (Kaiser starts at 150K and maxes out at about 220K after 9 years or so); for 200-300K, you would have to go private and work your buns off; for greater than 300 K, consider just doing procedures only; and above 450K, open a business or medical center and hire someone to work for you. Or marry well and double your income...

Good hunting.

 

[Dramkinola]

that's the kinda reply i was waiting for...
i am marrying well...haha
double the pleasure, double the fun