Hate sports med, is PMR not right for me?

[uhmocksuhsillen]

In the ideal world I'd love to work with people recovering from stroke, spinal cord issues, learning to walk with prosthetics.

The times I've rotated with a pmr doc it felt like sports medicine. Lots of painful joints which bore me to no end.

Is it possible to practice in that type of way? Will I always have my fair share of sports medicine type patients?

As an aside, I'm nearing end of M3 and have been psych all the way. Only recently have I started to consider pmr. Is it too late at this point? For ref, DO w low 240step/660s comlex. Thanks!

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[runfastnow]

PM&R definitely has a wide variety and not all is what you have experienced. You may still get random OA/joint/MSK patients that get on your schedule, but if you want a specific practice then you can make it happen.

We have physicians who see only TBI/CVA/Botox. Purely SCI practice generally entails a hybrid inpatient/outpatient practice (but you will still see a lot of MSK/joint complaints as their UEs break down from wheelchair propulsion and general overuse). Prosthetics can be highly specialized and something that makes up a large part of your practice, but again most amputees are dysvascular (and older so OA/joint/MSK issues).

If those things interest you then go for PM&R. OA and MSK complaints will be there in a large majority of patients, but if you can tolerate it as a secondary issue to your main interest (CVA/SCI/Amp) then you should go for it. Your scores seem very competitive.

 

[timisdaman]

In the ideal world I'd love to work with people recovering from stroke, spinal cord issues, learning to walk with prosthetics.

The times I've rotated with a pmr doc it felt like sports medicine. Lots of painful joints which bore me to no end.

Is it possible to practice in that type of way? Will I always have my fair share of sports medicine type patients?

As an aside, I'm nearing end of M3 and have been psych all the way. Only recently have I started to consider pmr. Is it too late at this point? For ref, DO w low 240step/660s comlex. Thanks!

You can absolutely do that type of career. It would probably be best to do an inpatient elective.

 

[uhmocksuhsillen]

PM&R definitely has a wide variety and not all is what you have experienced. You may still get random OA/joint/MSK patients that get on your schedule, but if you want a specific practice then you can make it happen.

We have physicians who see only TBI/CVA/Botox. Purely SCI practice generally entails a hybrid inpatient/outpatient practice (but you will still see a lot of MSK/joint complaints as their UEs break down from wheelchair propulsion and general overuse). Prosthetics can be highly specialized and something that makes up a large part of your practice, but again most amputees are dysvascular (and older so OA/joint/MSK issues).

If those things interest you then go for PM&R. OA and MSK complaints will be there in a large majority of patients, but if you can tolerate it as a secondary issue to your main interest (CVA/SCI/Amp) then you should go for it. Your scores seem very competitive.

Thanks for your feedback, I appreciate it. That's really good to hear. One follow up question I had - given a practice of that sort, will I be restricting my ability to certain geographic regions? I really want to come home to southern california after school/residency and would really need something that would allow for that. I hope that doesn't sound like a superficial reason for going into a specific career, I just really value being back with my family and friends. Thanks!

 

[runfastnow]

Thanks for your feedback, I appreciate it. That's really good to hear. One follow up question I had - given a practice of that sort, will I be restricting my ability to certain geographic regions? I really want to come home to southern california after school/residency and would really need something that would allow for that. I hope that doesn't sound like a superficial reason for going into a specific career, I just really value being back with my family and friends. Thanks!

The more specialized/niche you want to be the more you will be restricted in location/big city/academics.

If you want to do "true" TBI with severe/low level brain injury or "true" SCI with traumatic SCIs then you will more than likely have to be at an academic institution or minimally larger urban area. There are certainly people who can do these things in private practice - just much more effort needed to create a network to take these patients and have facilities/staff (if funding even available for such) to have the "true" TBI/SCI type patients.

CVAs and amputees can have a healthy practice pretty much anywhere. Outpatient Botox/spasticity can be practiced most anywhere.

 

[uhmocksuhsillen]

The more specialized/niche you want to be the more you will be restricted in location/big city/academics.

If you want to do "true" TBI with severe/low level brain injury or "true" SCI with traumatic SCIs then you will more than likely have to be at an academic institution or minimally larger urban area. There are certainly people who can do these things in private practice - just much more effort needed to create a network to take these patients and have facilities/staff (if funding even available for such) to have the "true" TBI/SCI type patients.

CVAs and amputees can have a healthy practice pretty much anywhere. Outpatient Botox/spasticity can be practiced most anywhere.

Makes sense - and when you say private practice, does this involve opening up my own shop? Or would I likely be able to find employment within a group and/or locums to do this kind of work?

 

[j4pac]

Keep in mind that patients who have Neuro rehab needs also very commonly have MSK problems. The outpatient and inpatient knowledge and skills are complementary. Definitely recommend more PMR exposure, including inpatient rehab, before investing in a PMR residency.

 

[uhmocksuhsillen]

Keep in mind that patients who have Neuro rehab needs also very commonly have MSK problems. The outpatient and inpatient knowledge and skills are complementary. Definitely recommend more PMR exposure, including inpatient rehab, before investing in a PMR residency.

Definitely. Going to try to set up an early 4th year elective, and talk to a PMR doc at my home hospital.

It's too bad I didn't get a clue about PMR until so late in third year and have no electives available to rotate. If I'm only able to land one PMR elective during 4th year would I be at a big disadvantage? (you can see my board scores above). Should be able to have 2 PMR letters though.

 

[j4pac]

Definitely. Going to try to set up an early 4th year elective, and talk to a PMR doc at my home hospital.

It's too bad I didn't get a clue about PMR until so late in third year and have no electives available to rotate. If I'm only able to land one PMR elective during 4th year would I be at a big disadvantage? (you can see my board scores above). Should be able to have 2 PMR letters though.

Auditioning at a residency program has significant potential for upside. I honestly think that not auditioning at your #1 option is a missed opportunity.

 

[DMBandFan86]

I'm a PM&R resident and I don't like pure sports medicine. But I don't really consider OA, chronic pain, pain disorders, etc to be sports medicine.

 

[runfastnow]

Makes sense - and when you say private practice, does this involve opening up my own shop? Or would I likely be able to find employment within a group and/or locums to do this kind of work?

Private practice in the sense of a private rehab hospital or private practice group not associated with an academic institution. You wouldn't necessarily have to open your own shop - although there are pros/cons to every type of employment (from hospital employee to independent contractor and everything in between).

 

[RangerBob]

I also disliked sports medicine. MSK is actually fun, and like the above poster, I consider it very different than sports med. Most inpatients do have MSK problems, so the training will come in handy.

I'm going into an all-inpatient PM&R practice in CA. There were plenty of general inpatient jobs in SoCal when I was looking at jobs. Inpatient jobs are not in high demand--most current residents really want to do MSK/pain, so it's relatively easier to find inpatient jobs if that's your interest. If you really want to focus on TBI or SCI, then typically you're looking at dedicated units at large academic or VA hospitals, but if you like general inpatient rehab, you'll find lots of jobs even in more rural places like Montana (I've actually seen quite a few listings in that state) and Alaska.

 

[Jitter Bug]

If you hate sports/MSK don't worry, you can refer that stuff to plenty of colleagues who love it and will be happy to take off your hands.

Not so with SCI, stroke, and amputees. You will be a hot commodity with those clinical interests.