I cant decide between PM&R and Neurology. Looking for advice

[Twub13]

I am a crossroads regarding what I want to go into between Neuro and PM&R. Hoping someone could shed some light on suggestions as there are benefits to both specialties and reasons I like them each.
Neuro: I enjoy like neuro trauma and the acute care aspect of it. Deciphering the diagnosis and looking at the imaging is very interesting. Very broad in terms of what I could do with it but, I could see myself in neuro ICU. I recognize however, it is a hard residency and I am definitely a "i like my work, don't live for my work" person and work-life balance is important to me. I know i'll enjoy every second of the job while there but with all my family/friends not in medicine, I worry being able to balance neurology and my life (at least until after residency, which i recognize is only temporary, but still worrisome to me)
PM&R: Very much interested in brain injury within pm&r or spinal cord injuries. I am very interested in disability advocacy and QoL, and felt like this was the only specialty that adequately addressed it to the degree I'd prefer. Obviously there is less chaos, which I worry I will miss, but I thoroughly enjoy the nice work-life balance associated with it. I like being able to help patients adapt after big function changes/disability changes and help them find their new normal, which is sometimes missing for me in neurology. I like spasticity management with injections for brain injury and also like IM/primary care and like that for some folks with disabilities, I can become sort of like their primary doc. A con I worry about is that I have heard the disrespect physiatrists can get in the hospital, and I worry that it will bother me.
I feel like I am so split because I love the fast pace/acute care/diagnostic possibilities of Neuro, but appreciate the advocacy/QoL improvement/patient relationship of the PM&R and it just feels like I like them both for very different reasons and I don't know what to pursue.

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[HeftyGo37]

Definitely a difficult decision and it sounds like you would find a happy life as an attending with either path. With your strong interest in TBI, SCI, and disability, it may be worth considering the relative aspects of each residency you would enjoy the "least." Perhaps that might be epilepsy, headache, movement disorders, MS, for Neuro? and perhaps that might be the musculoskeletal, sports, and pain medicine for PM&R? Think about which you would probably tolerate less during residency. I will say that it seems that more and more PM&R applicants seem to be taking a greater interest in the MSK/sports/spine/pain side of things, and you would be highly appreciated and revered for your strong neurorehab interest (especially among PDs). I have not heard of the disrespect for physiatrists that you mention, but I do think there is significant regional variance with how well other physicians know about/consult PM&R. Patients absolutely love PM&R docs and those relationships are one the most attractive things about the field. I don't think any doc who regularly works with well-trained physiatrists would ever think of them disrespectfully.

Also, one important thing that you may not have heard of because it is not common is that PM&R residents can do fellowships in neurocritical care. At University of Michigan PM&R, a resident has matched into highly-esteemed neurocritical care fellowships each of the past 2 years (scroll to the bottom of this link). People | Physical Medicine and Rehabilitation | Michigan Medicine

 

[JBM16BYU]

I'll throw in my 2 cents as well, as someone who pursued a residency in PM&R followed by a Neurology-based Neuromuscular Medicine fellowship. There are definitely differences between the training in both specialties, but there is quite a bit of overlap in patient population. From my experience, on the neurologic disease side of things, Neurology tends to participate more in the acute aspect of neurologic conditions and the initial work-up, diagnosis, and medicinal management of these conditions, while PM&R tends to participate in the long-term management of the patient's rehabilitation needs, spasticity, pain, bladder/bowel management, DME, wheelchairs, and other quality of life aspects. Both sides have their pros and cons, just depending on what you are interested in. You received great advice above which I would keep in mind while thinking about this decision. As well, like was mentioned, PM&R can do fellowships in neurocritical care (a newer development), brain injury medicine, spinal cord injury medicine, neuromuscular medicine (99% of these fellowships are in Neurology departments), and even more specific non-accredited fellowships in advanced spasticity management or multiple sclerosis rehabilitation. There will be regional variation on how PM&R is viewed by other physicians and hospital systems. Patients love their PM&R physicians and you do get the opportunity to build lasting relationships with your patients as you help them throughout their lives.