i want to know as much neuro as a neurologist...

[saiyagirl]

but provide the sort of long term care focused on maximizing function that only a physiatrist can offer. the stroke/TBI/SCI/MS/cerebral palsy/parkinson's patients are the ones that seem to resonate with me most....and i definitely have more interest in that aspect of PM&R than musculoskeletal or sports medicine.

i guess i wish to be both a neurologist and a rehab doc, so i could see patients--who have all different kinds of neurological disorders their ENTIRE way through...do the initial diagnosis and just be completely fascinated by the neuroscience, and then provide the rehab management and be completely fascinated by my patient. know what i mean?

how can i do this? (i'm an MS2)

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[kingyogurt]

but provide the sort of long term care focused on maximizing function that only a physiatrist can offer. the stroke/TBI/SCI/MS/cerebral palsy/parkinson's patients are the ones that seem to resonate with me most....and i definitely have more interest in that aspect of PM&R than musculoskeletal or sports medicine.

i guess i wish to be both a neurologist and a rehab doc, so i could see patients--who have all different kinds of neurological disorders their ENTIRE way through...do the initial diagnosis and just be completely fascinated by the neuroscience, and then provide the rehab management and be completely fascinated by my patient. know what i mean?

how can i do this? (i'm an MS2)

You can do a joint residency PM&R/Neuro=6 years total, or you can do one of the above residnecies and then do a fellowship to get the extra neuro or PM&R training..i think these types of fellowships are not accredited but are out there.

 

[mrmed]

I absolutely understand how you feel. I matched in PM&R and have now switched to neurology and I absolutely love it. PM&R does not provide a solid foundation for neurology. I found myself doing alot of social work and form filling with some superfical neurology. However, the program I was at was very inpt and neuro focused.
I think the bes t bet is to do a neuro residency and a rehab fellowship afterwards. This way you can feel comforatbale diagnosing neuro issues and rehabing them afterwards.

 

[axm397]

I'm sorry, I have to respectfully disagree with mrmed. I did a Neuro A.I. during med school and really liked the neuroscience part but got frustrated that there was little to do after making the diagnosis. I'm not sure where mrmed matched in PM&R but when I rotated at Kessler and JFK, the rehab docs definietly knew their neuro. The TBI unit taught me about different stages of coma, brain function recovery, etc.... The stroke unit taught me about the rehabilitation of a stroke patient - speech therapy for speech and swallowing, PT/OT for ADLs, etc. As a PM&R doc, you learn to manage these patients' spasticity, neuro function, alertness, energy, depression, etc. You definitely have more of a long term relationship with these patients as well.

If you match into a STRONG PM&R program, you will learn your neuro. You will also be able to EMGs without a fellowship.

On the otherhand, if you really enjoy the process of getting to a diagnosis, if you want to do Neurology research, if you want to do more acute inpatient neuro type medicine, Neurology is probably better for you. If you are interested in a particular diagnosis (MS, migraine, etc) then Neuro is better as well.

i suggest, since you are a MS2, to try to shadow/rotate with a neurologist and a physiatrist and see which one you like better. Go to a model facility for TBI or SCI for PM&R. I worked with Dr. Kirshblum who is well-know in the SCI world - and he taught me how to do a complete neuro exam including the correct way of assessing motor function. (the motor part - I did not learn correctly during my Neurology rotation) I don't know where you go to med school so I can't tell you much more specifics. You can pm me if you want to.

Hope this helps, good luck whatever you decide.

 

[axm397]

Actually - I just realized, you stated in a thread that you did an RIC externship. Did you not rotate through the TBI/Stroke units? Were you not convinced about the neuro knowledge of the physiatrists you worked with?

 

[rehabmd]

Does anyone know why the American Academy of Pediatrics recently approved their own fellowship in neurodevelopmental disability open only to pediatricians, neurologists and psychiatrists, to care for disabled children with special physical needs, that is not open to physiatrists, although physiatrists were instrumental in consulting for the creation of the one year neurodevelopmental disability fellowship that they are not allowed to be a part of. Because of this new fellowship offered by pediatrics, physiatry residents are now required to do a 2 year pediatric rehab fellowship offered by rehab.
Does anyone also know what happened when the American Board of Internal MEdciine approached the physiatry leadership a few years ago about creating a geriatrics fellowship open to internal medicine and physiatry but (I am told ) that the physiatry leadership was not interested in integrating with mainstream medicine? I sometimes have difficulty understanding the vision of this specialty and would appreciate any input.

 

[saiyagirl]

Actually - I just realized, you stated in a thread that you did an RIC externship. Did you not rotate through the TBI/Stroke units? Were you not convinced about the neuro knowledge of the physiatrists you worked with?

oh i definitely was. it's because i was there that i became interested in neuroscience at all. in our second year of med school we've started neuroscience/psych (we have a strange curriculum) and i love it even more (and a lot of stuff i didn't understand over the summer i'm starting to!).

it's not that i think physiatrists don't know neuro. but (at least as a student) i like the coming to the initial neurologic diagnosis as well, which is usually the area of neurologists. i am primarily interested in rehab because of the long-term care and focus on regaining function, and in general i had an incredible experience at the RIC. these doctors are among the smartest, most giving, and happiest that i've seen. i've had no experience in an inpatient neurology unit, so i guess i have to wait and see what that is like next year!

i guess, in general, i really like neuroscience and patients with all kinds of neurological disorders really strike a chord with me. i just wish i could be there for their initial diagnosis and then follow them the whole way through, with the expertise of a seasoned neurologist AND a seasoned physiatrist.

 

[charcot]

I agree, I have met quite a few people who are neurology residents and have some regrets, Most of them are NOT MD/PhD or have NO research interests and they realize how tough it is to get a good postion in academic neurology or to make money w/clinical neuro.

Remember, choosing a specialty is not like choosing a college major. Sometimes, just being fascinated by a field is not always the practical choice.
if you;re debating between pmr and neuro, and leaning toward neuro, go to a top 5 program like Partners, hopkins, columbia, UCSF, or Penn, with aneurorehab fellowship like at UCLA.

 

[Gauss]

I really suspect you'd prefer being a neurologist and helping manage rehab for patients. Perhaps you should focus your effort on neuro and then take another look at rehab. Maybe you'd like to do both in a combined residency, but I have a suspicion you'll prefer one over the other.