Is rehab for me?

[sirsam84]

I am an MSIII who has had an interest in PM&R for a couple of years now. However, I can't help but have some trepidation when every time I mention this as one of my preferred residencies, the listener invariably makes comments like "that's way too boring," or "they never do anything." I realize that these comments could merely come from a general lack of knowledge about the field, but coupled with the relatively uncompetitive nature of the residencies and purported low satisfaction among PM and R docs makes me wonder if there is something about the field I should be wary of. Is the field limited to working with the severely incapacitated, or is there a wider range of patients? Also, is the field sufficiently intellectually stimulating?

Having said this, I think it would be a great fit for me, since I have a strong athletic background and have always been very interested in non-surgical management of musculoskeletal injuries (much to the chagrin of the orthopedists I have talked too). I fit the Orthopedic stereotype to a t, but I think Ortho would be too narrow for me (not to mention that it would destroy my back as I am circus-freak tall), and I am almost certain I am more medicine than surgery (I've always leaned more toward "thinking" than "doing.") In addition, probably my favorite class in the basic sciences was neuroanatomy/neurology, but I do not want the life of the neurologist, with all diagnosis and little to no betterment of the patient's condition.

I have also heard different things about the lifestyle. Is it generally good with little call, or hectic with much call? Also, an anesthesiologist I talked to said that pain management anesthesiologists get paid twice as much as PM and R pain management. Is this true?

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[drusso]

I am an MSIII who has had an interest in PM&R for a couple of years now. However, I can't help but have some trepidation when every time I mention this as one of my preferred residencies, the listener invariably makes comments like "that's way too boring," or "they never do anything." I realize that these comments could merely come from a general lack of knowledge about the field, but coupled with the relatively uncompetitive nature of the residencies and purported low satisfaction among PM and R docs makes me wonder if there is something about the field I should be wary of. Is the field limited to working with the severely incapacitated, or is there a wider range of patients? Also, is the field sufficiently intellectually stimulating?

Having said this, I think it would be a great fit for me, since I have a strong athletic background and have always been very interested in non-surgical management of musculoskeletal injuries (much to the chagrin of the orthopedists I have talked too). I fit the Orthopedic stereotype to a t, but I think Ortho would be too narrow for me (not to mention that it would destroy my back as I am circus-freak tall), and I am almost certain I am more medicine than surgery (I've always leaned more toward "thinking" than "doing.") In addition, probably my favorite class in the basic sciences was neuroanatomy/neurology, but I do not want the life of the neurologist, with all diagnosis and little to no betterment of the patient's condition.

I have also heard different things about the lifestyle. Is it generally good with little call, or hectic with much call? Also, an anesthesiologist I talked to said that pain management anesthesiologists get paid twice as much as PM and R pain management. Is this true?

Where have you heard that PM&R physicians have low job satisfaction? I've always heard that we have the highest?

 

[drvlad2004]

Where have you heard that PM&R physicians have low job satisfaction? I've always heard that we have the highest?

Actually on an outdated edition of First Aid for the Match, it did mention that physiatrist HAD a low job satisfaction. I don't think that is quite the case anymore since more interested and qualified people have entered the field. It is a bad idea to get opinions from people who are not in the field. Go with your own feelings.

 

[Finally M3]

I think the amount of call you have is directly proportional to how many inpatient rehab sites you wish to cover, and if you/the rehab hospital has outsourced some of those calls to a medicine service.

As for gas pain v. pm&r pain, I would guess that gas pain would make more than pm&r pain because they can cover ORs on the side as well as performing procedures. However, I really haven't been able to find a good source for pain doc salaries (I found one stating gas-pain would start at $300K).

 

[axm397]

I think the best way to confirm is to do a PM&R elective. All doubts I had were blown away when I actually rotated at GOOD PM&R programs. I met so many happy PM&R docs and was able to analyze for myself the compatibility of my character and personality with the field.

The only unhappy PM&R docs are probably those who wanted to be something else and "settled" on PM&R due to life constraints... (i.e. I wanted to be a Neurosurgeon but my wife would've divorced me... I wanted to do Ortho but I wasn't competitive enough... I was an FMG and there was a PM&R spot open and I didn't have much of a choice...)

The field is definitely getting competitive and many of the information sources out there are outdated at best.

The patient population is diverse and it really would depend on what kind of practice you want. If you want very "incapacitated" patients (in your words), you can do in-patient rehab at an academic medical center where there can even be codes on the floor. If you want the exact opposite, you can do sports medicine and be a team doctor for a professional sports team. If you want to only do out-patient, you can do that. You can also only do in-patient or somewhere in between. Lifestyle depends on what you want - but unlike some specialties, you do have the option of having a good lifestyle and still being able to make a good living. You can also take call like crazy and work weekends and make lots of money and very little time.

In terms of "intellectual stimulation", there are many areas of potential research in PM&R. Technological advances have really made a difference in the field, and will bring exciting changes in the future. I think PM&R docs also have to be proficient in their neurophysio/anatomy knowledge to treat SCI, stroke, and TBI patients. They also have to have a solid musculo-skeletal knowledge base as well as very strong physical exam skills to be able to diagnose some of the more complex MSK conditions. You can make yourself an expert in P&Os and wheel chairs if that's your interest. You also definitely need a strong medicine foundation to be able to manage some of the more complex patients in in-patient rehab. (because of financial reasons, many of the in-pt patients are more medically complex and unstable.)

I don't know about the pay difference between gas and PM&R pain docs - but do consider that malpractice insurance premiums are also different between those specialties. Gas pain docs also cover the OR and take call if they are affiliated with an Anesthesia dept. PM&R pain docs can also add EMGs, and other procedures to their out-pt practice as well. Money is really what you make of it - if you land a good fellowship in pain in PM&R and are lucky enough to get good job offers - you will be very successful. It all depends on the state of the economy, the job market, and the timing of your training. I have never met a broke PM&R doc.

Sounds like you are at an "old-school" medical school where PM&R is not very well known and well-meaning docs are trying to talk you out of the field. I also went through that - but after experiencing for myself what PM&R is all about, nothing could dissuade me from entering the field. I am actually very thankful I found a field that I so love - when many of my classmates are still unsure (after the match) whether they like the field they are going into. I have a few friends who have switched specialties after starting residency.

Anyways, no one on this forum is going to "sell" PM&R to you. We wouldn't be doing you a favor by doing so. Do a PM&R rotation, or shadow a few physiatrists and get a "feel" for yourself.

Good luck

 

[kurt rambis]

Sirsam:

Yeah man, I found myself in a similar situation during my third year of medical school. Like you I have an athletic background and have had experience first-hand with musculoskeletal injuries. I really liked the ortho residents but I realized quickly that I hated surgery and enjoyed the thinking more than the doing. The advice of the people on this board is strong: do a rotation. Honestly evaluate how you feel during your PM&R rotation and figure out why you like or don't like the rotation. Make sure you are into the subject material and not just the laid back residents and the good hours. PM&R is a great field that offers a broad spectrum of options, but it isn't for everyone.

To address your question about anesth vs PM&R pain practices, from what I have heard once you have the knowledge and skills to be a pain doc if either through a fellowship or work experience, the pay is roughly the same for the 2 fields if both are doing just pain work. The bulk of the pay comes from the procedures that you do not from the residency you came from. i have a friend that just finished his PM&R residency and is joining a group of anesthesiologists in a pain practice: he will be partner in 3 years and making over 400,000 in a large urban area.

Also could you fill me in on PM&R docs having low job satisfaction? I don't have the First Aid book and I'm curious about where this data came from. Like DRUSSO I had always heard that we have some of the highest job satisfaction. Anyway good luck in your decision!

 

[sirsam84]

The career satisfaction bit is from First Aid for the Match. The reference is Am J Phys med Rehabil 77(4) 317-325, 1998. Analysis of current practices in recruitment of residents for physical medicine and rehabilitation. At least, it must be the reference they used, since that is the only one cited for the PM&R section.

What do you love and hate about PM&R, if you don't mind me asking. Also, do you know what the lifestyle is like after residency? Finally, how much Neuro do you really use? (Neuro was probably my favorite basic science course)

BTW, props for the Rambis reference (being a 7 footer myself, gotta root for the bigs)

 

[Stinky Tofu]

Finally, how much Neuro do you really use? (Neuro was probably my favorite basic science course)

If you want a program that provides a greater emphasis on Neurology, you should consider the SRH program. We spend two months as a Neurology resident at MGH and we also spend four months in the Neurophysiology lab at MGH and BWH.

 

[paz5559]

Am J Phys Med Rehabil. 1998 Jul-Aug;77(4):317-25.

Analysis of current practices in recruitment of residents for Physical Medicine and Rehabilitation: survey of PM&R department chairs.

Braddom RL, Crawford J, DeLisa JA, Heilman D.

Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine, Indianapolis, USA.

The purpose of this study was to survey the current opinion of Physical Medicine & Rehabilitation (PM&R) chairs on issues of resident recruitment. There was a 92% response rate after two mailings. A majority (62%) of chairs reported more difficulty now than two years ago in obtaining an adequate number of American medical graduates for their residency programs. This was true regardless of program size, type, or location. The three highest ranking reasons for this difficulty were as follows: competition from primary internal medicine; primary care emphasis in medical school curriculums; competition from family medicine. The majority of chairs (87%) reported no increased difficulty in recruiting international medical graduates. The three most frequently used recruiting methods were as follows: clinical rotation electives; using faculty as student advisors; teaching in the physical diagnosis course. The chairs' opinion of the three most important reasons residents choose a specific program include the following: having a committed and interested faculty; having happy current residents; having an established program with successful graduates. A reduction in the number of residents in their programs during the next four years was predicted by 27% of the chairs. The chairs also felt that we currently have too many residency slots, preferring numbers of 600 to 1,300 (mean, 1,010). The chairs had no clear choices in methods to downsize programs if that were to be mandated by the federal government but appeared the least interested in doing so by reducing every program by a flat percentage.

Note: No reference to job satisfaction, and the ARTICLE is 6 years old, based on data that is older than that. Seems like a pretty flimsy factor to base your decsion on.

 

[tari]

PM&R is the most rewarding field of medicine for those who really like taking care of patients. Our underlying philosophy is different because we deal with function rather than mere disease. I liked ortho well enough, but it was a little frustrating not to have time to really deal with what incapacitated my patients.

I'm please with the options I have upon graduation. If I like procedures, I can do interventional or EMG's. If I like sports, I can join an ortho group (yes, they even let us operate if we have any surgical background). If I like neurology, I can do TBI or Stroke rehab. If I like kids, I can do peds rehab. Salaries start at about $150k from the ads I've seen. I think the numbers that are published are also based on the rural physiatrists who are the only physicians in a 300-mile radius who also take chickens or eggs for payment. Most of the interventionalists I've ever met make about $500k after their practice is established (takes about 2-3 years.) I plan to be in academics, so it's a moot point.

Coming from a high-maintenance surgical specialty, the PM&R lifestyle is a godsend. I have time to read up on business and estate planning, write articles, train for triathlons, hang out with my family regularly, play the market, etc. I guess I'm not all that worried about money because my residency gives me enough time to actually invest my money wisely so I'll already be ahead when I graduate. Not every PM&R resident is as energetic or have similar interests, but if you are inclined, there is enough time to indulge in your leisure activities. I can honestly say that I really enjoy my life!

 

[lilabz89]

PM&R is the most rewarding field of medicine for those who really like taking care of patients. Our underlying philosophy is different because we deal with function rather than mere disease. I liked ortho well enough, but it was a little frustrating not to have time to really deal with what incapacitated my patients.

I'm please with the options I have upon graduation. If I like procedures, I can do interventional or EMG's. If I like sports, I can join an ortho group (yes, they even let us operate if we have any surgical background). If I like neurology, I can do TBI or Stroke rehab. If I like kids, I can do peds rehab. Salaries start at about $150k from the ads I've seen. I think the numbers that are published are also based on the rural physiatrists who are the only physicians in a 300-mile radius who also take chickens or eggs for payment. Most of the interventionalists I've ever met make about $500k after their practice is established (takes about 2-3 years.) I plan to be in academics, so it's a moot point.

Coming from a high-maintenance surgical specialty, the PM&R lifestyle is a godsend. I have time to read up on business and estate planning, write articles, train for triathlons, hang out with my family regularly, play the market, etc. I guess I'm not all that worried about money because my residency gives me enough time to actually invest my money wisely so I'll already be ahead when I graduate. Not every PM&R resident is as energetic or have similar interests, but if you are inclined, there is enough time to indulge in your leisure activities. I can honestly say that I really enjoy my life!

Hello, MS3 hear in a similar predicament as the above students mentioned. I have an athletic history, am very appreciative of physiatry's focus on holistic care, quality of life, and function. I love neuro/msk. I actually did do a rotation in PM&R between 1st and second year and I loved it, but this was far before any of my clinical rotations, I had no responsibilities what so ever, I didn't actually get to do more than shadow, and now that I am most way through my third year I am questioning things. Wondering if I would miss diagnosing. I'm hearing others say I will get bored and fear boardroom tremendously. Additionally, I love working with my hands and would want to do procedures.

What is interventional Physiatry? or is it in relation to pain management/ nerve blocks type thing?

Currently I am on my surgery rotation and was very upset to realize how much I loved it (love anatomy, love doing things with my hands, enjoying suturing a lot). I didn't want to like surgery because of the terrible work life balance, back breaking work, no eating or peeing, long hard residency etc. I just had my week of ortho and really liked it. I also got to work with sports med ortho guys and I really like the aspect of working with athletes.

I wonder how many opportunities to work with healthy athletes I would have in PM&R as opposed to the chronically ill.

I am curious if you are still loving PM&R, as I see this post of yours was over 10 years ago (hoping you even see this).

Additionally, I was curious about what you said about "yes they even let us operate if we have any surgical background." Is this true? Can I be a PMR doc and also do some operations?

Finally I have a questions about satisfaction. I did hear that physiatrists are very happy/satisfied, but a recent article came out showing that in the past year physiatrics have the largest percent increase in burnout rate. Wondering why?

Also Wondering if there is a ton of paperwork and disabilities claims etc. if you don't want that to be part of your practice?

 

[DMBandFan86]

I would check out and read about interventional spine / pain management and sports medicine. Those are both 2 fellowship options. Yes they are competitive. You will get good training in both in a PM&R residency. Pain management is the only area where I believe you will able to do any operations in an OR so you'd have to do that fellowship.

If you want to work with professional athletes, I'd probably say you need to go the Ortho route. If you want to work with kids, high school athletes and adults taking zumba classes, I'd say PM&R with a sports medicine fellowship is probably a good route. You can also do sports medicine from doing family medicine. Someone else with more experience can probably give a better opinion on this.

PM&R is a big field. If you really just want to do procedures all day, there are PM&R doctors who only do botox injections all day long and manage baclofen pumps. You could also just do EMG's all day. It's really your choice as to what you narrow you skill set down to. Or you can be broad and deal with a lot of different types of patients.

I personally never take these job satisfaction surveys to heart. I'd rather stay home and never work.

 

[swimMD]

Hello, MS3 hear in a similar predicament as the above students mentioned. I have an athletic history, am very appreciative of physiatry's focus on holistic care, quality of life, and function. I love neuro/msk. I actually did do a rotation in PM&R between 1st and second year and I loved it, but this was far before any of my clinical rotations, I had no responsibilities what so ever, I didn't actually get to do more than shadow, and now that I am most way through my third year I am questioning things. Wondering if I would miss diagnosing. I'm hearing others say I will get bored and fear boardroom tremendously. Additionally, I love working with my hands and would want to do procedures.

What is interventional Physiatry? or is it in relation to pain management/ nerve blocks type thing?

Currently I am on my surgery rotation and was very upset to realize how much I loved it (love anatomy, love doing things with my hands, enjoying suturing a lot). I didn't want to like surgery because of the terrible work life balance, back breaking work, no eating or peeing, long hard residency etc. I just had my week of ortho and really liked it. I also got to work with sports med ortho guys and I really like the aspect of working with athletes.

I wonder how many opportunities to work with healthy athletes I would have in PM&R as opposed to the chronically ill.

I am curious if you are still loving PM&R, as I see this post of yours was over 10 years ago (hoping you even see this).

Additionally, I was curious about what you said about "yes they even let us operate if we have any surgical background." Is this true? Can I be a PMR doc and also do some operations?

Finally I have a questions about satisfaction. I did hear that physiatrists are very happy/satisfied, but a recent article came out showing that in the past year physiatrics have the largest percent increase in burnout rate. Wondering why?

Also Wondering if there is a ton of paperwork and disabilities claims etc. if you don't want that to be part of your practice?

PM&R does offer you the opportunity to do procedures and work with athletes. An interventional spine/pain fellowship would allow you to do procedures; a sports fellowship would let you work with athletes. Like what was stated in a previous post, you would be able to work with high school students. If you wanted to work with collegiate or professional athletes, you woul need to do an accredited sports fellowship.

But you are going to have to decide if you would like to do the surgery life or a PM&R life. Weigh the pros and cons of each. Analyze the life not just during residency but also at an attending status to decide which one would suit you better. Everyone will be able to give you reasons for/against both fields, but really only you can decide for yourself and what would be best for you. Hope this helps a bit!