Medicine VS PM&R

[medicinebest]

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Could someone give me his/her two cents on this question of mine?

Which is a better field? Medicine or PM&R?

First, let's focus on the similarities then the differences.

Regarding the similarities... Let's focus on the positives first...
Both are interesting. Both provide average hours for doctors.
Now the negatives...
For an average medicine doc or a physiatrist, money's not that sky high. Treatment options for both are not as drastic as in surgeries. Little bit of tweaking here and little bit of tweaking there...

Now, the differences... First the positives...
An internist is a real doctor who understands human pathophys and pathologies well. He has a good sense of real medicine. An internist is always respected as a clinician who understands what goes on in a human body... A physiatrist will not have to do much, really, for patients. No pressure to do much, really...

Negatives now... Internist has to know too much stuff for what he gets paid for... A physiatrist will forever be silently disrespected for not knowing much of real medicine, and therapists are better in doing therapies... There is no clear role of a physiatrist however you put it...

What do you think?

 

[tchoupdoc]

I'm a pmr attending at a university.

If I were still a resident, and read your post, i would blush and then mutter that you were right....

Now that I am out 1) internal medicine residents are quite eager to rotate with me,
and not because it's easy. Because they realize big gaps in their
MSK and neuro skillset. So I guess we have something, however small, to contribute.

2) The pay is quite good. Why? Once you start having to submit bills, you realize that real medicine problems require a lot of thinking and time. In the time it takes some of my IM colleagues to see 12 patients, I can see 30, and do a good job. It's like derm vs IM. Both sets submit 99213 for a follow up visit, and get paid the same. Difference is, that takes IM 15 minutes and derm 3-5. Do the math.

3) As for not really helping people, I recall the words of my best attending in residency. He was IM boarded, practiced a bit, and went back for PM&R. The difference? "When I was IM, once or twice a year a patient would say that no one else had figured out their diagnosis. In PMR, that happens several times a week."

 

[medicinebest]

Hi, Dr. Disciple (and other honest PM&R doctors),

I've read your posts, and I'd like to ask you (and other honest PM&R doctors) some questions...

Your posts tell me that you're very straightforward and accurate in my opionion and not threatened by any questions. You have no tendency to exagerrate and falsely advertise PM&R.

May I ask you how many years out of residency you are? If you really like PM&R? And why? or why not?

One annoying question... I think it is difficult to be a good physician in "everything," including neuro, ortho, sports med, some internal med... Is it practically possible? I am strongly convinced, as you have stated in other posts, that rehab is headed towards,
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one: taking care of more acutely sick --relative to the past-- patients,
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two: a PM&R doc should be the preferred choice for many patients, who go through a bunch of specialists without any physician able to adequately put everything together. That is the reason for the annoying question earlier... Basically, I'm more of the opinion that it is not practically realistically possible to be able to put all the specialties together and be adequately good. By all the specialties, I'm mainly referring to neurology, neurosurgery, orthopedics, and sports medicine.
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three: I completely disagree with the notion that physiatrists are making "novel" diagnoses more often than internists. Not trying to be rude, but that's just not the case. Also, rehab docs seeing twenty patients when internists can only see five or whatever just drives me away from rehab. I would hate to be a patient of that type of doctors, who boast such claims, including that rehab docs make more novel diagnoses than internists...

Dr. Disciple and other doctors of his/her caliber, I seriously need your input...

Thank you...

 

[kungfufishing]

Im just passing through, and in neither specialty (EM). Both specialties provide a worthwhile and unique service that nobody does as well as they do. I hope my parents have a good internist, and I'm not sure there is any better way I can say that. However, if one of them were to have a CVA, I think you can't underestimate the benefit patients can gain from PM&R - what is life without functionality? I think the two fields are pretty different. I think it sounds like you like IM better. Good luck with your decision.

 

[medicinebest]

Dr. Disciple and the likes,

No PC answers to please everyone. Just the honest-to-god truths, as always. Gracias.

 

[tchoupdoc]

Medicinebest:

I like that you want honesty. here it is:

For me, PMR inpatient was miserable. It is absolutely essential, and I would want it for me or any family member. But as the physician, I felt like a babysitter. It exists because of the alice-and-wonderland, cost shifting and avoiding nature of inpatient medicine. Believe me, I never liked to tell the consulting service that their patient was "too good" for rehab, when it was obvious that they had serious functional deficits. In an ideal world, the patient would remain on the medicine service as long as they had to, with professional therapists.

But on the other hand, I don't know of any specialty outside of hospitalists who like rounding on patients who are basically stable, except when they crash, and then crash hard. Unlike in the ED, you already know that they are sick, so you have strikes against you. And the hospitalists wouldn't like it if it were not shift work.

If you are IM, with inpatients to round on before a full day of clinic, it is not shift work. The same is true for PMR.

Your question is a good one. But I get the sense that you have not seen what most IM and PMR docs do when they are not in the hospital. And that is where most make their livings.

 

[Llenroc]

Neither Internists nor Physiatrists spend most of their time rounding on patients. That's the impression of medical students who do rotations, as they don't get to see that most folks work outpatient private practices.

PM&R is essentially an Internal Medicine specialty which you can go into after 1 year of medicine instead of 3. There's also lot of overlap with Neurology, though less overlap with Orthopedics than what some people claim. Inpatient Physiatry is very similar to being an inpatient IM doctor, who rounds on patients and manages their myriad chronic medical issues. In fact there are discussions all the time in the Physiatry forum if it would make any difference if patients at rehab. hospitals were seen by IM or Neurology doctors with some CME in Rehab. instead of Physiatrists.

Honestly there's more Internal Medicine overlap in Physiatry than there is in some of the official IM subspecialties like Allergy/Immunology. My Dad is in A/I, and I don't think he has ever managed HTN, DM, UTI, etc. (things you will do a lot of in PM&R residency, and possibly as an attending if you do any inpatient).

Most people in Physiatry go into outpatient however, or at least predominantly outpatient. Outpatient involves procedures like EMG's, NCV's, botox injections, as well as pain management, taking care of prosthetics, counseling for wheelchairs, etc.

My goal was to do an IM subspecialty when I came into medical school. I was flexible as to which one, with a strong preference towards lifestyle factors. I'm glad I found Physiatry, even though it's not officially part of IM.

 

[DJ LACTULOSE]

one thing i don't like about PM&R is that they really rely on the physical therapists to do most of the "actual" therapy. the PM&R doc (from what i know) just evaluates the patient and prescribes what physical therapy he should recieve. the PT then actually goes and does it. i suppose this is kind of like the IM doc that prescribes a med to control someone's HTN, but how many PM&R MDs are really needed to prescribe rehab if PTs are the ones doing the actual work?

i actually have a few friends who've gone through PT school and are practicing now. they say that usually the PM&R doc just signs off on whatever the PT reccommends after the PT evaluates the patient. that doesn't sound good for the future of PM&R. i also wonder if evenutally there will be a PT vs PM&R debate like there is with CRNAs and anesthesiologists.

it sounds like you really like IM, but are thinking about PM&R because of the lifestyle. i don't know that PM&R will continue to be the cash cow that it supposedly is today. it may (since all the baby boomers will probably need rehab after their hip replacements), but general IM will also be in increased demand over the next 20 years for the same reason. personally, i would choose IM because i find working with the PM&R population to be depressing and not as interesting as general IM.

check out this thread from the PM&R board: http://forums.studentdoctor.net/showthread.php?t=442057

 

[Adcadet]

I"When I was IM, once or twice a year a patient would say that no one else had figured out their diagnosis. In PMR, that happens several times a week."

I'm an IM resident. A PM&R doc saved my patient's life last month by figuring out why he had pain and weakness, when neurosurg and neurology didn't think there was anything going on. I saw him after his surgery that PM&R recommended, and the difference was amazing. This great PM&R doc has also been a pleasure to work with in managing this patient's other serious problems. We need people in different specialties with different training, but in the end a good doc is a good doc.