Neurology vs PM&R

[imajin78]

Hi i am a 3rd year med student, and i was interested in doing neurology, however with the recent trend to doing pm&r, i was interested in what the real difference between the two were..Both manage strokes, both do emg's... Which is more profitable? Thanks <img src="confused.gif" border="0">

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[drusso]

Depends...neuro is more acute oriented and deals almost exclusively with CNS related disorders. PM&R is more chronic disease oriented and does more musculoskeletal, sports, spine, occ med, etc. PM&R is a better avenue for interventional techniques and training. Both do electrodiagnostic medicine and pain management. The lifestyle and hours are better in PM&R. Some people say that the future of PM&R is uncertain because of changes in fhe funding of inpatient rehab, but the physiatrists I talk to say that while changes are occurring, these won't negatively impact the field to the extent that critics say so.

There's plenty of neuro in rehab if that's your interest, even a few combined programs. I was considering both and chose PM&R because I wanted the musculoskeletal training and procedures that neuro did not offer. I also like the "big picture" "holistic" orientation of PM&R. Pretty much the only procedures that neurologists do are lumbar punctures...although this may changes with advances in interventional field.

Good luck.

 

[Neurogirl]

From what I've seen, there are many more differences between the two fields than similarities. However, to be honest, I don't have that much experience with PM&R. My only real interaction with them has been during neuro rotations, specifically, when managing stoke, spinal cord injury and traumatic brain injury. Regarding management, neurologists usually manage the actual injuries and physiatrists manage the rehab from the injuries. It's true that neurologists don't do many proceedures (mainly LPs and nerve biopsies), unless they do interventional pain mgmt (pretty uncommon). Also, regarding EMGs and NCS, it's my understanding (correct me if I'm wrong) that most initial diagnostic studies are done by the neurologist and progress studies are done by the physiatrist. Neurologists also do EEGs and diagnose and/or treat diseases of the CNS and peripheral nervous system (dementias, epilepsy, peripheral neuropathies, pain, stroke, infections(encephalitis/meningitis), non-surgical trauma (spinal cord and traumatic brain injury), MS, headache, cancer, Parkinsons disease, Huntingtons disease, muscular dystrophy etc., etc.)

Like drusso said, it all depends on what your interests are. If you like rehab, sports med, occ med, interventional med etc., go PM&R. If you like neuro, then go that route. I think both fields can be quite profitable...it mainly depends on how many procedures and electrodiagnostic studies you do. I know several neurologists who do quite well.

 

[imajin78]

thanks neurogrl and drusso, both your replys were helpful...

 

[drusso]

Both physiatrists and neurologists can both be specialty board certified in electrodiagnostic medicine. Both the neurologists or physiatrists do initial and or follow-up studies. In some places PM&R runs the electrodiagnostic labs (such as Univ of Washington) in others neuro does.

 

[imajin78]

hi neurogirl, i think that from what you said neuro is the way to go for me.. i had a question for you..when you apply for residency what should i look for in the program, how do i know what makes one program better then another? i live in in ny and would prefer to stay in the northeast..what programs do you know are good? also one last question i am a DO, is it possible to do the rotating intership and still be able to take the neuro boards...or is it just better to skip the intership?
thanks for your help

 

[Neurogirl]

Unfortunately, I didn't investigate or apply to any programs in the northeast or NY area so I can't help you there.

The program you choose should match your interests as much as possible. Like all specialties though, the most important thing is to find a program that matches your personality. Some applicants will want a program with a laid back atmosphere, while others will want something more structured and regimented. Even among major academic centers, some programs will be geared more towards research while others will be more dedicated to clinical medicine. When it comes to the quality of the program, ask about board pass rates and fellowship opportunities. Also, unfair as it may be, the number of IMGs in a program is a good indicator of the quality/competitiveness of the program. Since neuro is NOT a competitive specialty, most programs will have some IMGs, but a program with NO American grads is a red flag.

Regarding internship, ALL adult neurology programs require either a medicine internship or a transitional internship with at least 6 mos of IM and an additional 2 mos of IM, FM, Peds, or EM (doesn't matter whether you're a DO or MD). However, if you're a DO and you do an osteopathic internship you will only be able to sit for the osteopathic neurology boards. Honestly though, unless you're interested in academic medicine, I'm not sure it makes any difference. I've been told that it doesn't matter which neuro board certifies you (DO or MD) as long as you are board certified. Also, some programs will not accept an osteopathic internship...most will, but some won't, so it's important to check with each program regarding this issue.

Hope this info helps. If you have any other questions, just let me know.

 

[Pinky]

In General, Columbia (NY) and Partners (Mass Gen & Brigham) are considered by many to be the best programs in the Northeast. Some may argue that they're the best programs period. Penn, Hopkins, Cornell (NY) and Best Israel (Boston) are also very good. However these programs are all known to be very "East Coast." I've heard from others on the interview trail that NYU, while not having had the best reputation during the past several years is improving and impressed many people. I've also heard good things about Mt. Sinai but also heard that the interview was kind of weird. Good luck on your future endeavors and welcome to the club.