pain management?

[amyl]

So what is the real difference in doing an anes residency vs. a PMR residency and then a pain fellowship? Are there different procedures that each can do? Much harder to get a pain fellowship as PMR vs. anes? difference in reimbursement? I know I am likely going to hear that anes is the way to go in an anes forum but why? -- any advice greatly appreciated as always.

---

Members don't see this ad.

 

[Planktonmd]

Excuse my Ignorance, but what is PMR?

 

[veetz]

Excuse my Ignorance, but what is PMR?

Physical Medicine & Rehabilitation

 

[powermd]

Physical Medicine & Rehabilitation

Plenty of Money and Relaxation

The choice depends on how much you hate the OR and love clinic.

 

[amyl]

i don't hate the OR. actually want anes and then pain fellowship -- for the built in possibility that if i get burned out at either clinic or OR will be able to have the flexibility to go to the other. but realistically, anes is getting super competitive and i am wondering about PMR in case i don't get anes (am a third year now).

 

[fakin' the funk]

but realistically, anes is getting super competitive and i am wondering about PMR in case i don't get anes (am a third year now).

umm...not that this is the only determinant of a discipline's competitiveness, but didn't the PM&R match last year have NO unfilled spots?

 

[drusso]

Amyl,

It really comes down to which base specialty you enjoy the most. There are three roads to pain medicine: Anesthesiology, physiatry, neurology/psychiatry. For all intents and purposes, anesthesiology and physiatry are the two MOST recognized in part because the base specialties incorporate the most pain management education in their training.

Don't choose a specialty based upon what you MIGHT want to do for a sub-specialty---your opinions and desires will likely change as you progress through your training. Do a rotation in each and see which one you think "fits" better. Anesthesiology is more acute care oriented; physiatry more chronic care oriented. Anesthesiology tends to be more technical and procedural; physiatry a little more cognitive and intellectual. These are just broad generalizations.

Also, consider other sub-specialty opportunities that will available through each route. Anesthesiology offers critical care opportunities, cardiac, regional; physiatry offers sports medicine, neuromuscular, and musculoskeletal medicine.

You'll encounter many STRONG opinions on this topic. Take it all in stride. Best of luck.

 

[canavarim]

physiatry a little more cognitive and intellectual.
God help me please

 

[drusso]

physiatry a little more cognitive and intellectual.
God help me please

We used to do a lot of chin scratching about concepts like, "What is disability?" "What are different abilities?" "What is a disease?" "Is a disease a disability?" "Does pain make you disabled?" etc. These things actually have medico-legal implications and lawyers will try to hang you buy your own words. You get the gist.

Maybe anesthesiologists do that too?

 

[timtye78]

Dave,

You usually write some pretty solid posts, but to say that pmr being more cognitive and intellectual than anesthesiology is unusually simplistic and quite offensive to those of us who study and practice the field of anesthesiology.

Since the audience here and is relatively small, your insult only makes you look ill-informed.

I will assume you use those terms loosely, and didn't mean to insult anesthesiology.

If treating pain, and keeping people alive during surgery and the perioperative/ICU setting is not cognitive or intellectual, we will all stop and you can have your hip replaced using omt and physical therapy with nothing else.

Just kidding, but you get the drift.
I would expected a much more elegant description of the differences from someone like yourself.

 

[amyl]

I think the comments that pmr was cognitive and intellectual didn't mean that anes wasn't. In my VERY limited experience in pain it seems like the pmr guys do handle the medico-legal stuff, which is more like sitting in an office researching other cases, etc. (intellectual) versus the anesthesiologist that is performing procedures which is more hands on. i don't think he meant that pmr's are more intelligent than anesthesiologists in any way... i just don't think that is what he meant but i can totally see how it could be taken that way. seems like to me that the anesthesiologists are like the surgeons of pain manangement, but then that is my "freshman" impression.

 

[drusso]

Alright, alright, alright....poor word choice: I didn't mean that anesthesiology wasn't a cognitive or intellectual specialty--of course it is. I meant, based upon my experiences teaching anesthesiology residents on the pain service, that the specialty seems to attract more technically-oriented people, that's all. Of course there are exceptions. I'm just encouraging the OP to try different specialties and see "what fits."

Just for the record: I *LIKE* anesthesiologists---some of my best FRIENDS are anesthesiologists...