PM&R or Anesthesiology

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rjmcl11

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Hello,

I just started my fourth year, and I'm trying to decide between PM&R and anesthesiology for residency. Sorry for the long post. I included a summary at the bottom for those that don't want to read the whole thing.

About me
Allopathic school in Northeast
Step 1: 247 Step 2 CK: 244
Clerkships: Everything basically HP with nice comments except H in peds and P in medicine
No red flags, publication in undergrad for molecular exercise physiology research
Incredibly handsome

I went into medical school thinking I would do PM&R. I enjoy working out, and I like the idea of helping people gain mobility. However, I recently did my 4 week PM&R rotation, and I didn't really enjoy it. Specifically, it was a little mind numbing, I thought that the physiatrists didn't have many tools to treat, and I think dealing with arthritis (bread and butter) is frustrating because there are limited treatment options besides exercise and weight loss, which nobody wants to do haha. On clinic days, I would see 20-30 patients complain about similar things and then just get prescribed physical therapy with cream. I thought learning the musculoskeletal physical exam was enjoyable, but the residents explained that the maneuvers have limited sensitivity/specificity and it's mostly about billing. I also enjoyed watching the joint injections, but I understand the limited benefits of these procedures.

Furthermore, anesthesiology was my last rotation of 3rd year, and it was probably my most enjoyable rotation. It was only a 2 week rotation. I enjoyed the personality of the residents/attendings and the combination of procedures and cerebral nature of the job. It felt like the practice of medicine without all of the BS of medicine (making endless phone calls, writing tons of notes). Though, when speaking to two of the anesthesiology attendings, they said PM&R is probably better because it has ownership of the patient, doesn't rely on the surgeon, has a better lifestyle and there is less fear of job takeover.

I made my fourth year schedule before I did my anesthesiology rotation so I didn't include any anesthesiology courses. I've been frantically trying to set up away rotations in anesthesiology for July and August before I apply in September because my school doesn't have any open spots. I set a meeting with one of my school's head anesthesiologist to discuss my options.

I guess I like the idea of doing anesthesiology more than PM&R, because I like that anesthesiology has a well defined and very important role for the patient. The patient comes in for surgery, and the anesthesiologist ensures that he/she is safe and doesn't experience pain. I think I would take more satisfaction in that as oppose to writing a prescription for physical therapy. However and sadly, I don't know if I have the personality for anesthesiology. Namely, I'm not very good in emergency situations, and I can't think quickly on my feet. Also, the idea of dealing with very potent drugs and having someone's life in my hands freaks me out. I imagine that I would constantly worry that I gave too much or too little of something or did something wrong. So I how important this is? Do you guys think that anyone who can graduate medical school can be trained to become a good anesthesiologist or will my slow brain and apprehensive self crumble in the OR? Also, what are my chances of getting into a program if I only have a two week rotation in anesthesiology? I don't know if I could get an adequate letter of recommendation from that rotation. Would dual applying to both be stupid?

Summary
I'm trying to decide between applying to PM&R and anesthesiology. I think PM&R is fairly boring with limited treatment options for frustrating diseases (arthritis). Though I get excited about possibly treatment modalities in the future. I think Anesthesiology is great based on a two week rotation, but I worry about being able to perform in emergency situations and constantly freaking out about making a mistake and killing someone. Have you guys met residents that just couldn't cut it as an anesthesiologist due to these fears or can anyone become a great anesthesiologist so long as they are motivated? I'm trying to set up more rotations in anesthesiology before I apply in September, but I'm having trouble getting a rotation. What are my chances of getting a residency spot without LOR from an anesthesiologist and limited exposure? Would dual applying to PM&R and anesthesiology be a bad idea?

Thanks so much
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POW16 said:
Another option to think about: anesthesia then a pain fellowship.
Click to expand...

Yeah, pain fellowship is a possibility. Though I'm trying to take things one step at a time. If I don't do pain, I must enjoy the underlying field. I also understand that it would easier to get into pain from anesthesia as oppose to PM&R.
 
Plug for PM&R here. I loved anesthesiology as well so know that any positives I list for PM&R is not necessarily a deficit in anesthesiology.

Great jawlines
Large variety of pathology
Inpatient medicine knowledge stays sharp
Evolving new treatments and diagnostics
Wide range of miniminally invasive procedures
Private practice potential. Consult only potential. Inpatient only potential. Outpatient only potential. Mixed practice potential. Many practice options, all available with or without fellowship
Growing popularity among hospitals, patients and medical students
Big time schedule autonomy
Fantastic PTs, Prosthetists, specialized nursing staff
Patients rock
 
Tigerhawk77 said:
Plug for PM&R here. I loved anesthesiology as well so know that any positives I list for PM&R is not necessarily a deficit in anesthesiology.

Great jawlines
Large variety of pathology
Inpatient medicine knowledge stays sharp
Evolving new treatments and diagnostics
Wide range of miniminally invasive procedures
Private practice potential. Consult only potential. Inpatient only potential. Outpatient only potential. Mixed practice potential. Many practice options, all available with or without fellowship
Growing popularity among hospitals, patients and medical students
Big time schedule autonomy
Fantastic PTs, Prosthetists, specialized nursing staff
Patients rock
Click to expand...

I completely agree with everything you said. On paper, it seems crazy not to do PM&R, which is why I always planned on pursuing it. During my PM&R rotation, some residents told me that the program isn't a great representation of rehab and that I should complete another PM&R rotation at another place. So maybe it's as simple as that. I'm set to complete another rotation, which will obviously give me a better idea. I just didn't expect to enjoy my anesthesiology rotation so much, and I wanted to get some advice before I make my decision.
 
I appreciate all of the replies, I just want to clarify my questions.

1. I like anesthesiology, but I worry about being able to perform in emergency situations and constantly freaking out about making a mistake and killing someone. Have you guys met residents that just couldn't cut it as an anesthesiologist due to these fears or can anyone become a great anesthesiologist so long as they are motivated?

2. I'm trying to set up more rotations in anesthesiology before I apply in September, but I'm having trouble getting a rotation. What are my chances of getting a residency spot without LOR from an anesthesiologist and limited exposure (2 week rotation)?

3. Would dual applying to PM&R and anesthesiology be a bad idea? I would like to increase my chances of landing a residency in a nice city.
 
Everyone should be afraid of harming their patient when they start out. Experience is what helps you conquer your fears. If you still freeze and can’t get over a mental block in the OR as you gain experience then it’s a problem. And my program did ask a resident to switch fields because he could not stop freezing after several remediation efforts.
 
Do you like clinic or the OR more - I think that's really the deciding factor? If pain is your eventual goal then do anesthesia. I just matched anesthesia so I can't comment on how to be composed during emergency situations but I would think that's what residency is there for...to train you to handle these types of situations confidently. That said, if you're the type that freaks out very easily at the sight of blood, maybe anesthesia won't be for you.

If you're going to apply gas - I would try to get at least one LOR. You're scores are good enough to match good gas and pm&r programs that I feel like if you dual applied it would detract from one application, not to mention costs, interview fatigue, etc.. In the end when you have to make your rank list, you'll have to decide between the two so mind as well make that decision before applyhing
 
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ToKingdomCome said:
Do you like clinic or the OR more - I think that's really the deciding factor? If pain is your eventual goal then do anesthesia. I just matched anesthesia so I can't comment on how to be composed during emergency situations but I would think that's what residency is there for...to train you to handle these types of situations confidently. That said, if you're the type that freaks out very easily at the sight of blood, maybe anesthesia won't be for you.

If you're going to apply gas - I would try to get at least one LOR. You're scores are good enough to match good gas and pm&r programs that I feel like if you dual applied it would detract from one application, not to mention costs, interview fatigue, etc.. In the end when you have to make your rank list, you'll have to decide between the two so mind as well make that decision before applyhing
Click to expand...

Thanks for the response. I've thought about that question, and it's hard for me to decide. I guess I would prefer to spend the next month in the OR, but I don't know if that means I want to spend the rest of my career in the OR if that makes sense.

I see your point about experience. Perhaps I'm just overthinking things. I definitely need to try to get another anesthesia rotation before September. Hopefully I'll hear back from the away rotations that I applied to.
 
"Allopathic school in Northeast
Step 1: 247 Step 2 CK: 244
Clerkships: Everything basically HP with nice comments except H in peds and P in medicine
No red flags, publication in undergrad for molecular exercise physiology research
Incredibly handsome"

Yea, uh, your post was way too long so I'm just gonna go ahead and say do ortho. 😀
 
rjmcl11 said:
1. I like anesthesiology, but I worry about being able to perform in emergency situations and constantly freaking out about making a mistake and killing someone. Have you guys met residents that just couldn't cut it as an anesthesiologist due to these fears or can anyone become a great anesthesiologist so long as they are motivated?
Click to expand...

Yes - I've definitely worked with residents who couldn't function during crisis situations. Usually the issue is poor judgment, paralysis in emergency situations, or inadequate preparation (usually because they couldn't focus on key crucial things and then missed something obvious and important). It's rare that a resident doesn't care or is willfully/negligently bad at their job. Rather, it's usually a mismatch between temperament and their speciality choice.

There are certain people who'd be better suited (when compared against anesthesiology) to non-acute specialty options like IM/peds/FM, radiology, pathology, psych, PM&R, etc. And there's nothing wrong with that - it's just the nature of personality. Also there are people who'd function well in whatever speciality...
 
vector2 said:
"Allopathic school in Northeast
Step 1: 247 Step 2 CK: 244
Clerkships: Everything basically HP with nice comments except H in peds and P in medicine
No red flags, publication in undergrad for molecular exercise physiology research
Incredibly handsome"

Yea, uh, your post was way too long so I'm just gonna go ahead and say do ortho. 😀
Click to expand...
S/he has already missed his/her calling. Incredibly handsome? That's a plastics PA right there.

Seriously, anybody who would even consider PM&R has no business in anesthesiology. The personality disorders needed to shine in those two are way too different.
 
If you haven't already, I would try to get some exposure to PM&R and anesthesia at the attending level instead of following along with a resident. You might want to get exposure to PP PM&R pain folks.

Residency is a short portion of a hopefully long career, so don't stress the boredom there. Think about what your opportunities will be and what you'll want in 3 - 5 years when you're able to be an attending and in 20 - 30 - 40 years when you're ready to retire.

They can be very different and and can be very boring in different ways.
In both though, you're a consultant.
In both you're herding cats, especially if you're doing an ACT model with 3 or 4 rooms.
The acuity is very different but everything gets boring.
The time, content, and quality of talking to a patient/family in the two is very different.

If you have to just pick one, go with anesthesia as you can do pain only to bring yourself more in line with PM&R later. If you do PM&R though, the doors to the OR are generally closed unless you're posting blocks/implants.

If you're attracted to the excitement, pick PM&R and pick a risky sport/fun hobby to do.

Your handsomeness will be hidden by a mask and possibly even a bouffant cap in anesthesia, so choose wisely.
 
rjmcl11 said:
I appreciate all of the replies, I just want to clarify my questions.

1. I like anesthesiology, but I worry about being able to perform in emergency situations and constantly freaking out about making a mistake and killing someone. Have you guys met residents that just couldn't cut it as an anesthesiologist due to these fears or can anyone become a great anesthesiologist so long as they are motivated?

2. I'm trying to set up more rotations in anesthesiology before I apply in September, but I'm having trouble getting a rotation. What are my chances of getting a residency spot without LOR from an anesthesiologist and limited exposure (2 week rotation)?

3. Would dual applying to PM&R and anesthesiology be a bad idea? I would like to increase my chances of landing a residency in a nice city.
Click to expand...

I was initially interested in PM&R as well, but found it way too boring and the mind numbing patients didnt help. I feel it takes a special person to want to deal with all that stuff, from chronic pain to stroke victims, etc.

I'm only a fourth year, so take this with a grain of salt.
1. I think every resident [in every field] is afraid of killing someone, it will probably go away with practice and time.
2. From my research, every residency requires an anesthesia letter, do your best to find a spot, or talk to the gas docs you worked with and explain your situation, im sure they would help you out and write a letter.
3. ive always read to not apply to multiple specialties at the same institution, these are two really different fields though. you should do a lot of soul searching and figure out what you want to end up doing in life.
 
Thanks for all the replies.

Orin said:
If you haven't already, I would try to get some exposure to PM&R and anesthesia at the attending level instead of following along with a resident. You might want to get exposure to PP PM&R pain folks.

Residency is a short portion of a hopefully long career, so don't stress the boredom there. Think about what your opportunities will be and what you'll want in 3 - 5 years when you're able to be an attending and in 20 - 30 - 40 years when you're ready to retire.

They can be very different and and can be very boring in different ways.
In both though, you're a consultant.
In both you're herding cats, especially if you're doing an ACT model with 3 or 4 rooms.
The acuity is very different but everything gets boring.
The time, content, and quality of talking to a patient/family in the two is very different.

If you have to just pick one, go with anesthesia as you can do pain only to bring yourself more in line with PM&R later. If you do PM&R though, the doors to the OR are generally closed unless you're posting blocks/implants.

If you're attracted to the excitement, pick PM&R and pick a risky sport/fun hobby to do.

Your handsomeness will be hidden by a mask and possibly even a bouffant cap in anesthesia, so choose wisely.
Click to expand...

Thanks for the reply. You bring up an important point. I think I have reservations about talking to patients all day about their pain in clinic. One of my frustrations with PM&R is the subjective nature of the diseases. I find it difficult to get a history from a patient in PM&R clinic when he/she won't give clear answers. Even the radiologic evidence can be ambiguous.

On the other side, I like that anesthesiology often comes with a clear problem and solution. For example, the patient is undergoing a knee replacement, therefore, he needs a nerve block to prevent pain in that area. Obviously I'm over simplifying things but that was my general sense.

azygos the grey said:
I was initially interested in PM&R as well, but found it way too boring and the mind numbing patients didnt help. I feel it takes a special person to want to deal with all that stuff, from chronic pain to stroke victims, etc.

I'm only a fourth year, so take this with a grain of salt.
1. I think every resident [in every field] is afraid of killing someone, it will probably go away with practice and time.
2. From my research, every residency requires an anesthesia letter, do your best to find a spot, or talk to the gas docs you worked with and explain your situation, im sure they would help you out and write a letter.
3. ive always read to not apply to multiple specialties at the same institution, these are two really different fields though. you should do a lot of soul searching and figure out what you want to end up doing in life.
Click to expand...

Thanks for the reply, and I agree with your comments. I'm going to avoid dual applying, and I'll try to contact the attending I worked with briefly if I can't land another rotation.

FFP said:
S/he has already missed his/her calling. Incredibly handsome? That's a plastics PA right there.

Seriously, anybody who would even consider PM&R has no business in anesthesiology. The personality disorders needed to shine in those two are way too different.
Click to expand...

lol
 
rjmcl11 said:
I appreciate all of the replies, I just want to clarify my questions.

1. I like anesthesiology, but I worry about being able to perform in emergency situations and constantly freaking out about making a mistake and killing someone. Have you guys met residents that just couldn't cut it as an anesthesiologist due to these fears or can anyone become a great anesthesiologist so long as they are motivated?

2. I'm trying to set up more rotations in anesthesiology before I apply in September, but I'm having trouble getting a rotation. What are my chances of getting a residency spot without LOR from an anesthesiologist and limited exposure (2 week rotation)?

3. Would dual applying to PM&R and anesthesiology be a bad idea? I would like to increase my chances of landing a residency in a nice city.
Click to expand...

3 question first - sure apply for both. People do that all the time in different specialties.

1. As people have mentioned, don't worry about not performing. That is what residency is for. Some residents are very good, others struggle and we wonder how they will be - but after a few years in practice, we all look the same (despite people on here saying how great they are, etc). The routine of anesthesia makes you less fearful as you become skilled at avoiding issues, and managing them as they arise. But full disclosure, I have the perfect job. I work 50/50 in anesthesia and pain. When I am nearing the end of my pain time, I think - I can't wait to be back in the OR. When I am in the OR day after day, I think - pain is way better then this. I am lucky I get to do both. I have known a few people to leave anesthesia after many years to do the pain fellowship because they were a little bored with anesthesia. I think any job would be boring as you become a master of it.

Here are some intangibles that may seem silly - but reasons I love anesthesia. I like the conversation daily with different surgeons, nurses, etc. I like that I wear pajamas every day and don't have to dress in nice clothes. I like that I get to sit when I want. I like the pay. I like doing some of the procedures, and I love the pharmacology and the immediacy of it all. I find that other anesthesiologists are great people (and so are PM&R actually....) I like that I don't have patients to follow and manage that have huge expectations of things I am supposed to fix and they have no respnsibility (thinking about my pain patients here....). I do not like how cold I am every day in the OR. That part sucks.
 
What I gathered is that I probably want to do anesthesiology more than I want to do PM&R. I just fear that I'll turn into one of those residents that gets asked to leave for failing to perform well. It seems difficult to know whether I will be one of those residents. I certainly don't freak out over blood or guts. I just tend to way over think things. I'll figure it out.
 
epidural man said:
3 question first - sure apply for both. People do that all the time in different specialties.

1. As people have mentioned, don't worry about not performing. That is what residency is for. Some residents are very good, others struggle and we wonder how they will be - but after a few years in practice, we all look the same (despite people on here saying how great they are, etc). The routine of anesthesia makes you less fearful as you become skilled at avoiding issues, and managing them as they arise. But full disclosure, I have the perfect job. I work 50/50 in anesthesia and pain. When I am nearing the end of my pain time, I think - I can't wait to be back in the OR. When I am in the OR day after day, I think - pain is way better then this. I am lucky I get to do both. I have known a few people to leave anesthesia after many years to do the pain fellowship because they were a little bored with anesthesia. I think any job would be boring as you become a master of it.

Here are some intangibles that may seem silly - but reasons I love anesthesia. I like the conversation daily with different surgeons, nurses, etc. I like that I wear pajamas every day and don't have to dress in nice clothes. I like that I get to sit when I want. I like the pay. I like doing some of the procedures, and I love the pharmacology and the immediacy of it all. I find that other anesthesiologists are great people (and so are PM&R actually....) I like that I don't have patients to follow and manage that have huge expectations of things I am supposed to fix and they have no respnsibility (thinking about my pain patients here....). I do not like how cold I am every day in the OR. That part sucks.
Click to expand...

Working 50/50 in anesthesia and pain seems like a great gig. I agree with all your points though I love the cold haha. I definitely appreciate hearing that I shouldn't let fear prevent me from applying.
 
rjmcl11 said:
What I gathered is that I probably want to do anesthesiology more than I want to do PM&R. I just fear that I'll turn into one of those residents that gets asked to leave for failing to perform well. It seems difficult to know whether I will be one of those residents. I certainly don't freak out over blood or guts. I just tend to way over think things. I'll figure it out.
Click to expand...

If you are going to do anesthesia, think about the program then.

There are some programs (think UCSD) where the residents NEVER see the attendings. Our program is the exact opposite - we rarely leave our residents alone. Both have issues. But I bet there are programs that do it the appropriate amount (oversite).
 
epidural man said:
If you are going to do anesthesia, think about the program then.

There are some programs (think UCSD) where the residents NEVER see the attendings. Our program is the exact opposite - we rarely leave our residents alone. Both have issues. But I bet there are programs that do it the appropriate amount (oversite).
Click to expand...

That's a great point I never thought about. Thanks.
 
Being afraid of failing isn't a reason to avoid it unless you have objective evidence you'll fail at it.

I will say you're falling victim to exposure to an academic clinic, as there are many successful providers who focus on injections, complementary therapies, PT,etc without getting lost in the rabbit holes of vague complex non-structurally concordant pain and the psychosocial issues.

Still, it seems you're just worried about how you will do as it's very different from most of the other clinical things you've trained in and it can be very high acuity

That's normal and it's good to be self aware of where you might fail so you can work on that mentally.
 
rjmcl11 said:
I appreciate all of the replies, I just want to clarify my questions.

1. I like anesthesiology, but I worry about being able to perform in emergency situations and constantly freaking out about making a mistake and killing someone. Have you guys met residents that just couldn't cut it as an anesthesiologist due to these fears or can anyone become a great anesthesiologist so long as they are motivated?

2. I'm trying to set up more rotations in anesthesiology before I apply in September, but I'm having trouble getting a rotation. What are my chances of getting a residency spot without LOR from an anesthesiologist and limited exposure (2 week rotation)?

3. Would dual applying to PM&R and anesthesiology be a bad idea? I would like to increase my chances of landing a residency in a nice city.
Click to expand...


1. Your comments show wisdom and insight- More midlevels should feel as you do but unfortunately do not recognize all the issues. Anyone with reasonable hand/eye coordination, motivation and slightly above average intelligence can become a great Anesthesiologist.

2. You will match into Anesthesiology even with just 2 weeks of exposure. Lower Top tier programs are certainly within your grasp. With just another 4 week rotation nationally ranked programs in the 10-20 range are highly likely matches for you. Do another rotation and get more letters of recommendation.

3. Bad idea because you can match into either specialty. Pick one.

4. Plan on a fellowship because a mind is a terrible thing to waste.
 
BLADEMDA said:
1. Your comments show wisdom and insight- More midlevels should feel as you do but unfortunately do not recognize all the issues. Anyone with reasonable hand/eye coordination, motivation and slightly above average intelligence can become a great Anesthesiologist.

2. You will match into Anesthesiology even with just 2 weeks of exposure. Lower Top tier programs are certainly within your grasp. With just another 4 week rotation nationally ranked programs in the 10-20 range are highly likely matches for you. Do another rotation and get more letters of recommendation.

3. Bad idea because you can match into either specialty. Pick one.

4. Plan on a fellowship because a mind is a terrible thing to waste.
Click to expand...

Thanks for the response! Definitely makes me feel better about applying.
 
AA1128 said:
What did you end up choosing, and how is your first year of residency going?! I am trying to decide between the same specialties.
Click to expand...
Bump! I have the same question for you, OP!
 
AA1128 said:
What did you end up choosing, and how is your first year of residency going?! I am trying to decide between the same specialties.
Click to expand...
Sharingan001 said:
Bump! I have the same question for you, OP!
Click to expand...

pretty easy choice since so different fields. if not particularly interested in either PMR/anesthesiology and narrowed it down to only these 2. Go for PMR
PMR is life style specialty. No/minimal weekends, nights, calls. Salary is very high and going up (for how much they work). My med school classmates in PMR got attending jobs with higher salary than anesthesiology jobs working similar type of hours.
 
sloh said:
PM&R here. 1099 SAR jobs also very lucrative. 350-450k, complete control of your own schedule; full-time is 4 days per week and if efficient, ~5 hrs/day
Click to expand...

prob partially why pmr getting more and more competitive

no chance i can find an anes job close to that. non call jobs here pay around 250-300 for 40s hr week
 
The difference between these two specialties is self- and situational-awareness.
If your awareness is strong do anesthesia; if not, do PM&R.

I’m speechless reading about the factors people take into account to pick their specialty. I mean, don’t get me wrong, we all want quality of life, salary, reasonable call schedules etc etc but I never see as top factor what really pleases you doing for the rest of your life. What challenges you to become better at. What you derive pleasure from. What patient population you would love to serve. This for me is a red flag that people with this mentality or differently, with lack of deeper interest for medicine and it’s particularities, should not be in medicine at the first place. It’s true that after several years doing the same thing gets you into a terrifying routine no matter what specialty you do, but having this feelings even before starting is concerning to me
 
Hafiz brother, why on earth did you make that decision? One day while working all night on ob and having to work the next day in private practice for the same as you would have for comfortable hours in pmnr, you will regret your decision.
 
Lidolover said:
The difference between these two specialties is self- and situational-awareness.
If your awareness is strong do anesthesia; if not, do PM&R.

I’m speechless reading about the factors people take into account to pick their specialty. I mean, don’t get me wrong, we all want quality of life, salary, reasonable call schedules etc etc but I never see as top factor what really pleases you doing for the rest of your life. What challenges you to become better at. What you derive pleasure from. What patient population you would love to serve. This for me is a red flag that people with this mentality or differently, with lack of deeper interest for medicine and it’s particularities, should not be in medicine at the first place. It’s true that after several years doing the same thing gets you into a terrifying routine no matter what specialty you do, but having this feelings even before starting is concerning to me
Click to expand...

Feel exactly the same way. I once considered PMR but after being exposed to it during pain, much happier I did anesthesia.

In PMR I felt like it was very slow paced, with very long exams and histories which I did not believe increased accuracy of diagnosis or speeded recovery compared to the care given by an anesthesia pain guy or ortho sports medicine guy. Lots of thinking, not a lot of doing, sloooow go PMR, my two cents
 
Hoya11 said:
Feel exactly the same way. I once considered PMR but after being exposed to it during pain, much happier I did anesthesia.

In PMR I felt like it was very slow paced, with very long exams and histories which I did not believe increased accuracy of diagnosis or speeded recovery compared to the care given by an anesthesia pain guy or ortho sports medicine guy. Lots of thinking, not a lot of doing, sloooow go PMR, my two cents
Click to expand...

Highly variable although in an academic/residency setting, that’s what you will likely see. A full day of 1099 SAR work usually consists of 30-35 patients, which only takes like 2 hours to round on patients.

FWIW, I don’t think private practice PM&R outpatient is going to be that viable in the future. Many of these injections don’t work
and could really be managed by ortho or primary care.

Many of the interventional spine procedures also don’t work. Complicated patient population. I originally wanted to pursue pain but decided against it after I actually saw what it was like and getting familiar with the evidence.

Could probably be viable if employed by Kaiser etc., but you are a slave to patient phone calls/inbox messages which is all uncompensated work. And still lots of procedures that don’t work...placebo mills. Acupuncture acupuncture acupuncture!
 
sloh said:
Highly variable although in an academic/residency setting, that’s what you will likely see. A full day of 1099 SAR work usually consists of 30-35 patients, which only takes like 2 hours to round on patients.

FWIW, I don’t think private practice PM&R outpatient is going to be that viable in the future. Many of these injections don’t work
and could really be managed by ortho or primary care.

Many of the interventional spine procedures also don’t work. Complicated patient population. I originally wanted to pursue pain but decided against it after I actually saw what it was like and getting familiar with the evidence.

Could probably be viable if employed by Kaiser etc., but you are a slave to patient phone calls/inbox messages which is all uncompensated work. And still lots of procedures that don’t work...placebo mills. Acupuncture acupuncture acupuncture!
Click to expand...
Still wondering what OP decided since I have a very similar thought pattern regarding these two specialties.

Also sloh, if we are concerned about effectiveness of procedures/ treatment plans, future job security, and lifestyle/ pay, which specialty would you recommend? I am seeking a reasonable balance amongst these things for the more average applicant. Anesthesia, PMR, and psychiatry are a few specialties I'm considering. It's concerning to hear that many treatment approaches in PMR are ineffective. I hear similar things about psych. Wouldn't the public/ referrers catch on eventually and destroy demand for the specialty? Sorry, just an ignorant first year medical student here. If you could go back, what field would you go for?? Or what might you recommend for me? Thanks!!

Ps: what is 1099 SAR work?
 
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sloh said:
Highly variable although in an academic/residency setting, that’s what you will likely see. A full day of 1099 SAR work usually consists of 30-35 patients, which only takes like 2 hours to round on patients.

FWIW, I don’t think private practice PM&R outpatient is going to be that viable in the future. Many of these injections don’t work
and could really be managed by ortho or primary care.

Many of the interventional spine procedures also don’t work. Complicated patient population. I originally wanted to pursue pain but decided against it after I actually saw what it was like and getting familiar with the evidence.

Could probably be viable if employed by Kaiser etc., but you are a slave to patient phone calls/inbox messages which is all uncompensated work. And still lots of procedures that don’t work...placebo mills. Acupuncture acupuncture acupuncture!
Click to expand...
Subacute rehab doesn't work either.
They still go home and fall, then come to us for kypho.
Meh, maybe it does work. 😀
 
Sharingan001 said:
Still wondering what OP decided since I have a very similar thought pattern regarding these two specialties.

Also sloh, if we are concerned about effectiveness of procedures/ treatment plans, future job security, and lifestyle/ pay, which specialty would you recommend? I am seeking a reasonable balance amongst these things for the more average applicant. Anesthesia, PMR, and psychiatry are a few specialties I'm considering. It's concerning to hear that many treatment approaches in PMR are ineffective. I hear similar things about psych. Wouldn't the public/ referrers catch on eventually and destroy demand for the specialty? Sorry, just an ignorant first year medical student here. If you could go back, what field would you go for?? Or what might you recommend for me? Thanks!!

Ps: what is 1099 SAR work?
Click to expand...

A lot of stuff we do doesn't work. Look at the studies for cath in nstemi but if you have a heart, hey we can cath you. Because at outside hospital, we care.
 
Sharingan001 said:
Still wondering what OP decided since I have a very similar thought pattern regarding these two specialties.

Also sloh, if we are concerned about effectiveness of procedures/ treatment plans, future job security, and lifestyle/ pay, which specialty would you recommend? I am seeking a reasonable balance amongst these things for the more average applicant. Anesthesia, PMR, and psychiatry are a few specialties I'm considering. It's concerning to hear that many treatment approaches in PMR are ineffective. I hear similar things about psych. Wouldn't the public/ referrers catch on eventually and destroy demand for the specialty? Sorry, just an ignorant first year medical student here. If you could go back, what field would you go for?? Or what might you recommend for me? Thanks!!

Ps: what is 1099 SAR work?
Click to expand...
As @GassYous posted above, there are many meds/interventions (especially for subjective symptoms like pain and dyspnea that are susceptible to placebo, contextual factors, natural history, regression to the mean) that are deployed without RCT's to back them up. However, when sham controlled RCT's are carried out which not unusually show the procedures to be ineffective, there's always the possibility that CMS could decide not to cover them anymore (e.g. arthroscopic debridement for osteoarthritic patients presenting with knee pain only). You can look up the various other procedures commonly performed for musculoskeletal conditions on UpToDate (e.g. subacromial steroid injections, facet joint injections, medial branch blocks, epidurals, intra-articular knee injections). Stem cells and PRP border on grifting IMO. As a medical student, had I known that the procedures were so ineffective, I do not think I would have pursued PM&R. I feel pretty lucky to have the job I have right now doing 1099 SAR work but I will admit my current priorities are compensation/hour, lifestyle, autonomy, flexibility, financial independence asap. I have other interests outside of medicine and I'm more of a "work to live" kind of guy. YMMV. As a medical student, It's hard for me to believe I would have chosen PM&R with the expectation I would be working in SNF's after residency.

If you want the holy grail of effective procedures/treatments, job security, lifestyle/pay, I'd look into derm, optho, medonc (just a couple off the top of my head). I don't like working nights or taking call—at all. So most surgical specialties were off the table for me. Of course, nothing in medicine is ever certain—just go look at what has happened to the job market for EM and RadOnc (more info can be found in their respective sub-forums)

I've posted about SAR work a lot on this board already. You can look through my older posts for more info!
 
epidural man said:
If you are going to do anesthesia, think about the program then.

There are some programs (think UCSD) where the residents NEVER see the attendings. Our program is the exact opposite - we rarely leave our residents alone. Both have issues. But I bet there are programs that do it the appropriate amount (oversite).
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Do you mind elaborating on what is up with UCSD? Why do the residents never see the attendings? Anything else about the program that you can speak about?
 
epidural man said:
Great staff. Great city. Some free food. Lots of Asians.
Click to expand...
I know but can you speak more to the educational experience? I'm a prospective applicant to the program and would love to know more about the pros/cons, how do you know about the fact that you never see the attendings?
 
Sriddymopboi said:
I know but can you speak more to the educational experience? I'm a prospective applicant to the program and would love to know more about the pros/cons, how do you know about the fact that you never see the attendings?
Click to expand...
Full disclosure - I really know very little about the program. I know people that teach there.

When I rotated there as a resident some years back, that was my experience and that is what the residents said. The staff is rarely there. That is good and that is bad.

However, things change. Bad things happen and staff become more mandated to be there. So who knows what it is like now.

When I was a resident, I was VERY impressed at how independent they practiced...they got things done and quickly. But also, they did things I would NEVER do and thought was somewhat dangerous. I thought..well, at least they have their indepedence.

If left to do anesthesia on your own, you will learn bad habits. If you have an attending by your side constantly, you will learn great habits, but probably lack in true confidence and independence. I'm sure there is a good balance.
 
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