Pm&r Or Neurology

[uthopeful]

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So I am having trouble deciding between pm&r and neurology for my residency. I thought after my pm&r rotation that I would be able to make my mind up but am still undecided.

All the things that I like about PM&R relate to the neuro aspect of the field. I am not interested in any of the ortho, sports medicine, etc. I rotated through neuro as an ms3. Any advice on how to decide. The one thing that I would still like to keep open is a pain fellowship, not sure if it would be eaiser via neuro or pm&r (just thinking about it).

Some questions, would really appreicate some feedback.


1.) How to decide, any suggestions?

2.) Lifestyle, I know PM&R is known to have a great lifestyle, what is the lifestyle of a neurologists

3.) Salary, anyone see any major differences or potential

4.) Future of both fields

Thank You

 

[Shalom77]

Check out this thread. The answer about the difference between neurology and neurorehabilitation might be helpful to you.

http://forums.studentdoctor.net/showthread.php?t=405971

 

[drusso]

Here's my back of the envelope/neurology litmus test:

1) Do you like treating headaches?

2) Do you like treating patients who fall down and shake?

 

[njdevil]

either from seizure or upper motor neuron disease...do like to treat people that pee themselves?

 

[topwise]

I was stuck on a similar decision. I absolutely loved neurology and I may have ended up in that field except that the programs were all horrible in the area where I wanted to live.

Reasons why I sometimes wish I had picked neuro:

1) Saying you're a neurologist sounds cool and smart

2) Figuring out neuro diagnoses is really fun

3) I feel like in PM&R, you don't learn how to read the brain imaging studies nearly as well, so you're often stuck having to call a consult.

Reasons why I'm glad I picked PM&R:

1) Residency is so much easier for PM&R!!!

2) I'm not a big emergency person and that's something I rarely have to deal with in rehab.

3) It's satisfying to help patients get better instead of just diagnosing them.

4) Money is about equal.

5) You actually learn a lot of the electrodiagnostic stuff better in a PM&R residency. I was considering doing a neurophysiology fellowship, but I think there's a good chance I'll be proficient in EMG/NCS when I finish residency.

6) I think you develop deeper relationships with your patients in rehab. I can't tell you how many presents I've gotten from patients.

7) You very rarely have to deliver a terminal diagnosis.

That said, there are times when it seems like rehab ought to be a specialty of neuro and that physical medicine ought to be a specialty of ortho.

In terms of the future of physiatry, people who think it will disappear as a field are a little confused. EMG's aren't going to disappear. Botox injections aren't going to disappear. Epidural injections aren't going to disappear. And more and more people are going to have strokes and need inpatient rehab. Inpatient rehab is a wonderful thing.

 

[ShrikeMD]

This is not a simple question to answer. I think everyone has wondered, at one time or another, how their life or career might be different had they chosen a different path. I would like to believe that for most of us, different specialties would still have allowed us to find satisfaction in taking care of others (and dissatisfaction with some of the hassles that go along with taking care of others).

I have been a physiatrist for a number of years, with a practice that is overwhelmingly neuro-rehabilitation in scope. My patients have neurological diagnoses, I read neurological (and non-neurological) journals, I attend neurological (and non-neurological) meetings, and I publish in neurological (and non-neurological) journals, yet I remain convinced that these interests were primarily fostered and nurtured because I chose to become a physiatrist.

Having said this, there are some generalizations that warrant mention. If you are more interested in movement disorders/parkinson's disease or the dementias, our neurology/neurorehabilitation colleagues will likely have better training exposures in these patient populations than most physiatry programs. For multiple sclerosis, there are certain physiatry programs (like University of Washington) that have attendings with strong interest in this patient population, but there are more neurology programs with specific exposures to this diagnostic group. On the other hand, traumatic brain injury educational exposures strongly favor physiatry. (Anyone that has attended more than one American Academy of Neurology meeting can attest to the fact that aside from a couple of abstracts on neuroimaging or neuro-ICU management, and perhaps sports-concussion topics, TBI is not discussed.) Even in stroke neurorehabilitation, a field of intense interest for our neurology-neurorehab colleagues, most clinical and (non-NIH) research work is done by physiatrists. Spinal cord injury rehabilitation (as a field of clinical and research study) has been dominated by physiatry for decades; this is not going to change anytime in the near future.

In summary, IF you believe that you are drawn to the idea of taking care of patients with neurological disorders for longer than just a brief ICU stay; and IF diagnosis AND management of their symptoms and adjustment to life after injury seems interesting and satisfying as a career path; then I suggest that you will probably be happier as a physiatrist. On the other hand, if you are overly concerned about issues of professional prestige and identity, or are bothered by the fact that many physiatrists still have challenges in explaining who they are to the lay public, or if you are more interested in movement disorders, headaches, dementia, neurooncology or primary epilepsy (not remote symptomatic epilepsy-physiatrists see a lot of this), or if you prefer the excitement/intensity of the ICU setting, then perhaps neurology is for you.

Good luck with your decision.

 

[DMBandFan86]

if you wake up in the morning and say 'epilepsy is cool!' then go neuro

 

[Punkn]

I struggled with this as well. Do as many rotations as you can in each, as close to "bread and butter/day in the life" as you can, not super specialized. My mentors recommended that if you feel good doing 90% of the usual stuff in said field, it's the one for you. I disliked headaches and seizures, so I discounted Neuro. I do mostly neuro-rehab and did a fellowship in SCI, would be unhappy doing mostly MSK/sports/procedures, but PM&R gives you the freedom to carve out such a practice pretty easily.

 

[Ogliodendrocyte]

I struggled with this as well. Do as many rotations as you can in each, as close to "bread and butter/day in the life" as you can, not super specialized. My mentors recommended that if you feel good doing 90% of the usual stuff in said field, it's the one for you. I disliked headaches and seizures, so I discounted Neuro. I do mostly neuro-rehab and did a fellowship in SCI, would be unhappy doing mostly MSK/sports/procedures, but PM&R gives you the freedom to carve out such a practice pretty easily.

I also like neuro-rehab. Do you feel like you use a lot of medicine doing SCI? I'm in the minority of enjoying IM but didn't want to do it as specialty. Do you manage vent settings as they relate to neuromuscular respiratory failure?

 

[RangerBob]

I also like neuro-rehab. Do you feel like you use a lot of medicine doing SCI? I'm in the minority of enjoying IM but didn't want to do it as specialty. Do you manage vent settings as they relate to neuromuscular respiratory failure?

You can do quite a bit of IM as an inpatient rehab physician (this is what many residents really dislike about inpatient rehab). Some attendings consult IM for everything, others have IM managing all medical problems, and at other units PM&R is first call for all medical stuff, so there is some variety.

There is a ton of medicine in SCI. As far as the vent goes, the SCI unit is the only unit in most hospitals allowed to take ventilated patients other than the ICU. Depending on the hospital you're at and their protocol, the SCI physician is typically the one managing the vent, making recommendations on SCI vent weaning, etc. If you're at the VA doing SCI, probably about 90% of your job is actually medicine, and about 10% rehab. Most VA SCI patients are chronic SCI patients. I had one co-resident get really upset about her VA SCI rotation because she felt she was just managing a medicine service, not a rehab service.