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any views? in terms of compatitiveness,future scope of practice,income potential?
thanks
thanks
PM&R vs NEUROLOGY
- Thread starter sam pitroda
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So some docs love to pick on other specialties. I've found myself recently bashing on Neurologists. This is not to say that I don't respect Neurologists--I have some wonderful friends who are Neurologists. But I'll just give my very myopic, stereotyped viewpoint. 😉
Neurologists love to play "where's the lesion?" They love to ponder obscure diagnoses (acting wacky => gotta consider CJD). They deal in a world of sad, many times terminal, diseases. They have 1,001 diagnoses, and about a half-dozen treatment options. Neurology consultants come in, make the diagonsis, then leave the rest of the team to figure out the next step. (Please realize this is all in jest.)
Of course, none of this answers your questions, so here goes:
competitiveness -- varies year-by-year. Recently PMR has become more competitive than neurology, but both remain moderately competitive
future scope of practice -- again, highly variable. They can be quite similar or very different depending on what you are looking at. My bias is that a PMR doc has more breadth. A PMR physician can run a movement disorder clinic that can be quite similar to Neurology. He/She could also have a musculoskeletal clinic that can look quite similar to an Orthopedic clinic. Another clinic could be a Seating/Mobility/Amputee clinic, which would not look similar to any other specialty.
Income potential -- I know I sound like a broken record here, but it is quite variable. Average salaries are about the same. Academic physiatrists generally have additional revenue generators (disability physicals, IMEs, etc.) so that it is quite difficult to make a side-by-side comparison.
Sorry. Lengthy response with no real meat.
Neurologists love to play "where's the lesion?" They love to ponder obscure diagnoses (acting wacky => gotta consider CJD). They deal in a world of sad, many times terminal, diseases. They have 1,001 diagnoses, and about a half-dozen treatment options. Neurology consultants come in, make the diagonsis, then leave the rest of the team to figure out the next step. (Please realize this is all in jest.)
Of course, none of this answers your questions, so here goes:
competitiveness -- varies year-by-year. Recently PMR has become more competitive than neurology, but both remain moderately competitive
future scope of practice -- again, highly variable. They can be quite similar or very different depending on what you are looking at. My bias is that a PMR doc has more breadth. A PMR physician can run a movement disorder clinic that can be quite similar to Neurology. He/She could also have a musculoskeletal clinic that can look quite similar to an Orthopedic clinic. Another clinic could be a Seating/Mobility/Amputee clinic, which would not look similar to any other specialty.
Income potential -- I know I sound like a broken record here, but it is quite variable. Average salaries are about the same. Academic physiatrists generally have additional revenue generators (disability physicals, IMEs, etc.) so that it is quite difficult to make a side-by-side comparison.
Sorry. Lengthy response with no real meat.
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Both PM+R and Neurology deal with many of the same issues- neuromuscular disease. Both take care of stroke patients, brain injury patients, cerebral palsy (although both encourage some pediatric specialization), etc. For those areas where the fields overlap, neurologists tend to focus more on diagnosis and medical management, whereas as phyiatrists tend to focus more on multiple modality management (including medication) and restoration of function. The emphasis on function is the unique aspect of PM+R, and in my biased opinion, it's strength.
Neurology have some areas of special focus, including epilepsy, sleep disorders, EEG, movement disorders, multiple sclerosis. While some physiatrists focus on these areas as well, generally the training in a neurology residency will be more comprehensive
Physiatry residencies tend to have a broader scope, focusing also on musculoskeletal training, sports medicine, spinal cord injury, rheumatological disorders, amputee medicine, etc. While neurologists may get some exposure to these areas, it is not in the depth that physiatrists do. Additionally, electrodiagnosis (EMGs and nerve conduction studies) is a core part of PM+R training, while it is rare for the neurology residency to develop competency in electrodiagnosis without fellowship training.
The other big difference is that PM+R training is much more procedurally oriented. In addition to more residency training in electrodiagnostics, residents usually develop strong competency in joint injections, and depending on the program, some competency in Botox injetions, alcohol/phenol blocks, lumbar interventional spine procedures, etc.
Like many physiatrists, I loved neurology, and still find the diagnostic emphasis interesting and valuable. In practice, however, the emphasis on restoration and maximization of function is what led me to physiatry. I am very happy with that decision, and would definitely make the same decision again.
Neurology have some areas of special focus, including epilepsy, sleep disorders, EEG, movement disorders, multiple sclerosis. While some physiatrists focus on these areas as well, generally the training in a neurology residency will be more comprehensive
Physiatry residencies tend to have a broader scope, focusing also on musculoskeletal training, sports medicine, spinal cord injury, rheumatological disorders, amputee medicine, etc. While neurologists may get some exposure to these areas, it is not in the depth that physiatrists do. Additionally, electrodiagnosis (EMGs and nerve conduction studies) is a core part of PM+R training, while it is rare for the neurology residency to develop competency in electrodiagnosis without fellowship training.
The other big difference is that PM+R training is much more procedurally oriented. In addition to more residency training in electrodiagnostics, residents usually develop strong competency in joint injections, and depending on the program, some competency in Botox injetions, alcohol/phenol blocks, lumbar interventional spine procedures, etc.
Like many physiatrists, I loved neurology, and still find the diagnostic emphasis interesting and valuable. In practice, however, the emphasis on restoration and maximization of function is what led me to physiatry. I am very happy with that decision, and would definitely make the same decision again.
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CasaElGato said:
Not Gone. He's been reincarnated.
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are you dependent on orthos for referal though?? i spoke with one of the pmr guy and he told mehe gets patients from intrnists after they have tried rehab and it dint help. it must be hard in practice.
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Referral patterns are very variable, just as they are for any non-primary care specialty.
My fellowship director gets the majority of his referrals from other patients, and prefers this to referrals from other doctors. I agree that this is the ideal, and I anticipate that when I am in practice in an attending, I will develop my patient base more from community outreach than by depending on other doctors.
Other docs rely on orthopods or family docs or neurosurgeons, etc. for referrals. This is easier, but probably not as satisfying.
I would guess that referral patterns are similar to that of neurologists- and therefore very variable within the specialty.
My fellowship director gets the majority of his referrals from other patients, and prefers this to referrals from other doctors. I agree that this is the ideal, and I anticipate that when I am in practice in an attending, I will develop my patient base more from community outreach than by depending on other doctors.
Other docs rely on orthopods or family docs or neurosurgeons, etc. for referrals. This is easier, but probably not as satisfying.
I would guess that referral patterns are similar to that of neurologists- and therefore very variable within the specialty.
