PM&R vs. Rheumatology

[francheezy]

I am a 4th year student who is currently interviewing for both PM&R and Internal Medicine programs. I know I have to submit my match list soon but am torn about where to rank these 2. I know they are completely different in a way but at the same time I would be happy with either as they both pertain to my interests. I really enjoy treating patients with disabilities and disorders involving the musculoskeletal system and would like to practice primarily in an outpatient setting, preferably in a group practice. Although this relates really well with PM&R, I know that Rheumatology can offer something very similar to my interests.

The length of training would be the same since I plan to do a fellowship in PM&R if I go that route (PM&R: 4 yrs + 1 yr fellowship vs. Rheumatology: 3 yrs IM + 2 yrs fellowship)

I know I would be happy going into either field but I have a few questions. Do I have a higher chance finding a job with PM&R or Rheumatology down the line? Which one is harder to obtain fellowships in? Where do you see both fields going in the future? Not that I'm primarily interested in the salary, but which field can be more lucrative? I've heard stories about PM&Rs in pain management making millions. I've also heard about rheumatologists in group practices making up to 500k if they offered Biosynthesis Infusion (ex: Infliximab infusions, etc). Just some things I would want to keep in mind as I progressed through either residency.

PM&R
Pros: outpatient, lifestyle, good salary with high potential, teamwork (orthopedics, IM, PT, etc)
Cons: many other doctors aren't familiar with it so less referrals, internship yr issues for DO/MD practicing in certain states

IM
Pros: great clinical exposure to various fields, flexibility to specialize via numerous fellowships, Rheumatology can be primarily outpatient with good lifestyle
Cons: residency is primarily hospital based so less clinic exposure, salary isn't as much as other IM fellowships (but still good enough for me)

Any help on this matter would be greatly appreciated. It is tough making career decisions in such a short time!

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[bleeker10]

One thing you need to ask yourself is whether you want to endure a 3 year IM residency just to be able to do a rheum fellowship

 

[Brachyury]

I always hear about the shortage of rheumatologists; I never hear about a shortage of PM&R physicians (then again, I never hear about PM&R)

 

[ArcGurren]

One thing you need to ask yourself is whether you want to endure a 3 year IM residency just to be able to do a rheum fellowship

Perhaps OP might actually like an IM residency. Whoda thunk

 

[francheezy]

I would prefer more of a PM&R type residency over an IM one but I would not mind doing an IM residency if it got me where I wanted (which is Rheumatology). I think I'm going to try real hard into matching into PM&R programs this upcoming year and if it doesn't work out, I can always try IM next year, although it would be wasting a year.

 

[hawkeye pierce]

Couldn't you apply to both pm and r and IM. Then just rank the PM and R higher? that might prevent wasting a year.

 

[yesno]

MGMA avg for both of them is the same as primary care. Thats the con.

 

[cliquesh]

MGMA avg for both of them is the same as primary care. Thats the con.

2010 MGMA says mean of 250k for rheum and 270k for PM&R. Family Med is 190k and 220k for General IM.

You really should just do what you love. Those fields are totally different.

 

[bedrock]

I always hear about the shortage of rheumatologists; I never hear about a shortage of PM&R physicians (then again, I never hear about PM&R)

Huge demand for outpatient MSK medicine/EMGs which any physiatrist can do.
Can work in any state/city without a problem.

Pain/PMR jobs depend much on the state as highly desirable locales are saturated with pain docs.

Rotate with both and then do what you love. Can use plenty of OMT in either, although I rarely hear of rheum docs doing this.

 

[Back 5]

2010 MGMA says mean of 250k for rheum and 270k for PM&R. Family Med is 190k and 220k for General IM.

You really should just do what you love. Those fields are totally different.

Geez. Florida must be saturated because the PM&R I worked side by side with was only making ~$130k a year, with 10 years of experience.

Granted, he had a buy in option with the practice, something I never was offered, so his earnings might be a bit higher via bonuses, but a very low salary imo.

 

[GlowInTheDark]

Perhaps OP might actually like an IM residency. Whoda thunk

impossible!

 

[fozzy40]

impossible!

Both fields are great. I was looking at FM vs. PM&R. I always saw my career heading in a MSK direction. FP plus a sports medicine fellowship was attractive but I wanted to spend my residency learning about the neurological and musculoskeletal training. PM&R happened to be the best fit.

Having gone through the job process recently, there is no shortage in outpatient or inpatient positions. The salary range is EXTREMELY variable based on geographic and type of practice.