PM&R vs. Rheumatology

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francheezy

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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, patient volume? (since they can compete with anesthesiologists for pain or ortho for musculoskeletal)

IM
Pros: great clinical exposure to various fields, flexibility to specialize via numerous fellowships, Rheumatology can be primarily outpatient with good lifestyle and solve cases other docs couldn't
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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