practice options in pmr

[Bee09]

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so i was recently told by an attending that inpatient rehab is on the downswing b/c of insurance companies not reimbursing, etc. my problem is that i really like the inpatient aspect of this field and i'm not sure if i could see myself doing any outpatient stuff to a major degree or being in private practice.

but if a few years from now, the demand for inpatient docs is down, then where would that leave me? do all physiatrists have to have a certain amount of outpatient care as part of their practice?

 

[Llenroc]

Inpatient is for suckers.

my problem is that i really like the inpatient aspect of this field and i'm not sure

Why? Do you like looking at people's asses each time they come in to check for pressure sores?

 

[axm397]

so i was recently told by an attending that inpatient rehab is on the downswing b/c of insurance companies not reimbursing, etc. my problem is that i really like the inpatient aspect of this field and i'm not sure if i could see myself doing any outpatient stuff to a major degree or being in private practice.

but if a few years from now, the demand for inpatient docs is down, then where would that leave me? do all physiatrists have to have a certain amount of outpatient care as part of their practice?

all aspects of medicine is on the downswing. There are opportunities to do anything you want but you may have to compromise on pay or geographic location. finding a good job in a saturated area where everyone wants to be is difficult in any specialty. inpatient PM&R is still paying well in most areas of the country and there are some outpatient MSK docs going back to covering some inpatient for job security.😱

I have friends and colleagues who have taken inpatient jobs in various areas of the country within the past 2-3 years. As the population ages, many are going to need inpatient rehab. You may have to carry more patients and do more work for the same amount of money but I don't think the demand will go down.

I think some amount of outpatient care is probably not avoidable because the inpatient patients you are taking care of need to follow up somewhere and wouldn't you be curious to see how they are doing after the inpatient stay?

 

[SSdoc33]

Inpatient is for suckers.



Why? Do you like looking at people's asses each time they come in to check for pressure sores?

because of enlightened people like llenroc over there, you will always have a job. in general, the majority of physiatrists go into an outpatient MSK setting, and the demand is clearly present for inpatient rehabilitationfor this reason.

 

[RUOkie]

Inpatient is for suckers.



Why? Do you like looking at people's asses each time they come in to check for pressure sores?

There are some people who love wound care. There is no reason to be ugly to someone just because they don't share the same worldview as you. I hope you treat your patients with more compassion.🙁

 

[Ludicolo]

Inpatient is for suckers.

Different strokes for different folks. That’s one of the beauties of our broad field. Because preserving and restoring function casts a wide shadow, there is something for everyone. I try not to rag on other specialties or subspecialties. God bless ‘em for doing something that I don’t necessarily want to do.

OP - You will be successful if you can do things well that nobody else can do, or wants to do. There will always be a need for quality inpatient rehab physicians. And if you truly enjoy it, then awesomeness. I think people find great personal satisfaction when they like things that nobody else likes. Makes them feel unique. As my son gleefully puts it, “more broccoli for me!”

And I agree w/ axm. Even if you do primarily inpatient, there will still likely be a need for an outpatient clinic for followup, to address long-term rehab needs. As an aside – outpatient SCI and TBI are fascinating worlds, ones not many students/residents are exposed to unfortunately.

 

[Bee09]

dont get me wrong, of course i would want to have some sort of outpatient practice to f/u with inpatients, and if it were all sci and tbi, i think i would be ok with that.

its just that i dont have a passion for MSK issues at all, i just dont want to deal with it... i recognize that MSK is obviously part of all residency programs, and if i have to do it for a few months out of 3 years, i'll do it, but long term i would prefer not to.

i guess my question is, is this a strong reason not to go into pm&r. or will i still make it despite my strong dislike for MSK?

 

[PMR 4 MSK]

dont get me wrong, of course i would want to have some sort of outpatient practice to f/u with inpatients, and if it were all sci and tbi, i think i would be ok with that.

its just that i dont have a passion for MSK issues at all, i just dont want to deal with it... i recognize that MSK is obviously part of all residency programs, and if i have to do it for a few months out of 3 years, i'll do it, but long term i would prefer not to.

i guess my question is, is this a strong reason not to go into pm&r. or will i still make it despite my strong dislike for MSK?

I think with most newer PM&R docs moving away from inpt, more due to lifestyle and glamour (😉), you'll have less competition for inpt jobs. You can't predict the future of any field, so don't make decisions based on that.

 

[Hemisphere]

dont get me wrong, of course i would want to have some sort of outpatient practice to f/u with inpatients, and if it were all sci and tbi, i think i would be ok with that.

its just that i dont have a passion for MSK issues at all, i just dont want to deal with it... i recognize that MSK is obviously part of all residency programs, and if i have to do it for a few months out of 3 years, i'll do it, but long term i would prefer not to.

i guess my question is, is this a strong reason not to go into pm&r. or will i still make it despite my strong dislike for MSK?

noting your *strong dislike* for MSK you can still practice in the area of neurorehabilitation coming out of a neurology residency you can do a neurorehabilitation fellowship. then you won't have to stomach any MSK. I know of the chairman of one neurology department who went this route, sees stroke patients in the rehab hospital, and doesn't touch the ortho patients with a ten foot pole. (not that i'm in the business of discouraging people from PM&R, only encouraging them to focus on what they are most interested in) the other part is whether or not you are interested in ACUTE stroke managment. If you are then go neurology, if not then decide whether you'd rather stomach acute strokes in the ED or your MSK rotations 😀 In the long run though, you could end up doing what you want TBI/SCI inpatient/outpatient coming from neurology or physiatry residency programs, and ditch MSK and/or acute neuro managment once you land a job in a rehab hospital.

Although, keep in mind even neurorehab patients will have MSK issues - consider a hemiplegic patient with shoulder subluxation, heterotopic ossification in TBI patients, and spasticity management procedures require a detailed knowledge of neuromuscular anatomy and function.

 

[Ludicolo]

dont get me wrong, of course i would want to have some sort of outpatient practice to f/u with inpatients, and if it were all sci and tbi, i think i would be ok with that.

its just that i dont have a passion for MSK issues at all, i just dont want to deal with it... i recognize that MSK is obviously part of all residency programs, and if i have to do it for a few months out of 3 years, i'll do it, but long term i would prefer not to.

i guess my question is, is this a strong reason not to go into pm&r. or will i still make it despite my strong dislike for MSK?

After training is complete, you do what you want to do, balanced with what you feel you need to do.

That said, an outwardly displayed hatred or aversion to MSK medicine could be a barrier. Knowledge of MSK function and being able to perform a proficient regional neuromusculoskeletal examination is one of the foundations of our specialty. And you’ll need to know it even if you pursue inpatient rehab. Think of all the shoulder problems and overuse injuries that manual wheelchair users can get.

 

[Hemisphere]

can you practice PM&R out of residency and not see any stroke, Parkinsons, CP type patients at all?

yes, you can have an outpatient practice with a focus on musculoskeletal/sports/ and/or interventional spine procedures and/or pain management.

check out the threads on fellowship opportunities.

 

[RUOkie]

That said, an outwardly displayed hatred or aversion to MSK medicine could be a barrier. Knowledge of MSK function and being able to perform a proficient regional neuromusculoskeletal examination is one of the foundations of our specialty. And you’ll need to know it even if you pursue inpatient rehab. Think of all the shoulder problems and overuse injuries that manual wheelchair users can get.

I personally do not think that HAS to be a barrier. The trick is just to keep it to yourself during interviews. You need to understand the mechanics, but many SCI/TBI docs refer their MSK problems in their patients to their peers who practice MSK medicine. Even when I was in training, I remember doing an EMG on the TBI inpatient floor. I was in an EMG rotation, but the patient needed the study after an electrical injury. The TBI docs recognised the problem and then requested the electrodiagnostician to do the test.

You just need to be able to recognize the problems and then refer out. In exchange, they will refer the mild TBI or myelopathy patients to you!