Random PM&R questions

[AviatorDoc]

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To be honest, this is my first post since my MS-I year.

First off, I should say that I've had a passion for Family Practice for some time for several reasons, including variety of patients & geography (1. you can practice anywhere, 2. I dont have to move my family for residency).

Anyway, I've been trolling this board trying to learn a bit more about PM&R. My best bud in med school is a former PT who will be vying for one of the upper eschelon PM&R programs. Meanwhile, he has encouraged me to consider the specialty for myself. I'm applying to do a rotation at the Mayo Clinic in Scottsdale in the fall to see if I'd like it. I've got some random questions regarding the profession. I know that some of these cannot be answered until I do a rotation myself. I apologize if some of these are already hashed out in other threads.

1.) If I am someone who enjoys a fast pace & immediate results, can I still tailor PM&R to my style? My PT friend says that I can specialize in interventional, doing injections & EMG.


2.) Are there entrepreneurial opportunities available? I'm thinking of pain clinics (possibly "wellness centers" with an integration of various pain-relieving modalities), rehab centers, kinesiology therapy gyms, etc.


3.) Is there a need for PM&R in small town settings? What if I'm willing to travel an hour or so to expand my population base?


4.) If I'm a very poor applicant on paper, do I stand a chance of getting a PM&R spot? Should I be working my tail off for Comlex Step 2? Location is extremely important to me, so I would be looking at California programs primarily.

5.) Lifestyle is an important point for me. Income is only slightly important, but time at home away from work is more important. Does PM&R fit this?


Any help would certainly be appreciated.


Aviatordoc
MS-IV KCOM

 

[delicatefade]

To be honest, this is my first post since my MS-I year.

First off, I should say that I've had a passion for Family Practice for some time for several reasons, including variety of patients & geography (1. you can practice anywhere, 2. I dont have to move my family for residency).

Anyway, I've been trolling this board trying to learn a bit more about PM&R. My best bud in med school is a former PT who will be vying for one of the upper eschelon PM&R programs. Meanwhile, he has encouraged me to consider the specialty for myself. I'm applying to do a rotation at the Mayo Clinic in Scottsdale in the fall to see if I'd like it. I've got some random questions regarding the profession. I know that some of these cannot be answered until I do a rotation myself. I apologize if some of these are already hashed out in other threads.

1.) If I am someone who enjoys a fast pace & immediate results, can I still tailor PM&R to my style? My PT friend says that I can specialize in interventional, doing injections & EMG.


2.) Are there entrepreneurial opportunities available? I'm thinking of pain clinics (possibly "wellness centers" with an integration of various pain-relieving modalities), rehab centers, kinesiology therapy gyms, etc.


3.) Is there a need for PM&R in small town settings? What if I'm willing to travel an hour or so to expand my population base?


4.) If I'm a very poor applicant on paper, do I stand a chance of getting a PM&R spot? Should I be working my tail off for Comlex Step 2? Location is extremely important to me, so I would be looking at California programs primarily.

5.) Lifestyle is an important point for me. Income is only slightly important, but time at home away from work is more important. Does PM&R fit this?


Any help would certainly be appreciated.


Aviatordoc
MS-IV KCOM

Well, I'm not a doctor yet, but I am a PT so maybe I can help a little. Some of the PM&R guys here might do a little better than me. 🙂

1. I think PM&R can be both slow paced or fast paced depending on whether you further specialize or not. Being a PM&R doctor on a rehab floor or at a rehab hospital will generally be a lot slower paced. Functional gains are often made slowly, after hours, days, and sometimes weeks of work by the therapists. Specializing in SCI or TBI would probably be more interesting but again, still a little slow paced.

Injections and EMG would definitely provide more immediate results and a somewhat more fast paced, yet comfortable setting. I still wouldn't call it fast paced, and unless I'm wrong, dealing with chronic pain via injections, etc can be hit or miss as far as immediate results.

2. There are absolutely entrepreneurial opportunities available. Many PM&R docs do only outpatient visits/procedures, and many of them hire PT's and OT's to do therapy in their clinics. I know a few classmates that work for physician owned practices. Be prepared for some resistance from PT lobbying groups though, as they are politically trying to get more independent practice for PT's (yet still within their scope) through direct access.

3. I think there is a great need for PM&R in small towns and rural settings. Often they do not have any PM&R doctors, and I think that the expertise in musculoskeletal, neurological, and cardiopulmonary conditions often associated with PM&R docs can be an invaluable asset to the community.

4. Can't answer this one.

5. I think the lifestyle of a PM&R doc is excellent. There is flexibility to work not so much or to work like a madman depending on what you want to do.

 

[AviatorDoc]

Thanks for the input. I can compromise on fast-paced, especially considering the alternative -- family practice can become fairly tedious at times.

 

[delicatefade]

You may want to check out this forum as well: there seem to be some people there who are familiar with physician owned PT clinics.

http://forums.studentdoctor.net/showthread.php?t=126655

 

[axm397]

1.) If I am someone who enjoys a fast pace & immediate results, can I still tailor PM&R to my style?
You can also do sports medicine - that should be fast paced and exciting. Be a team physician for a sports team.

2.) Are there entrepreneurial opportunities available? I'm thinking of pain clinics (possibly "wellness centers" with an integration of various pain-relieving modalities), rehab centers, kinesiology therapy gyms, etc.
I think in general, you can do whatever you want in Medicine. Doesn't mean you'll necessarily be successful but... anything is possible. You just have to tailor your practice to your patients' needs and also make it make financial sense.

Check out: http://forums.studentdoctor.net/showthread.php?t=68723, http://som.umdnj.edu/f_practice/rehab.htm, http://directory.webguest.com/Health/Medicine/Medical_Specialties/Rehabilitation_Medicine, etc.

3.) Is there a need for PM&R in small town settings? What if I'm willing to travel an hour or so to expand my population base?
There's a need for PM&R everywhere. People always have strokes, MIs, general deconditioning, etc. - where there are old ppl, there needs to be rehab 🙂. Also, if you do sports medicine, I can't imagine any small town American NOT having sports... So I don't think that would be a concern.

4.) If I'm a very poor applicant on paper, do I stand a chance of getting a PM&R spot? Should I be working my tail off for Comlex Step 2? Location is extremely important to me, so I would be looking at California programs primarily.
The California programs can be more competitive mainly because of location. Check out the sticky on PM&R applicant trail for feedback on some of the california programs. The programs in California are: UC Irvine, UC Davis, UCLA, Stanford, and Loma Linda. Also check this out: http://www.medfools.com/match/pm_r.php. Many programs give interviews to ppl who rotate there - so you may want to consider rotating at one of those programs. Especially if you think you are a poor applicant on paper. I think Step 2 would make up for a poor Step 1. You should also be working on getting good LORs and if you have time, do some research in PM&R. Browse through some of the other threads about how to make yourself more competitive.

5.) Lifestyle is an important point for me. Income is only slightly important, but time at home away from work is more important. Does PM&R fit this?
Lifestyle is definitely what you make of it - but I think in general, lifestyle is one of the biggest drawing points of PM&R. Again, it depends on what sub-field of PM&R, what type of practice you enter, and how much you want to work.

Hope this helps - the www.aapmr.org website also has resources for med students. You may also want to check out the websites of the california PM&R residencies to get a "feel" of the programs. Good luck!

 

[Finally M3]

1) PM&R work hours is as much as you want to make it; you can mix inpt and outpt, work solely doing EMGs or injections. The choice is yours. The EMG/injection portion of the field is the more lucrative avenue, however.

2) Things get very hazy in that there are laws (Stark, Denial of Choice) in the books that prevent a physician from referring patients solely to an outside facility that they have a financial interest in (majority OR part-ownership by self, family members, etc.). Fines can be up to 15K per offense, and jail time as well. (We just had our corporate duties lecture in our resident orientation). However, it's ok to employ PT/OT/etc in-house...you just have to provide your patients other options besides your in-house staff.

3) Can't answer

4) Yes, work your butt off on Step 2. Like Axm, I didn't do all that hot on Step 1 but did much better on Step 2. Also, do rotations, get good letters of rec! Treat them as audition rotations.

5) yes indeed! 😀

 

[axm397]

addendum - regarding #3,

I actually went to med school in central pennsylvania - in a pretty rural setting. There are physiatrists in this area who practice in community hospitals, nursing homes, do emgs, pain management, sports medicine, etc... So yes, it is entirely possible to set up a practice in rural america. You'll probably also make more $$ that way since the market will not be as saturated. However, I'm not sure about your idea about making a holistic center - most of the ppl in rural america - at least here in pennsyltucky seem to be no-nonsense type of ppl who believe in hard work and toughing it out. Not sure if "wellness" centers would generate much trust from them. Those kind of centers seem to do better in cities where there are more ppl exposed to diversity and alternative/complementary medicine. but that's my .02

 

[AviatorDoc]

Its interesting you mention "holistic centers" not doing well in rural towns. There are some small towns that are hotbeds for wellness... kirksville, missouri and sedona, az are two. There are many throughout California, especially in Nocal.

When I mentioned rural settings, I was sort of referring to general PM&R (is there such a thing?).

I suppose I need to research a bit more on the whole "self-referral" thing. For example, could a Neurologist own an MRI and hire a radiologist to read for him? (Ignore the probable cost-prohibitive nature of the question.)


Thanks for all the support. I'm looking at doing some elective time at Mayo Scottsdale and the University of Utah. I may have to ditch some FP rotations, and I'm not sure I don't want to do FP!! How are we supposed to decide on a specialty if it's temporally impossible to experience every specialty!??! ARGH!!! (Sorry... random venting there.)

 

[axm397]

It may just be an east coast thing... Or a central Pennsylvania Dutch thing...

I didn't know University of Utah had a PM&R program. Also, Mayo Scottsdale is quite different from Mayo Rochester where the PM&R residency program is located. But I suppose an LOR from a doc there may carry some weight at Mayo-Rochester.

I understand your frustration about having to make up your mind in such a short time with relatively little exposure to the many specialties medicine has to offer. I considered FP for a while before learning about PM&R. I think both fields attract laid back, nice ppl - and offer lots of option when it comes to types of practice. Can't go wrong either way.

I was also wondering, from your signature, are you at KCOM?? If so, there are several ppl going into PM&R from your school that I had the pleasure of meeting on the interview trail. I have their email addresses if you are interested - or perhaps you already know them. I think they would be a great resource for you as well. PM me with your email address if you are interested in getting in touch with them.

 

[paz5559]

Utah has a terrific program, very sports oriented. Stuart Willick is a real up and coming voice in the highest levels of the field. If you have any questions, Faisel Zaman is there, and is listed on the mentor board on the AAPM&R website (he is also the Vice-President of the AAPM&R RPC). (He is going into my area of interest, and will be one of Dr. Slipman's fellows come July, so he may well also be a good resource for any interventional questions)