Some Advice about the Specialty

[PhysRehabMed]

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I did quite a bit of research about PM&R but there are no contacts/advisors at my school that I can ask questions, specifically tough questions about the field. As a medical student trying to decide upon a specialty, any feedback would be appreciated.

1. What do you see for the future of the specialty? I know that PM&R lacks research/EBM. Do you think that this makes the specialty unstable? Do you think that insurance companies will continue to reimburse for your services or make cuts? Do you think that PM&R can get phased out in the future?

2. What services do you offer your patients? I did a PM&R rotation in several different specialties (stroke, cardiac, msk), but with only seeing snapshots of the specialties, it was difficult to see progress of patients. I saw that on the inpatient side, physiatrists mainly handled minor stable medical issues while patients got PT/OT. On the outpatient side, I saw back pain patients, sprains/strains, EMGs, workers comp eval, some injections, P+O. Do you see much progress/ get good results/ feel like you are making a difference? Is there a percentage of patients that you feel like you dont have much to offer because their conditions are difficult to treat or their disability is difficult to improve?

3. Does the lack of visibility/understanding of the field ever stop bothering you? What is it like interacting with attendings from other specialties?

4. I heard that PM&R was getting more competitive but this article on the aapmr website does not support that http://www.aapmr.org/resident/newslttr/064c.htm

Thanks in advance.

 

[PMR 4 MSK]

I did quite a bit of research about PM&R but there are no contacts/advisors at my school that I can ask questions, specifically tough questions about the field. As a medical student trying to decide upon a specialty, any feedback would be appreciated.

1. What do you see for the future of the specialty? I know that PM&R lacks research/EBM. Do you think that this makes the specialty unstable? Do you think that insurance companies will continue to reimburse for your services or make cuts? Do you think that PM&R can get phased out in the future?

2. What services do you offer your patients? I did a PM&R rotation in several different specialties (stroke, cardiac, msk), but with only seeing snapshots of the specialties, it was difficult to see progress of patients. I saw that on the inpatient side, physiatrists mainly handled minor stable medical issues while patients got PT/OT. On the outpatient side, I saw back pain patients, sprains/strains, EMGs, workers comp eval, some injections, P+O. Do you see much progress/ get good results/ feel like you are making a difference? Is there a percentage of patients that you feel like you dont have much to offer because their conditions are difficult to treat or their disability is difficult to improve?

3. Does the lack of visibility/understanding of the field ever stop bothering you? What is it like interacting with attendings from other specialties?

4. I heard that PM&R was getting more competitive but this article on the aapmr website does not support that http://www.aapmr.org/resident/newslttr/064c.htm

Thanks in advance.

Valid questions, but hard to answer. Our specialty chronically suffers from identity crisis, you just have to get used to it. We do many of the things other docs don't want to do - like disability medicine and handle patients on the rehab ward. Some do more medicine, some more babysitting in the inpt arena.

Outpt is the opposite - we're now doing things other specialties used to provide exclusively - pain medicine for example, and other specialties often don't like it. There are constant turf battles and overlap.

Insurance companies will continue to cut down on what they approve across all specialties. Unless PT and injections get some better science behind them, they do seriously risk losing their reimbursement.

I do outpt MSK, with a little outpt general rehab - spasticity, disability evals, pts with MD, SCI, TBI, etc. I don't do any inpt rehab - schedule and money are much better outpt, bu it depends where you go and what you want to do.

Most of my patients get better, but many have chronic conditions, so it often comes back intermittantly. You have to have a paradigm shift in your mind where you no longer concentrate on curing the patient (although that's what they want), but amelioratin their symptoms and improving the function and quality of life.

Most of the patient I can't help are iether too medically complex and require a tertiary care center, or are too psychologically co-morbid to be able to get through to them. You do what you can for who you can, and refer out the rest, or refer back to PCP (punt).

There appears to be a growing disparity among residency programs in the US - the top tier fills with American MD grads, the bottom 2/3rds or so gets what's left - DO and IMG. That may be offensive to DO's and IMG's, but its the reality - American trained MD's will usually get ranked higher than others. If you fel this is not the case - look at the tone of the article mentioned - the measure of the strength of a field and it's general respect is how many American-trained MD's get in.

What those stats should look at is not neccesarily the field as a whole, but concentrate on what the differences are between the top tier programs and the bottom.

AAPMR needds to get serious about recruiting and get more med students interested in PM&R. Problem is, like your program, many med schools have no PM&R to work with.

 

[Shalom77]

Some of the stats used in the article are bogus. Like the percent of positions filled by US MDs vs. DOs other Independants. If the author had picked 2000 or 2001 as a comparison instead of 2003, the percent of positions filled by US seniors would have been 40%. It's never been that low since then but it hovers around 50% +/- 5%. So if you cherry pick a high year and compare it to a low year you get a false trend. In any case I think it's to be expected that DOs would be attracted to the field - I'm not sure why that's an issue.

The "top" programs are highly competitive and perhaps getting more so. But there is a lower tier of programs that is not as competitive. I was actually advised by someone that there is a lot more variability in the quality of PM&R programs than in some other specialties and that it would be better to go unmatched that to match at a program of questionable quality. Although I agree that we should be engaging more med students - I think this (program quality) is an important issue (or perception) that needs to be addressed.


I just matched this year - but I can say that some of the strongest advocates for my going into PM&R are attendings in other specialties. So at least some attendings in other fields think PM&R is a GREAT specialty.

I think there is a lot of opportunity in PM&R. I see the relative paucity of research as providing a lot of opportunity for a person interested in research. As we gain a greater understanding of neural plasticity - I think there will be exciting advances in neurorehabilitation. With an aging population - there will be plenty of people who need PM&R services - certainly MSK but also in rehabilitating from other chronic disease. It's a broad field - which despite the moaning about "identity crises" 🙄 has the advantage that even if there's an aspect you don't like there are other aspects that may be a good fit to develop your niche. The insurance climate is changing for everyone not just PM&R - prediction is difficult.
I think though some skills that PM&R docs have (such as MSK) are things people are willing to pay out of pocket for.

 

[pinkeclipse]

Thanks for starting this thread! I have a lot of the same q's. As application season starts, I have been debating whether or not I should go into PM&R. All I hear is doom and gloom news. I'm afraid I'll regret this decision later on in my future.

It's hard constantly hearing people around you say that I'd be much better off in another specialty (both intellectually, financially, job-security-wise) and trying to maintain my stance on applying. I need info, more info. And although I've read this entire forum more than once, I still worry and read the same threads over & over again trying to find any piece of new info I might have missed that will help me.

All the uncertainty worries me. ESPECIALLY the lack of research and EBM in the field. It's like they could do away with our specialty in a heart beat if they wanted to-- since we don't contribute much in terms of EBM and proving our need in the world of medicine.

And yes, the identity crises DOES bother me a great deal. It's so hard trying to explain to people the use of PM&R and how it differs from other specialties that each do a piece of what we do. I hate to say it, but I almost feel like it's a specialty of left overs. We picked up the scraps thrown out by the other fields, and try to make a resemblance of a legitimate specialty. I hate to feel this way about the field I want to go into, but these have been my thoughts lately. Talk about a bruised ego here.

I hate the lack of security in my future in PM&R. It's like I'll be taking a huge gamble and I'm not sure where I'll end up. I never imagined I'd become so stressed out about applying to PM&R, but I am.

I could choose something else, but nothing ever grabbed my interest the way PM&R did. I could say I'll go into a fellowship, but that is not guaranteed and highly competitive as well as getting harder for PM&R residents to get pain as time goes on. Who knows if PM&R will even be able to get into pain fellowships (by the time I'm ready to apply) the way things are going for us. See, they are already starting to pull the rug out from under us. Things seem to be slowly falling apart. *sigh* It looks like the hayday of PM&R has come and gone and the powers that be in medicine are slowly realizing this. 🙁

I'm not trying to bash PM&R, I'm just voicing my concerns. I don't want to feel like I'm blindly jumping into something especially when others are warning me not to. But I love the idea of PM&R. Oh the dilemma.

 

[SportsMed09]

I'm applying to PM&R this year as well, and being on my PM&R rotation, I think this specialty can carve itself a significant niche in the medical world.
I'm currently on outpatient, and we see predominantly MSK problems. These are the kinds of things that PCP's refer to Ortho or PT, but let's be real: surgeons don't care about a patient's shoulder pain, neck pain, or knee pain unless it is something they can operate on. And sometimes, PT is not the answer. This week alone, we've barely referred to PT, since we've diagnosed the problem in clinic, and have given appropriate medication or reassured the patient that time is the best cure.
I'm not sure of the inpatient side of things yet, but I don't understand why we, as med students going into it, or as residents or fellows, can't start reshaping PM&R as the "primary care" of the specialty/MSK world. Physiatrists already do this as evidenced by the fact they work in multispecialty groups. Doing what? Screening patients for the Orthopods in the group!
I don't think this will be accomplished in a year or two, but this "identity crisis" didn't occur in that short of a time span either.
I don't see a reason to be worried about lack of recognition: if you're great at what you do, docs will refer to you and patients will come to see you, regardless of which specialty you're from.

 

[olafa]

All the uncertainty worries me. ESPECIALLY the lack of research and EBM in the field. It's like they could do away with our specialty in a heart beat if they wanted to-- since we don't contribute much in terms of EBM and proving our need in the world of medicine.

Pink Eclipse- I am not sure what you mean by lack of EBM- our journal is full of nauseating Phd research in the field regarding pain, SCI, TBI stroke, gait etc.... ???? Other journals you may find EBM related to our specialty, any of the ortho journals, bone and joint, sports med journal, muscle and nerve (those are only off the top of my head). Possible you just haven't been exposed to this side. There is plenty of research going on. Having said that, not everyone is crazy about doing research either, the clinical side is more gratifying.
BTW the journal "Archives of PM&R"- red and white - is in the process of changing is face and hopfully becoming less benchwork research oriented to more clinically oriented. I don't think you have to worry about PM&R "going away." We do plenty of things other docs don't do for various reasons I am sure.

 

[PMR 4 MSK]

EBM is overrated and rarely translates from academia to real practice, mainly due to reporting bias and exclusionary criteria. But we could have pages of debate on that.

If you think PM&R is in danger look at this - my current ortho group recruited me because they wanted the following:

1) Someone who could do EMG's in the office instead of sending them out.
2) Someone who can take care of the non-operative patients so they can spend more time with operative cases
3) Someone who can help them sort out spine cases from peripheral - i.e. is the shoulder pain from the neck or the shoulder? Is the hip pain back or hip? Are the paresthesias neurologic or referred?
4) Someone who can do fluoroscopic procedures at their ASC (they own it).
5) Someone who can do pain management
6) Someone who can do non-operative Sports Medicine

I fit the bill for all of this. No need for a neurologist, an anesthesiologist and an FP sports med. I bring in new patients, and I help them with their existing patients. I make them a lot of money, and I make a lot. Everyone is happier.

I spent my first few years in private practice cutting my teeth by being a dumping ground, because that's what I thought we did - mopped up after everyone else was through with the patients. It doesn't have to be that way at all.

Here's a sampling of what I did today (It's friday and I keep the day light) - I had 5 consults - 3 were for neck and/or back pain, one was a lady 2 days post running injury in softball - partial achilles tendon rupture, one was shoulder pain. One of the back pains was a 15 year-old with a strain from cheerleading and track, one was an adult lady with neck and back pain 1 year s/p MVA. The other was cervical spondylosis with shoulder adhesive capsulitis + recent clavicle Fx.

I had 5 follow-ups for various MSK complaints, one was work comp. I had a couple follow-ups cancel because the injections I gave them last week are working well and they didn't need to come in. I had another cancelled because he decided when he came in he wanted it to be covered by work comp and it hadn't been authorized yet.

In the afternoon I had 2 EMG's, both R/O carpal tunnel syndrome, then I was done by 3 pm and went home.

In the average week I do 10 - 11 EMG's, 12 - 16 fluoro procedures and three half-days of clinic. No inpt work. I see pts for about 30 hours a week. I take vacation and days off whenever I want, but I like to work, and I like the money (not working = not producing = less $).

And I have no call. Our CEO (an orthopod) recently said to me, in front of other docs, "Man, no call, that's got be be awesome!" I couldn't agree more.

 

[lobelsteve]

Here's a sampling of what I did today (It's friday and I keep the day light) - I had 5 consults - 3 were for neck and/or back pain, one was a lady 2 days post running injury in softball - partial achilles tendon rupture, one was shoulder pain.

I had 5 follow-ups for various MSK complaints, one was work comp. I had a couple follow-ups cancel because the injections I gave them last week are working well and they didn't need to come in. I had another cancelled because he decided when he came in he wanted it to be covered by work comp and it hadn't been authorized yet.

QUOTE]

Sounds a lot like me. I used to do a lot more chronic, but in my current role as the Pain Doc, I see acute, subacute more than chronic pain. I got frustrated at my 1 week follow-ups because they come in with 1/10 pain. I usually give them the DLS home exercise program at the procedure visit so if the pain is reduced they can get right to it. Other NP/consults get disappointed because they cant have the injection today. I have a Neurologist in my office so I do not do the EMG's. I do about 30 fluoro procedures a week and 10-15 office based procedures (occipitals, knees, shoulders, neuromas, NO trigger points). 8-4, No call, no weekends. Stim, vertebroplasty, disc decompression, celiac block, RF's were all done in my office in the last 3 weeks.

 

[predodoc]

EBM is overrated and rarely translates from academia to real practice, mainly due to reporting bias and exclusionary criteria. But we could have pages of debate on that.

If you think PM&R is in danger look at this - my current ortho group recruited me because they wanted the following:

1) Someone who could do EMG's in the office instead of sending them out.
2) Someone who can take care of the non-operative patients so they can spend more time with operative cases
3) Someone who can help them sort out spine cases from peripheral - i.e. is the shoulder pain from the neck or the shoulder? Is the hip pain back or hip? Are the paresthesias neurologic or referred?
4) Someone who can do fluoroscopic procedures at their ASC (they own it).
5) Someone who can do pain management
6) Someone who can do non-operative Sports Medicine

I fit the bill for all of this. No need for a neurologist, an anesthesiologist and an FP sports med. I bring in new patients, and I help them with their existing patients. I make them a lot of money, and I make a lot. Everyone is happier.

I spent my first few years in private practice cutting my teeth by being a dumping ground, because that's what I thought we did - mopped up after everyone else was through with the patients. It doesn't have to be that way at all.

Here's a sampling of what I did today (It's friday and I keep the day light) - I had 5 consults - 3 were for neck and/or back pain, one was a lady 2 days post running injury in softball - partial achilles tendon rupture, one was shoulder pain. One of the back pains was a 15 year-old with a strain from cheerleading and track, one was an adult lady with neck and back pain 1 year s/p MVA. The other was cervical spondylosis with shoulder adhesive capsulitis + recent clavicle Fx.

I had 5 follow-ups for various MSK complaints, one was work comp. I had a couple follow-ups cancel because the injections I gave them last week are working well and they didn't need to come in. I had another cancelled because he decided when he came in he wanted it to be covered by work comp and it hadn't been authorized yet.

In the afternoon I had 2 EMG's, both R/O carpal tunnel syndrome, then I was done by 3 pm and went home.

In the average week I do 10 - 11 EMG's, 12 - 16 fluoro procedures and three half-days of clinic. No inpt work. I see pts for about 30 hours a week. I take vacation and days off whenever I want, but I like to work, and I like the money (not working = not producing = less $).

And I have no call. Our CEO (an orthopod) recently said to me, in front of other docs, "Man, no call, that's got be be awesome!" I couldn't agree more.

Im doing a rotation in Outpat. MSK with a PMR doc that seems to have the exact same job decription as you do. Just like the other med students Im strongly considering PMR but having my worries too. Im trying to decide b/t IM and PMR and Im having difficulties. I like the more challanging IM but I think I would burn out fast. PMR I like b/c I feel like I would be pretty good at it. When I asked my IM attending last month he said " Future of PMR is in question and IM you have so many options and will always be in need". When talking to a PMR doc he said " If you go IM you might one day wish you had gone PMR. but if you go PMR you will never wish you did IM".

Right now Im leaning more toward PMR since I like the lifestyle and my wife likes that Im at home more. I think I am just like many other med students searching these forums looking for the same answer...Will PMR be a good career decision in the future?? And after all the reading Ive done the answer is very debatable. So I have to just go on my gut. But If I somehow found out PMR was going to be an uphill battle the rest of my carrer (finding jobs, pay, respect, ect) then I would change my mind for sure.

I do have a few questions Im curious about right now I dont want to ask the doctor Im rotating with so Ill ask you

1. . What range of $ are people like you making doing the outpt msk thing?

2. How difficult do you think it is it to find a good outpt job in an ortho clininc fresh out or nearly fresh out of residency?


Here's a more personal question. If I decide to go PMR, when I apply I will have only 1 PMR rotation under my belt (outpt MSK) and will not have a chance to do another elective until November. Do You think residency programs will look down on this? Not to mention I will only have 1 PMR Letter or rec.

 

[Disciple]

If you think PM&R is in danger look at this - my current ortho group recruited me because they wanted the following:

1) Someone who could do EMG's in the office instead of sending them out.
2) Someone who can take care of the non-operative patients so they can spend more time with operative cases
3) Someone who can help them sort out spine cases from peripheral - i.e. is the shoulder pain from the neck or the shoulder? Is the hip pain back or hip? Are the paresthesias neurologic or referred?
4) Someone who can do fluoroscopic procedures at their ASC (they own it).
5) Someone who can do pain management
6) Someone who can do non-operative Sports Medicine

I fit the bill for all of this. No need for a neurologist, an anesthesiologist and an FP sports med. I bring in new patients, and I help them with their existing patients. I make them a lot of money, and I make a lot. Everyone is happier.

I spent my first few years in private practice cutting my teeth by being a dumping ground, because that's what I thought we did - mopped up after everyone else was through with the patients. It doesn't have to be that way at all.

Here's a sampling of what I did today (It's friday and I keep the day light) - I had 5 consults - 3 were for neck and/or back pain, one was a lady 2 days post running injury in softball - partial achilles tendon rupture, one was shoulder pain. One of the back pains was a 15 year-old with a strain from cheerleading and track, one was an adult lady with neck and back pain 1 year s/p MVA. The other was cervical spondylosis with shoulder adhesive capsulitis + recent clavicle Fx.

I had 5 follow-ups for various MSK complaints, one was work comp. I had a couple follow-ups cancel because the injections I gave them last week are working well and they didn't need to come in. I had another cancelled because he decided when he came in he wanted it to be covered by work comp and it hadn't been authorized yet.

In the afternoon I had 2 EMG's, both R/O carpal tunnel syndrome, then I was done by 3 pm and went home.

In the average week I do 10 - 11 EMG's, 12 - 16 fluoro procedures and three half-days of clinic. No inpt work. I see pts for about 30 hours a week. I take vacation and days off whenever I want, but I like to work, and I like the money (not working = not producing = less $).

And I have no call. Our CEO (an orthopod) recently said to me, in front of other docs, "Man, no call, that's got be be awesome!" I couldn't agree more.

The practice described above by PMR4MSK is the model most Physiatrists envision when going into Interventional Spine/MSK/Sports, etc.

The Holy Grail of PMR musculoskeletal is to have the above practice without surgeon involvement.

It has been achieved by a select few pioneers.

http://www.soarspine.com/

For now, the trade off for higher earning potential/control is full scale Pain Medicine.

As a specialty, with the right attitude, the Holy Grail can be possible for all of us.

 

[SportsMed09]

Are there any other groups out there like this?

 

[Finally M3]

EBM is overrated and rarely translates from academia to real practice, mainly due to reporting bias and exclusionary criteria. But we could have pages of debate on that.

If you think PM&R is in danger look at this - my current ortho group recruited me because they wanted the following:

1) Someone who could do EMG's in the office instead of sending them out.
2) Someone who can take care of the non-operative patients so they can spend more time with operative cases
3) Someone who can help them sort out spine cases from peripheral - i.e. is the shoulder pain from the neck or the shoulder? Is the hip pain back or hip? Are the paresthesias neurologic or referred?
4) Someone who can do fluoroscopic procedures at their ASC (they own it).
5) Someone who can do pain management
6) Someone who can do non-operative Sports Medicine

I fit the bill for all of this. No need for a neurologist, an anesthesiologist and an FP sports med. I bring in new patients, and I help them with their existing patients. I make them a lot of money, and I make a lot. Everyone is happier.

I spent my first few years in private practice cutting my teeth by being a dumping ground, because that's what I thought we did - mopped up after everyone else was through with the patients. It doesn't have to be that way at all.

Here's a sampling of what I did today (It's friday and I keep the day light) - I had 5 consults - 3 were for neck and/or back pain, one was a lady 2 days post running injury in softball - partial achilles tendon rupture, one was shoulder pain. One of the back pains was a 15 year-old with a strain from cheerleading and track, one was an adult lady with neck and back pain 1 year s/p MVA. The other was cervical spondylosis with shoulder adhesive capsulitis + recent clavicle Fx.

I had 5 follow-ups for various MSK complaints, one was work comp. I had a couple follow-ups cancel because the injections I gave them last week are working well and they didn't need to come in. I had another cancelled because he decided when he came in he wanted it to be covered by work comp and it hadn't been authorized yet.

In the afternoon I had 2 EMG's, both R/O carpal tunnel syndrome, then I was done by 3 pm and went home.

In the average week I do 10 - 11 EMG's, 12 - 16 fluoro procedures and three half-days of clinic. No inpt work. I see pts for about 30 hours a week. I take vacation and days off whenever I want, but I like to work, and I like the money (not working = not producing = less $).

And I have no call. Our CEO (an orthopod) recently said to me, in front of other docs, "Man, no call, that's got be be awesome!" I couldn't agree more.

You're my hero PMR 4 MSK...can I have your job? 🙂

Seriously, add some ancillary income from ASC/imaging/etc and it sounds like a fantastic gig.

 

[OMMFellow06]

Man, the focus of this thread has really just been on the outpatient side of things, but our field was made on the inpatient side.

Let's not forget SCI and TBI.

Spinal Cord injuries and how to take care of patients with them is something that I would say is very specific to our field. Most people don't know anything about neurogenic bowel or bladder or how to manage that. They don't understand why a SCI patient hasn't had a bowel movement in so many days or why they can't urinate. They come to our rehab floor and we end up changing medications and bowel and bladder management almost immediately.

Then there's Traumatic brain injury rehab, which is really an artform. Not as simple as say stroke rehab, you know where their stroke was and you have an idea of what you should expect them to have deficits in. TBI patients can have decificits in everything. They're a real challenge medically as well as psychosocially.

Those 2 fields I think are pretty unique to our field and will likely continue to be so. Yes, the outpatient world in PM&R is taking off, but don't forget that our field is still pretty stable in SCI and TBI.

 

[Ludicolo]

Ah. The annual med student “crisis of faith”. Or am I making the right choice with PM&R?

To those thinking about applying to PM&R – let me ask you some questions. Other than lifestyle, what draws you to the field? What do you absolutely love about PM&R? What don’t you like about PM&R, and can you live with that? Don’t get me wrong – lifestyle is an important consideration in choosing a specialty. But IMHO it should not be your primary focus. In a “lifestyle specialty”, yes you will get to spend more time with your family and friends, but you will still spend a good portion of your waking life at your job. You gotta love it - or you’re gonna bring that misery back home with you. Some love the mental gymnastics in solving the intricacies of the neuromusculoskeletal system. Some like the camaraderie that comes with working within a team dynamic to solve problems. Some like the inspiration of helping a young, newly disabled patient work their way back into society. Some may even like being around chronic pain patients (OK – that may be a stretch).

There are downsides to every field, and to medicine in general. The reimbursement issues for example, cut across all of medicine. Is PM&R an endangered species? As long as there is pain and disability, my guess is no. As long as there are quality candidates entering the field, my guess is no. I’m interested though in hearing why the IM attending thought that the future of PM&R is in doubt.

Will the opportunity to gain a pain fellowship and practice pain physiatry be more limited to rehab residents in the future? I can’t say as this is not my area of expertise, but I’m certain that others can chime in. It seems more competitive lately. But as OMMFellow06 notes there are other facets to PM&R – we are a surprisingly broad field. Who knows what you'll fall in love with during your residency? One of you may be the next pediatric cancer amputee guru.

The lack of recognition and respect is downheartening to some, humorous to others. (Fizz ee AT ree? Fizz EYE a tree?) Recognition? Our forefathers weren’t very good at marketing, were they? I have since accepted educating patients and other doctors as part of the gig. We each should serve as ambassadors for our field, teaching our patients and our referral sources what we have to offer. I can do it on an individual and at my institutional level, but obviously our Academy needs to do better on a national level and medical school level. Respect? That must be earned. Worry about individual respect before medical specialty respect and prestige. Become good and productive at what you do, and be collegial about it, and respect will come.

To the poster that said “if I found out that PM&R is going to be an uphill battle for the rest of my career… I would change my mind for sure”. Consider the battle that some of your patients will be going through. Fight for what you believe in.

 

[oreosandsake]

Ludicolo,

I hope you don't mind... I'm quoting you for my signature.

 

[Disciple]

I'm interested though in hearing why the IM attending thought that the future of PM&R is in doubt.

Probably because what he knows about PM&R are his consult requests to get patients off of his service.

Will the opportunity to gain a pain fellowship and practice pain physiatry be more limited to rehab residents in the future? I can't say as this is not my area of expertise, but I'm certain that others can chime in. It seems more competitive lately.

What I don't think most medical students understand is that this will likely not be the question that everyone is asking 5-10 years from now.

PM&R residencies (on average) are improving MSK training and the academy (and possibly the ABPMR) is throwing its support behind "Interventional Spine"
to facilitate the practice described above by PMR4MSK, and to standardize the skills of musculoskeletal Physiatrists

Pain Medicine, OTOH, is becoming its own residency

http://www3.interscience.wiley.com/journal/120089385/abstract

http://www3.interscience.wiley.com/journal/120089386/abstract

Interventional/MSK Physiatrists will be entrenched in Orthopedic type practices. Whether we will ever be truly independent of surgical groups remains to be seen.

There will be a few PM&R pain docs running RIC type comprehensive pain programs.

 

[Disciple]

I'm not really understanding what questions about PM&R are not clearly answered in the FAQs.

1. Lifestyle is better than most other specialties. I think most residents and attendings can agree on this.

2. Earning potential (look up the averages for interventional pain, a little less on average when you work for surgical groups, and the published averages for inpt jobs).

3. The recognition thing. Yes, this can be irritating at times. But I think after being in practice for a number of years, this probably means less to most private practice physicians. After a number of years, your average private practice doc wants to enjoy their work, make enough to support their family and lifestyle, and go home at the end of the day at a reasonable hour.

Isn't that exactly what PM&R gives you?

 

[PMR 4 MSK]

You're my hero PMR 4 MSK...can I have your job? 🙂

Seriously, add some ancillary income from ASC/imaging/etc and it sounds like a fantastic gig.

Imaging and PT profits are put into the general reciepts to lower overhead for everyone, ortho and others - so I am lucky to benefit from that, many ortho groups don't share ancillaries. ASC is their baby alone - I do proceures there, profits are retained by the ortho owners. I'm good with that. The buy-in for that would likely be hideous.

 

[Ludicolo]

Ludicolo,

I hope you don't mind... I'm quoting you for my signature.

I'm flattered. Permission granted. Post liberally.

 

[predodoc]

I'm interested though in hearing why the IM attending thought that the future of PM&R is in doubt.

.

He was referring to inpt. rehab and told me that he knows rehab docs will be needed in the future but how the govt keeps cutting out rehab its as if they want to phase it out all together....I would think about that before choosing. I dont know why he said that or if was trying to sway me or whatever.

What I meant when I said not choosing PMR if its uphill battle is that I wouldnt choose a specialty If I knew it would be a terrible career decision, and one that I would have a lot of difficulty finding a job(there was a thread about this a few days ago). But nobody knows the future of PMR, or any other specialty for that matter, and its all speculation. So everyone going into it will just have to go on their gut and decide if they like it.

I wasn't trying to down the specialty, I like PMR. I'm having such a difficult time deciding, so I just wanted to throw out all the thoughts in my head that I analyze at least 5x a day. I guess some came out wrong.

 

[chunkeroo]

"There are downsides to every field, and to medicine in general. The reimbursement issues for example, cut across all of medicine." 👍 Bingo - and beyond medicine for that matter.

If you really need to worry about something stop worrying about "should I go into PMR" and worry about the demographics that are going to affect our country in many areas ie SS, Medicare. This is the freight train that is going to hit our economy over then next decade or so. The boomers are ready to cashout and start sucking down the entitlements. The working population of Gen X and Yers are not going to be able to support this topheavy shift.

Neither the Dems or Repubs are talkin' about this elephant in the room. No specialty will be unaffected.