STILL can't figure out if PM&R is for me?

[keepsmiling10]

HI! I am a 4th year medical student that is frantically trying to figure out what field to go into. PM&R sounds pretty awesome to me but the dilemma I am facing is that I can't get a strong enough grasp on what to expect out of this field. I am currently doing my second PM&R rotation but can't figure out if I may be getting a skewed idea of it because both have been inpatient rehab at the VA (I couldn't get a different one). Here are my questions and ideas about this field:

1. How well do you get trained in medicine as a PM&R resident? How much training do you actually have in medicine? Do you really learn a lot about basic internal medicine or is it much more focused on just managing the rehab part of it?

2. How realistic and simple is it to incorporate integrative medicine practices into this field? How do you actually go about doing that?

3. Part of the reason I am highly swayed towards PM&R is that I understand it to be a program that tries very hard to find other ways to deal with disease processes as an alternative to surgery...is that really an accurate understanding?

4. How much of an inpatient PM&R's job is primarily social work issues or just foreseeing a team (even revolving around just organizing therapies and nursing and other people) rather than actually doing something yourself?

5. What is the patient population like? I know people say it's diverse but realistically is it mostly elderly or cognitively impaired (as in the VA), or is it actually really a variety?

Sorry there are so many questions but I can't seem to find answers that actually target my specific issues with not yet being able to commit to this field. Please let me know if you have any tips for me. Also, the other thing I'm mainly considering is Med-Peds (and maybe, maybe ER) so if that helps for comparison or advice.
Thanks for all your help!

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[Furiousangel]

1. How well do you get trained in medicine as a PM&R resident? How much training do you actually have in medicine? Do you really learn a lot about basic internal medicine or is it much more focused on just managing the rehab part of it?

The only medicine you get is really during your intern year. It is enough to cover most issues you see in an inpatient rehab setting. Any complex issues is usually covered by med consult or transferred off the service. That said, residency may cover medical-related issues in the context of rehab, such as knowing what medications to prescribe to aid in the rehab process.

2. How realistic and simple is it to incorporate integrative medicine practices into this field? How do you actually go about doing that?

Not sure what you're asking here. Care to give me examples or rephrase it?

3. Part of the reason I am highly swayed towards PM&R is that I understand it to be a program that tries very hard to find other ways to deal with disease processes as an alternative to surgery...is that really an accurate understanding?

More or less, for musculoskeletal-related cases, the answer is yes. Don't forget that you will also deal with patients who are deconditioned, post-stroke, TBI or SCI patients where surgery doesn't really come into place. Not sure what you've seen at your VA, but the scope of PM&R is quite broad.

4. How much of an inpatient PM&R's job is primarily social work issues or just foreseeing a team (even revolving around just organizing therapies and nursing and other people) rather than actually doing something yourself?

I would say 100% of the time you "lead" the team. You don't really participate in the actual "grunt" work. That's what the therapist are for.

5. What is the patient population like? I know people say it's diverse but realistically is it mostly elderly or cognitively impaired (as in the VA), or is it actually really a variety?

Variety. It all depends on the setting you're working in. There are units where it is strictly TBI or post-stroke patients. Outpatient setting is mostly MSK-related issues (back and peripheral joint pain, etc.). Obviously, some prosthetics is involved though not a large amount.

Sorry there are so many questions but I can't seem to find answers that actually target my specific issues with not yet being able to commit to this field. Please let me know if you have any tips for me. Also, the other thing I'm mainly considering is Med-Peds (and maybe, maybe ER) so if that helps for comparison or advice.
Thanks for all your help!

The fact that you're even considering ER tells me that you prefer something more fast pace in which you'll find PM&R to be quite opposite. It's more laid back, patients are of lesser acuity however there may be more rehab-related issues making the patient more complex. Med-Peds is also more cerebral and your patients are more sick. Most patients are considered medically stable before they are transferred to rehab. This is just my opinion and I don't mean this in a bad way but if you have already rotated through 2 VA rehab rotation and you're still asking these questions, most likely you didn't get a good feel of what PM&R is like OR perhaps PM&R is not right for you.🙂

 

[MSKalltheway]

Does your attending have outpatient clinic in the afternoons? I would suggest offering to go with him/her if so. If not, see if you can find one and go to that, I think most physiatrists would be happy that you want to see more, they tend to not want you to be a scut monkey and just be happy with what youre doing

Also, what draws you to EM and IM/Peds? I would see what you like about those fields and compare it to PM&R and that may help you out.

 

[topwise]

I don't think it's so crazy to be interested in both EM and PM&R. Both have in common that they're procedure-heavy. The procedures were the one thing I loved about EM (although I hated it in general).

 

[keepsmiling10]

Thanks for all of your input. It is very helpful!

I don't know if rotating through 2 VA inpatient rotations is really representative of what all of PM&R is like. At least, I'm hoping not? Although I don't mind my rotation, the VA has a very selective population and like you guys say, PM&R seems to have a much broader scope. I think an inpatient rotation treating a lot of patients with many, many, chronic diseases, a lot of psych issues and often underlying polysubstance abuse gets to be a little... "soulfully challenging." The problem seems to be that the only people that really know anything about PM&R are the people who are physiatrists and I'm hoping they will continue to hammer in all the endless possibilities included under the Physiatry umbrella because otherwise it sometimes appears kinda vague.

Topwise, you are right. The reasons I am attracted to ER include a large number of procedures, a large variety of patients, and building rapport with them just feels so natural to me. Also, I do like the fast-paced nature of the sport. On the other hand, I could never be happy stabilizing a patient and kicking them out the door. It's been my biggest pet peeve with health care and one of the reasons I wanted to be a doctor, so I could probably never feel satisfied doing that in the long run. I guess I should also realize that there are still a lot of procedures in PM&R, a pretty good variety of patients and although the pace is a little slower, you truly get to help this patient through without taking any shortcuts.

MSKall, thanks for the advice. Clinics is what I'm working on trying to go to this week, so hopefully that will work out. I have thought a lot lately about what is drawing me to ER and Med/Peds, and I think aside from the stuff I wrote above, I think the biggest two things are the following:
I think it is extremely important for every doctor to really know their general medicine well. I loved when one of my attendings once said that we are all physicians first and xyz specialty second. That's why Med/PM&R would be so perfect! Also, I LOVED my peds rotation. However, I don't think I could see myself giving up adults completely yet, either.

I am really leaning strongly towards PM&R based on what I read. It seems to be a lot of the stuff I've always looked for. Does anyone know how realistic or "easy" it will be to secure a likely position in outpatient PM&R?

 

[PMR 4 MSK]

Thanks for all of your input. It is very helpful!

I don't know if rotating through 2 VA inpatient rotations is really representative of what all of PM&R is like. At least, I'm hoping not? Although I don't mind my rotation, the VA has a very selective population and like you guys say, PM&R seems to have a much broader scope. I think an inpatient rotation treating a lot of patients with many, many, chronic diseases, a lot of psych issues and often underlying polysubstance abuse gets to be a little... "soulfully challenging." The problem seems to be that the only people that really know anything about PM&R are the people who are physiatrists and I'm hoping they will continue to hammer in all the endless possibilities included under the Physiatry umbrella because otherwise it sometimes appears kinda vague.

Topwise, you are right. The reasons I am attracted to ER include a large number of procedures, a large variety of patients, and building rapport with them just feels so natural to me. Also, I do like the fast-paced nature of the sport. On the other hand, I could never be happy stabilizing a patient and kicking them out the door. It's been my biggest pet peeve with health care and one of the reasons I wanted to be a doctor, so I could probably never feel satisfied doing that in the long run. I guess I should also realize that there are still a lot of procedures in PM&R, a pretty good variety of patients and although the pace is a little slower, you truly get to help this patient through without taking any shortcuts.

MSKall, thanks for the advice. Clinics is what I'm working on trying to go to this week, so hopefully that will work out. I have thought a lot lately about what is drawing me to ER and Med/Peds, and I think aside from the stuff I wrote above, I think the biggest two things are the following:
I think it is extremely important for every doctor to really know their general medicine well. I loved when one of my attendings once said that we are all physicians first and xyz specialty second. That's why Med/PM&R would be so perfect! Also, I LOVED my peds rotation. However, I don't think I could see myself giving up adults completely yet, either.

I am really leaning strongly towards PM&R based on what I read. It seems to be a lot of the stuff I've always looked for. Does anyone know how realistic or "easy" it will be to secure a likely position in outpatient PM&R?

VA is representative of only a small part of PM&R. Try shadowing a community physiatrist - one that does outpt +/- inpt. Can check out http://aapmr.org/ to find one if you need.

 

[AviatorDoc]

I chose PM&R because it is fun. I have fun every day. I enjoy diagnosing musculoskeletal conditions. I enjoy playing with all kinds of cool technologies. It's fun to be really good at something. I like taking the "what's the best evidence" approach as just one piece of the "what's the most practical solution" question. It's wonderful to not be a slave to the job, to have time with my family, and to go back to work on a Monday, well-rested, and ready to go again.

If you want to be a "House" style diagnostician, you can do Neuromuscular Diseases. If you want fast-paced, you can do a busy outpatient clinic. If you want the ultimate in "cush", you can be a medical director of a small general unit in a mountain town somewhere, with internal medicine covering nights and weekends, round on your patients in the morning, see your admissions in the early afternoon, and be fishing by late afternoon.

The biggest drawback I can think of is that you have to check your ego at the door. It can't bother you when for the millionth time in a week, someone asks, "so what do you do?" To me, it doesn't matter. By the end of the initial visit, my patients know what I do, and they appreciate the fact that I'm going to try to help them as much as possible. In many ways, we really are a dumping ground for patients no one else wants to take care of. I wear that mantle proudly.

 

[PMR 4 MSK]

In many ways, we really are a dumping ground for patients no one else wants to take care of. I wear that mantle proudly.

Or, as I like to think of it - "...patients that know one else can take care of."