Switching into PM&R

[gasping81]

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Hey guys.

I'm looking to leave my hi stress field, which is affecting my well-being overall, for something makes more time for me, friends, and family as well as maintain my interest.

I must say that PM&R has aspects that I like, but I wanted to hear how the life of PM&R residents and attendings are.

1. How many hours a week on average?
This really matters to me since I like to be away from work in order to one have time to read about the science and two not go insane. The 80 hours keep me away from a lot of things in my life and from opening a domn journal.

2. How stressful do you find PM&R field to be?
The OR can be stressful, and I don't know if I can handle finishing the residency + good chance that CRNAs taking over my life once a Dem gets in (guess what field I'm in). The specialty is lot more different than I imagined and experienced as a student. It's hellish some days, and I understand why gas docs find it irritating that people not in the field think it's all about cookies, magazine, and a stool. I guarantee the day is a lot more work than any medicine intern has to ever deal with.

3. How much of it deals with intervening on pain?
This is the part that I liked best about my time on gas, the procedures and working with my hands. I never had a chance to see PM&R as a student probably because NO one talks about at my school.

4. How is it when you are done with residency?
I was hoping some attendings could fill me in on the lifestyle once finished. I'm looking to get married in the next year, and then, kids might not be far. So I don't want to end up being that Dr. Dad who is gone for most of their childhood. Yes, I'm thinking really ahead, but all this matters to me.

Thanks for your time everyone.

 

[Shalom77]

Why not consider an pain fellowship post anesthesia residency with plans to practice outpatient pain medicine. (no OR). I've read some posts in the Pain forum (try checking that forum out) comparing life as an anesthesiologist with life with a purely outpatient practice - which talk about having greater control over one's time/hours as one of the pluses of the outpatient pain practice. And there are lots of procedures in interventional pain.

Seems like this might be a shorter and easier route than switching to PM&R particularly if you have no real interest in inpatient rehab (which will be most of your first year in most PM&R programs.) and where if you wanted to do interventional pain - you'd most likely end up doing a pain fellowship anyway.

 

[urheald]

I bet you are in the northeast.....New York? Just a guess.

I was in the same boat and recently found out that I matched into PM&R. I am incredibly excited about the transition. I did a tremendous amount of soul searching, speaking to my former PD, office hours and brain picking with PM&R attendings before pulling the plug. I wanted to make sure I did not have a case of the "grass is always greener". I also learned a great deal about the field during interviews.

The residents that are selected to give tours and attendings in interviews are a great source to learn about the field.

I cannot speak to questions #1 and 2 however, I think you will find that PM&R to be inherently one of the least in not the least stressful field in medicine. That said, there are many ways to have a stressful career in PM&R, IE. pain management DEA issues, practice ownership issues, litigation etc. I mean medicine is stressful enough, PM&R just makes sense!

1. How many hours a week on average?
2. How stressful do you find PM&R field to be?

3. How much of it deals with intervening on pain?

Within PM&R there is pain/interventional pain. Not sure how much anesthesia experience you have but, there will be plenty of opportunity to use those hands of yours if you so chose. Other than, chronic pain procedures, there are plenty of procedure heavy modalities. That said, there is so much more to PM&R than pain. MSK,TBI and SCI are incredibly complex, interesting and rewarding areas that are the bread and butter of your training. I too came into the process focusing on pain and interventional pain, but I think during interviews I quickly realized that to focus solely on pain, would be selling myself short.

4. How is it when you are done with residency?

Much like other specialties, there are a few fellowships to pursue, or if you feel confident you can go directly into practice or academia. I am sure that you will find others on this board, qualify in much more detail than I have. Most on this board, seem incredibly generous and willing to share their experience with PM&R Relaxed doctors = happy doctors.

Hope my limited exposure to PM&R has helped!

 

[Disciple]

I never had a chance to see PM&R as a student probably because NO one talks about at my school.

One of the main reasons the specialty hasn't completely taken off yet.

 

[Disciple]

To the OP:

I work about 40 hours/week, outpt procedural based subspecialty plus sports med and EMG.

Home call every 6 weeks, where I get about 2 calls/week. Hopefully no call one day.

The only real stress comes from a few particular pain patients, but I have a good staff who usually screens out most of the inappropriate phone calls during office hours.


How did you find out about PM&R, and hear enough to be interested?

 

[axm397]

I am a PGY4 at RIC and RIC is considered to be one of the more work heavy residencies in PM&R. As a PGY2, on average I came in around 8am and left by 4 or 5pm (if I had afternoon lectures). The earliest I came in was 7am for one rotation. I took call 10 times in 6 months and worked 2 notewriting weekends in addition to the calls. That is as heavy as the workload got. I probably averaged about 40-50hrs/wk as a PGY2. From then on, the hours got shorter and shorter and call got less and less frequent.

There were definitely days when I stayed later - (late admissions, sick patient had to be transferred out, etc.) but those were exceptions. That being said, I was one of the more efficient in my class and there were people who stayed late consistently. So some of it depends on your efficiency and speed.

I didn't know that anesthesia residents worked so many hours. when i did my rotation as a student, i remember early mornings (5-6am) but i was done by early afternoon (2 or 3pm).

if you can, take your time to find mentors in the field or attendings to shadow. PM&R is unique and like the previous poster said, you should make sure you don't have the "grass is greener" syndrome. You will not get the a-lines and intubations but instead you will get EMGs, botox injections, and joint injections in terms of procedures. The one biggest difference is probably the amount of time you spend interacting with patients. We spend a good amount of time rounding on patients, having team conferences and family meetings, etc. So if you are not a people person, you may be unhappy. We are also still a relatively obscure field and if you are not ready to have people constantly ask you what you do, you may want to reconsider. browse around this and the pain forums, read the FAQs, pm a few people, and explore. sdn is a great resource.

 

[PMR 4 MSK]

1. How many hours a week on average?


2. How stressful do you find PM&R field to be?


3. How much of it deals with intervening on pain?


4. How is it when you are done with residency?

1. Most PM&R's are in the 40 - 50 hour/wk range. It can be anything you want, as much or as little.

2. Here's the things that negatively stress me the most -
A) Chronic pain patients who won't listen and want to run their own treatment program.
B) Work comp adjusters who've never met my patient or me, and predetermine what they'll pay for.
C) Requests to be "worked in" today by a pateint I haven't seen in 2 years who's had several weeks of increased pain.
D) Lawyers who send me a 10-page form to fill out on a patient applying for disability.

Rough, huh?

3. Depends on what you want. As little or as much pain as you want. My clinics are 90% pain. My clinic is only 1/3 of my schedule. 1/3 is EMG and 1/3 is procedures under fluoro (about 75% of those are pain).

4. Better than being a resident. I work less hours, but see more patients than I did as a resident. Time = money.

Take a couple days out of your schedule when you can and shadow a PM&R doc. See if you like it.

 

[Disciple]

3. How much of it deals with intervening on pain?
This is the part that I liked best about my time on gas, the procedures and working with my hands. I never had a chance to see PM&R as a student probably because NO one talks about at my school.

4. How is it when you are done with residency?
I was hoping some attendings could fill me in on the lifestyle once finished. I'm looking to get married in the next year, and then, kids might not be far. So I don't want to end up being that Dr. Dad who is gone for most of their childhood. Yes, I'm thinking really ahead, but all this matters to me.

In my opinion, one of the most appealing things about PM&R is how versatile and broad it is for a specialty field.

Correct me if I'm wrong, but in Anesthesia it's either the OR/ICU or the pain clinic. Surgery/Cards/Derm (self-explanatory), etc.

As you may have noticed from reading these posts, once you're done with PM&R residency, you can shape your practice so that you only do specifically what you enjoy.

 

[SSdoc33]

In my opinion, one of the most appealing things about PM&R is how versatile and broad it is for a specialty field.

isnt this also the reason you have railed against PMR in other posts? its "identity problem"? i happen to agree with your point about a lack of identity. please correct me if im putting words into your mouth

 

[DukeOfEarl]

Hey guys.

I'm looking to leave my hi stress field, which is affecting my well-being overall, for something makes more time for me, friends, and family as well as maintain my interest.

I must say that PM&R has aspects that I like, but I wanted to hear how the life of PM&R residents and attendings are.

1. How many hours a week on average?
This really matters to me since I like to be away from work in order to one have time to read about the science and two not go insane. The 80 hours keep me away from a lot of things in my life and from opening a domn journal.

2. How stressful do you find PM&R field to be?
The OR can be stressful, and I don't know if I can handle finishing the residency + good chance that CRNAs taking over my life once a Dem gets in (guess what field I'm in). The specialty is lot more different than I imagined and experienced as a student. It's hellish some days, and I understand why gas docs find it irritating that people not in the field think it's all about cookies, magazine, and a stool. I guarantee the day is a lot more work than any medicine intern has to ever deal with.

3. How much of it deals with intervening on pain?
This is the part that I liked best about my time on gas, the procedures and working with my hands. I never had a chance to see PM&R as a student probably because NO one talks about at my school.

4. How is it when you are done with residency?
I was hoping some attendings could fill me in on the lifestyle once finished. I'm looking to get married in the next year, and then, kids might not be far. So I don't want to end up being that Dr. Dad who is gone for most of their childhood. Yes, I'm thinking really ahead, but all this matters to me.

Thanks for your time everyone.

I was in anesthesiology mostly for the money, and HATED every minute of it. I fell for the "propaganda". Seriously, for those out there reading this that like anesthesiology, more power to ya, it just wasn't right for me.

However, I would advise you to stay in your residency if you like pain management. When I left, it was the biggest pain in the butt for me to make the switch. If you like pain management, stay in anesthesiology, finish it, and do a pain management fellowship (unfortunately there is no guarantee you will get this however). If you don't like pain, and really want to do PM & R remember that it can be a pain to make the specialty switch, and you may endure a lot of hardship. Everyone will ask you why you left your residency if they interview you at all. Some won't even bother unfortunately because they are afraid you will leave their residency (which is just bonkers, but that is how a lot of the PDs think, I was told that flat out during my interviews). Good luck to you man, I feel for ya. Make this decision wisely.

 

[drusso]

You're in a difficult situation. As a physiatrist who trained in an anesthesia department for fellowship I can tell you that practically and culturally anesthesiology and physiatry are about as opposite as you can get! The personalities do converge a little around pain medicine and regional anesthesia.

It's hard to suffer through something you hate ever day especially when there are those around you who are ENJOYING the stress and finding their circumstances ENERGIZING. I would keep in mind that once you finish your residency, you will have more options and flexibility in what you do---especially if you do more of a community-based practice.

Based upon my experience with friends who ENJOY anesthesiology I imagine that one thing you might find very frustrating about physiatry is that it can be a spectator sport in medicine. The pace of work and payoff for your efforts is almost glacial. It's not like the OR where something bad happens, you detect it and treat it, and things return to normal again.

In physiatry, you *see* a lot of interesting things, but you aren't really *doing* a lot about them. It's sort of the Seinfeld of medical specialties. Try to get just a day or two away from your residency and arrange an opportunity to actually visit an inpatient rehabilitation unit or do some physiatry consults on a busy physiatry consult service. You'll see what I mean.

Your patients won't necessarily get better in a day, a week, or a month (or sometimes ever). You have to learn to recognize and celebrate the smaller human victories---Mrs. Smith hasn't fallen in three days; the polytrauma kid with the TBI recognized his father for the first time; Mr. Jones has finally become modified independent with his ADL's so he can go to an assisted living center and not a nursing home. Physiatrists don't save lives as much as they save quality of life. I'm not knocking the work--it's huge for patients and their families--but you have to have a certain humility about what you do in the field.

 

[Disciple]

In physiatry, you *see* a lot of interesting things, but you aren't really *doing* a lot about them. It's sort of the Seinfeld of medical specialties.

A specialty about "nothing"?

 

[gasping81]

Is litigation that bad in PM&R?


Once again, if anyone know of possibilities of opening spots in July 09 or maybe even earlier, please PM me. I'm looking ideally to stay midwest. Thanks to all.

 

[medicineman1]

drusso-

if to do over again, would you choose the same path ie PM&R to pain, or would you consider a different way (in retrospect of course)?

Are you doing any inpatient stuff now, or strictly pain with some EMGs etc?

 

[drusso]

A specialty about "nothing"?

Bingo.

 

[drusso]

drusso-

if to do over again, would you choose the same path ie PM&R to pain, or would you consider a different way (in retrospect of course)?

Are you doing any inpatient stuff now, or strictly pain with some EMGs etc?

I'm practicing the "full spectrum" of physiatry: Inpatient, outpatient, industrial, EMG, and pain.

I'm pleased with my specialty selection. I do regret not doing a neurosurgery rotation as a medical student...I might have been one might neurosurgeon...but, I'd probably still be in training!

 

[Disciple]

Bingo.

You should start an official list of Russo-isms:

Seinfeld of medical specialties
Napoleon Dynamite skills
Humpty Dumpy Medicine (you borrowed that one, right?)

 

[drvlad2004]

You should start an official list of Russo-isms:

Seinfeld of medical specialties
Napoleon Dynamite skills
Humpty Dumpy Medicine (you borrowed that one, right?)

We need to add the PROUD specialties to the list of Russo-isms:

Physical Medicine & Rehabilitation, Plastics
Radiology
Ophthalmology
Urology
Dermatology

 

[Disciple]

isnt this also the reason you have railed against PMR in other posts? its "identity problem"? i happen to agree with your point about a lack of identity. please correct me if im putting words into your mouth

It’s the versatility and breadth of the field (combined with the income potential/lifestyle) that probably accounts for the high rate of job satisfaction in this field.

As Physiatrists we tend to dabble in a lot of things. That’s all fine and dandy for primary care, but we’re supposed to be specialists, and specialists need referrals. It becomes really hard to explain what you do when you can’t claim expertise in anything. So, what ends up happening is that we come up with abstract descriptions of what we do such as “expertise in the neuromusculoskeletal system as it relates to functional restoration” What?? Sounds like the research interest of an eccentric professor cooped up in a lab.

How can we change this?

Become an expert in whatever you’re doing, and then let people know about it. If it’s interventions, learn interlaminars, sympathetic blocks, etc. Learn about stims and pumps, even if you have no intention of ever implanting one. If it’s EMG, bone up on Neuromuscular disorders and neuropathies. If it’s inpt rehab, do more than write orders for other specialists and fill out discharge papers, even if it means having to hire mid-levels so you can spend time on PM&R related issues. If it’s Occ Med, don’t be the typical PM&R IME/reviewer who denies interventions/opiates to patients on principle (citing functional restoration) and recommends only a home exercise program instead of a comprehensive balanced treatment plan. If you were trained this way in residency, well, that’s unfortunate, but don’t let that be an excuse to stay this way.

We can change things, or we continue comfortably as we have been, which means having referrals filtered through surgeons or having to enlist under “pain management” with the insurance companies instead of Physical Medicine and Rehabilitation in order to get referrals. We can start becoming diagnosticians and aggressive treaters or we can continue to wait until after other physicians have decided that the diagnosis has been made and treatment has been rendered.