Torn between Neuro and PM&R Need Opinions

[doodleman]

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I am a crossroads regarding what I want to go into between Neuro and PM&R. Hoping someone could shed some light on suggestions as there are benefits to both specialties and reasons I like them each.
Neuro: I enjoy like neuro trauma and the acute care aspect of it. Deciphering the diagnosis and looking at the imaging is very interesting. Very broad in terms of what I could do with it but, I could see myself in neuro ICU. I recognize however, it is a hard residency and I am definitely a "i like my work, don't live for my work" person and work-life balance is important to me. I know i'll enjoy every second of the job while there but with all my family/friends not in medicine, I worry being able to balance neurology and my life (at least until after residency, which i recognize is only temporary, but still worrisome to me)
PM&R: Very much interested in brain injury within pm&r or spinal cord injuries. I am very interested in disability advocacy and QoL, and felt like this was the only specialty that adequately addressed it to the degree I'd prefer. Obviously there is less chaos, which I worry I will miss, but I thoroughly enjoy the nice work-life balance associated with it. I like being able to help patients adapt after big function changes/disability changes and help them find their new normal, which is sometimes missing for me in neurology. I like spasticity management with injections for brain injury and also like IM/primary care and like that for some folks with disabilities, I can become sort of like their primary doc. A con I worry about is that I have heard the disrespect physiatrists can get in the hospital, and I worry that it will bother me.
I feel like I am so split because I love the fast pace/acute care/diagnostic possibilities of Neuro, but appreciate the advocacy/QoL improvement/patient relationship of the PM&R and it just feels like I like them both for very different reasons and I don't know what to pursue.

 

[s5260205]

I would recommend more clearly defining your eventual goals. It certainly can be too early to make such decision, though if you truly enjoy the acuity that neurology can offer (stroke, neuroICU), then physiatry is certainly out of question as that is not available through physiatry. However, if you are not sure whether you would eventually want to do inpatient versus outpatient, then both specialties offer their own repertoire of skillsets. For physiatrists, they have significantly more experience with procedural skills than neurologists, though there are aspects of procedural skills that physiatrists would not have access to (e.g., DBS, RNS, VNS, IOM, EEG). For neurologists, as you noted, we are expert diagnosticians on neurologic conditions, though physiatrists who are neuromuscular trained are also just expert diagnosticians.

In terms of advocacy/QoL improvement/patient relationship, that can be achieved either through neurology and physiatry. Significant portions of my time as a neurologist are doing exactly that - quality of life improvement. Some people may call it "palliative" as we are alleviating symptoms in neurologic conditions that mostly do not have a cure.

Judging from what you've listed, if the option of still being able to have the acuity as part of your practice is important, neurology residency would be more recommended, as you will still have the option of changing your practice settings eventually. I would not let the possibility of neurology residency being challenging deter you from it.