why do so few people go for PMR?

[unregistered]

Now I'm not a cynic, but when a specialty usually offers straightforward hours, good pay, and an easy lifestyle, it usu becomes quite competitive (ie derm, rads, etc). From what I've read of these posts, PMR is pretty relaxing & its pay is decent if it really is 150K.

So why is it that so few med students try to go for this? ignorance?? is the job tough or sobering? do you have to work in wisconsin to get a good paying job or soemthing? what is it? what have non-pmrs & pmr docs traditionally said that is critical of pmr?



PS
I attend highly competitive med school, and took an elective on PMR. the lecturers made it sound cool, so i might check it out with an elective rotation.

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[drvlad2004]

I think that for many students, most do not get exposure to this field until 4th year. I believe many students and doctors tend to prefer fields that you can diagnosis and treat a patient with fast results. Fast results is not the case with PM&R. It's more of a process in which you are working to a build a disabled patient back to maximal function and better quality of life. I also believe many students, as well as non-PM&R, are ignorant about this field and think physiatrist are "Glorified PTs," which is not the case at all.

This field is definitely not for everybody. You have to deal with patients who have serious chronic disorders, that its complications are sometimes permanent. I think that many people may not be able to deal with these types of patients. It's sometimes depressing. I guess this is why I love PM&R. Right now, I am having a blast at JFK Johnson rehab. The brain trama unit is phenomenal. Everybody, including all staff members are so nice and laid back.

This field is relatively new. It's almost as young as Emergency medicine but I don't think PM&R will ever be as competitive as EM. Regardless of lifestyle, the life of PM&R will not be the right fit for everybody. However, the ones enter this field are one of the most satisfied physicians I've met. The patients, themselves, are one of the most motivated individuals you will find at the hospital. You see that they want to get better and live their daily lives independently. Definitely do a rotation in PM&R during 3rd or 4th year.

 

[drusso]

Physiatrists are often viewed as "physicians of last resort." Basically, most PM&R referrals are for one of two reasons: 1) We don't know what's wrong with you, try rehab; 2) We know what's wrong with you, but can't do a thing about it. I think of us as "So, what now?" doctors. A polytrauma patient survives a deadly motor vehicle crash after several operations, being in a coma, having a ICP monitor, etc. Wonderful. Congratulations. So, what now? The surgeons walk away because the operation is over and the incision looks good. The intensivist walks away because the patient off a cardiac monitor, extubated, "moving all four extremities well", and hemodynamically stable. This patient is still not "well." They have a long road to go before becoming anywhere near the same person that they were before the accident. That's where PM&R comes in. The therapists can do ROM exercises all day, but someone has got to synthesize all the medical, surgical, and disability stuff into a practical, realistic, comprehensible rehabilitation protocol. That's why we're physicians trained in rehabilitation medicine.

I find PM&R very rewarding. Today in continuity clinic I saw a spinal cord injured patient who despite his disability is a world class sailing champion and corporate lawyer. I see people who survived the most horrendous injuries, gotten through multiple major, complex operations and months and month of inpatient rehabilitation and have rebuilt their lives. My patients inspire me. At the very least, when I'm having a bad day I'm often reminded, 1) I don't have a spinal cord injury; 2) I don't have a brain injury; and 3) I'm not disfigured or permanently disabled. I have voluntary control over all my sphincters. If I get a wound it heals, I can breath. I can talk and swallow. I can move around purposefully and willfully without the assistance of a gait aid, device, or wheelchair... It helps put things in perspective.

In all likelihood musculoskeletal rehab and sports/spine medicine is probably where I'll land. I hope to have comprehensive pain management and EMG referral kind of practice. I wouldn't mind dabbling in workman's comp or medico-legal work either (physiatrists are perfectly suited to be medicolegal experts in personal injury cases).

But, I won't forget these "train wreck" patients from my inpatient rehab days. They are the ones who will have taught me everything I know about real disability.

 

[daphilster]

I wonder the same thing myself. As a 2nd year, I know about pmr only because I've seen physical therapists before. I actually thought about a career in physical therapy prior to an MD, but was worried I wouldn't be able to do as much.

Anyways, it seems like I am the only one out of a class of 150 who has any interest in this. Nobody ever talks about this specialty, and its really hard to find out any info ANYWHERE about this--its not on the internet (aapmr is so scanty), few docs i know know much about this field, and there are no PMR student groups at my school, only Rads or Surgery Society, etc etc.

I think this is one of the least known of all specialties in medicine. Well, hopefully I'll find a way to interact with more docs and find out what its like.