Would PMR be competitive if it was a core rotation at medical schools?

[bronx43]

I'm just pondering here. Do you guys think PM&R would be a lot more competitive if students actually had exposure to the field? If so, do u think it'd be on par with something like ER?
I haven't heard of many schools that even offer PM&R rotations, let alone make it a required rotation. A guy that went to UMDNJ recently told me that PM&R was a required rotation there, and at least 10-15 students apply to the field every year. At my institution, we offer PM&R as an elective (that few select), and I can't think of more than 2-3 that are applying.
Thoughts?

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[rehabdocmd]

I'm just pondering here. Do you guys think PM&R would be a lot more competitive if students actually had exposure to the field? If so, do u think it'd be on par with something like ER?
I haven't heard of many schools that even offer PM&R rotations, let alone make it a required rotation. A guy that went to UMDNJ recently told me that PM&R was a required rotation there, and at least 10-15 students apply to the field every year. At my institution, we offer PM&R as an elective (that few select), and I can't think of more than 2-3 that are applying.
Thoughts?

Its also a required rotation at Northwestern and they also produce a lot of PMR residents. I do agree that many students dont apply because they dont know what it is, or make assumptions that it is like physical therapy

 

[sainteligius]

PM&R is actually pretty competitive now at least for the top programs
where rehab is a required rotation (Northwestern/RIC, Thomas Jefferson, UMDNJ/Kessler, etc.)

Most applicants who get interviews at the top competitive PM&R programs (Kessler, Thomas Jefferson, RIC, U.Washington, Harvard/Spaulding, Baylor, Mayo, etc.) published, wrote chapters, etc. The USMLE board scores of invited applicants have been mostly above 220 all the way to 256!

I'm not sure where you go to med school, but if you're in the East Coast
or Chicago areas, PM&R is more established and well-known and don't have a problem attracting highly competitive applicants, esp with PM&R being known for a "lifestyle specialty" with an attractive salary, esp if you do interventional procedures and EMG.

 

[Punkn]

I was lucky enough to find PM&R during my senior year of college, and I've found that many of my MS4 colleagues still don't know what a physiatrist is (and many attendings in other fields, for that matter). I would think that having a mandatory PM&R rotation would allow more med students access to a field they didn't know existed. As we increase the exposure, the more competitive our field will become, I think.

 

[fozzy40]

It truly is a shame that PM&R is not better represented in the medical school curriculum since it's such a great field. I hate running into medical students, or residents for that matter, who find out about the field after the fact. There are currently only 28 states that have PM&R residencies. This is pretty sad since nuclear medicine which is relatively "less obscure" to medical students is represented in 29 states. The other problem is that there is a lot of mis-information about the field which is just as bad.

As of right now, PM&R residents represent a little over than 1% of the total residents in the country. I think that increasing exposure would hopefully increase the number of applicants and indirectly make it "more competitive."

Make sure to spread the good word about PM&R!

 

[PMR 4 MSK]

I think your basic postulate is correct, not sure how far on the "a lot more" scale.

I've met many docs who have said if they knew about PM&R during med school they may have gone for it instead. mostly PCPs and rheum, but even an ortho suprisingly.

 

[SCIronMike]

Seems to me like the competitiveness of a specialty correlates directly with lifestyle and earning potential.

 

[VApmrdoc]

As a UMDNJ-NJMS grad we did have a required elective in 4th year which many students not going into PMR thought was practically vacation and made it somewhat more difficult, in a way, as a resident to enhance an appreciation for the field. I think there can certainly be a place earlier for exposure that may be a more positive light, such as residents or faculty giving guest lectures in anatomy lab which was my first exposure to PMR and probably one of the reasons I used 3rd year elective time to even look into the field and make a decision before the mandatory. I will say also that things go in waves, my class only had 4 apply to PMR but more recently it is true that 10-15 have applied, so we can't always assume that a mandatory schedule produces more candidates, although having more availability can hopefully raise the level of a candidate as someone mentioned previously regarding opportunity to do research or even publish.

In terms of competetive, the field is getting tougher in general, certainly compared to attendings I've spoken to in the past who could not get into other fields, say as foreign medical graduates, and somewhat were able to "fall into" our field. I don't know the statistics of how many apply and go unmatched but our field is becoming more important as there are higher numbers of elderly who still want to be active - an in my area we still have a great need for amputee care, both in the traumatic and dysvascular populations which is only going to worsen with obesity and diabetes on the rise.

 

[PMR 4 MSK]

As a UMDNJ-NJMS grad we did have a required elective in 4th year which many students not going into PMR thought was practically vacation and made it somewhat more difficult, in a way, as a resident to enhance an appreciation for the field.

That's really a double-edged sword. Many med students and even residents look for rotations/electives that are more of a "vacation." The "Radiholiday" and "Dermaholiday" rotations were very popular in med school for my class. When you are being pounded on IM, surgery and OB/Gyn, it's nice to have a "cushier" rotation between them, or after them.

I don't believe med school, residency or practice have to be a 24/7/365 job. If you want it to be, go for it.

I think the quality of the teaching that goes on during a rotation is worth far more than the amount of time in terms of % of a 24-hour day you are there. On my Ob/Gyn rotation, for instance, I was putting in 80+ hour weeks and 36 - 48 + hour shifts (like an entire weekend from Friday morning until Monday evening). Despite that, I learned little as 75% of the patients did not want a male med student in the room. Watching your 35th pap smear of the day on your 25th day doesn't offer you much in terms of education either.

 

[Ludicolo]

Of course the OP is preaching to the choir. IMHO – PM&R is the ultimate lifestyle field, since we are all about improving “quality of life”. Great variety of patients. Great variety of procedures. Controllable hours. Pays well. We are not competitive simply because of ignorance. And when people are ignorant, pre-conceived notions and assumptions about the field abound.

PM&R will never displace IM, surgery, peds, OB, etc. in the traditional MS3 core curriculum. Nor will any other specialty. It’s a complaint heard by many non-primary care specialties – radiology, anesthesia, PM&R, etc. – how to arrange early enough exposure to make an informed specialty choice in time for ERAS/interview season.

I agree w/ VApmrdoc. Exposure just in the MS4 year is too late. Senioritis is hard to treat. We need to get to students early. In general – the amount and quality of neuromuscular and musculoskeletal education in the basic science years is lacking. This is where I think we can make a difference. Anatomy lectures and physical exam workshops surely. We should be giving lectures about pain and disability. We should educate students on the differences between physiatry/PT/OT, and the different members of the health care team in general. Challenge to the residents: when you get consulted by a “core specialty” like IM or surgery, interact with the third year med students on that service and educate them on what we can do.

But all of this is admittedly difficult on a national level when only about half of LCME accredited schools have an affiliated PM&R department.

 

[surftheiop]

Of course the OP is preaching to the choir. IMHO – PM&R is the ultimate lifestyle field, since we are all about improving “quality of life”. Great variety of patients. Great variety of procedures. Controllable hours. Pays well. We are not competitive simply because of ignorance. And when people are ignorant, pre-conceived notions and assumptions about the field abound.

PM&R will never displace IM, surgery, peds, OB, etc. in the traditional MS3 core curriculum. Nor will any other specialty. It’s a complaint heard by many non-primary care specialties – radiology, anesthesia, PM&R, etc. – how to arrange early enough exposure to make an informed specialty choice in time for ERAS/interview season.

I agree w/ VApmrdoc. Exposure just in the MS4 year is too late. Senioritis is hard to treat. We need to get to students early. In general – the amount and quality of neuromuscular and musculoskeletal education in the basic science years is lacking. This is where I think we can make a difference. Anatomy lectures and physical exam workshops surely. We should be giving lectures about pain and disability. We should educate students on the differences between physiatry/PT/OT, and the different members of the health care team in general. Challenge to the residents: when you get consulted by a “core specialty” like IM or surgery, interact with the third year med students on that service and educate them on what we can do.

But all of this is admittedly difficult on a national level when only about half of LCME accredited schools have an affiliated PM&R department.

Hearing stuff like this makes being a pre-med hard, for example there are schools like Wake Forest that would likely be a great fit for me all around. But then there is the fact that I likely wouldn't have the oppurtonity to look at PM&R until 4th year and even then they don't have a PM&R residency program.

So I'm stuck knowing that its extremely unlikely that a pre-med will be able to guess their specialty so it seems unwise to make medschool choices based on a specific specialty, but at the same time I would hate to essentially rule out an entire field with my school selection.

 

[fozzy40]

There was a paper written by Delisa et. al looking at factors affecting graduating PM&R resident's decision to go into the field in 1995. Essentially, one the most influential factor in to go into PM&R was early exposure to the field specifically MS-1 and 2 years. Many of the subjects report meeting either a physiatrist who was moderating a case study and/or teaching anatomy or clinical examination class. The assumption is that their interaction was meaningful and positive since they did end up going into PM&R.

Early exposure is key and sought after for not only our field (as the previous poster has mentioned) but other fields as well. However, the distinct difference is that medical students likely have a better understanding (conceptually) about those other specialties compared to physiatrist. Studies have shown that the "perception" of quality teaching makes much more of an impact vs. quantity to medical students. In regards to medical education, the primary focus is to recognize acute disease, develop a differential, and initiate a treatment until vitals and/or labs are "normal." Unfortunately, medical school training is not long enough to learn about caring for the patient when the they don't die or go back to their previous function.

It's definitely a challenge but I love that we are brainstorming about ways to change the system! Personally, I've been doing more of a grassroots effort. I've been offering my time and giving noon time lectures to local medical schools about the field of PM&R. Until the system changes, I think reaching out to medical students is the best way to make a difference.

 

[Ludicolo]

Hearing stuff like this makes being a pre-med hard, for example there are schools like Wake Forest that would likely be a great fit for me all around. But then there is the fact that I likely wouldn't have the oppurtonity to look at PM&R until 4th year and even then they don't have a PM&R residency program.

So I'm stuck knowing that its extremely unlikely that a pre-med will be able to guess their specialty so it seems unwise to make medschool choices based on a specific specialty, but at the same time I would hate to essentially rule out an entire field with my school selection.

You’re not stuck. At least you’re even aware of PM&R, which is more than most students. Or the general population, for that matter.

Don’t choose a school based on its PM&R department, or lack thereof. Go to a school that provides you with the overall environment to thrive and do your best, and proceed through med school with an open mind. You’re correct in that you have no idea what specialty you’ll eventually settle into. I initially was gung-ho ortho and even had a brief fling with Family Med before I committed to PM&R.

Because you’re still early the game, as long as you remain interested in PM&R, you have the ability – no matter where you end up – to plan ahead of time and arrange for exposure/experience accordingly. Scheduling conflicts/difficulties will happen no matter where you are. Could it be more challenging for you at a given school, given limited resources? Certainly. But still quite doable.

 

[Hextra]

Hearing stuff like this makes being a pre-med hard, for example there are schools like Wake Forest that would likely be a great fit for me all around. But then there is the fact that I likely wouldn't have the oppurtonity to look at PM&R until 4th year and even then they don't have a PM&R residency program.

So I'm stuck knowing that its extremely unlikely that a pre-med will be able to guess their specialty so it seems unwise to make medschool choices based on a specific specialty, but at the same time I would hate to essentially rule out an entire field with my school selection.

Don't forget that you have the ability to call around and see if there are docs who would allow you to shadow them. Even though you won't get the experience that a third year rotation provides, it can still give you some insight as to what the field is about and, more importantly, begin to open doors that would otherwise remain closed.

If you want it, make it happen.

 

[fozzy40]

I definitely did a lot of shadowing in order to get a full understanding about the field. Make sure that you get both outpatient and inpatient exposure if possible. The practice of physiatry is so wide and varied so I encourage you to be see all that you can if possible.

 

[NRAI2001]

Seems to me like the competitiveness of a specialty correlates directly with lifestyle and earning potential.

What is the earning potential of a PMR doc? PMR has become known as a lifestyle field but what is the average work week hours/stress like and how much is an average to above average yearly salary?

Sorry I know income isnt everything but the more I learn about the field of PMR the more I m starting to become interested in it, good to have a complete idea of the field and practice.

 

[Ludicolo]

What is the earning potential of a PMR doc? PMR has become known as a lifestyle field but what is the average work week hours/stress like and how much is an average to above average yearly salary?

Sorry I know income isnt everything but the more I learn about the field of PMR the more I m starting to become interested in it, good to have a complete idea of the field and practice.

Depends on location, subspecialty, inpatient vs. outpatient, private vs. academic vs. hospital employed, group or solo, how effective the new Congress will be…

See the stickies or search.

 

[NRAI2001]

Depends on location, subspecialty, inpatient vs. outpatient, private vs. academic vs. hospital employed, group or solo, how effective the new Congress will be…

See the stickies or search.

I took a look at the stickies at it seems pretty dated it ranges back to 2003 with the majority of the posts in 2007.

Anyone with personal experience or the experiences of someone they know or work with?

Many people site those salary surveys which i think are bogus 90% of the time. My parents are both IM docs and many of our family and friends are in the medical field so they tell me frankly how much they make (ranging from FP to cardio and CT surgery) and those surveys are way way shooting low. Most surveys put IM/FP at about $160k and many many PCPs I ve spoken with are making mid $300s and some into the $400k's. The 2 CT surgeon I spoken with are making over a Mill each easily..... granted this is in a medium sized city and not some major metro area. I wonder if those surveys are only looking at job offers? Bc most private practice docs who work for themselves are making probably close to twice those survey estimates??

Similarly a friend of mine who is getting ready to start a PMR residency firmly believes that with PMR you can reach into the 400ks??

 

[ihaveaquestion]

Really? I was not aware that many PCP's break 300-400. Admittedly I am not the biggest fan of the income question because bottom line is this: how much you make depends on how much you bill. Interventional procedures and electrodiagnostic tests historically compensate well. So if you have patients who actually need these done and you are competent in performing these then you will do well. Unfortunately there are some who abuse the system and perform procedures indiscriminately or tests without proper training or indication. Anyway, I am sure 400 is possible but if making that much is important to you there may be easier ways.

I took a look at the stickies at it seems pretty dated it ranges back to 2003 with the majority of the posts in 2007.

Anyone with personal experience or the experiences of someone they know or work with?

Many people site those salary surveys which i think are bogus 90% of the time. My parents are both IM docs and many of our family and friends are in the medical field so they tell me frankly how much they make (ranging from FP to cardio and CT surgery) and those surveys are way way shooting low. Most surveys put IM/FP at about $160k and many many PCPs I ve spoken with are making mid $300s and some into the $400k's. The 2 CT surgeon I spoken with are making over a Mill each easily..... granted this is in a medium sized city and not some major metro area. I wonder if those surveys are only looking at job offers? Bc most private practice docs who work for themselves are making probably close to twice those survey estimates??

Similarly a friend of mine who is getting ready to start a PMR residency firmly believes that with PMR you can reach into the 400ks??

 

[PMR 4 MSK]

Salary in Medicine is not like a salary in another job. You cannot compare them.

For instance, some docs report only their take-home pay, gross or net. Some report take home pay + benefits. Some report collections.

My health insurance, malpractice, books, travel, cell phone and car are all paid by the practice, but come out of my collections (i.e. pre-tax).

You might have a practice collecting $1M, of which $200 - 800K might go to overhead. That leaves a large variation in net pay.

When paying taxes, your goal is to pay as little as possible, so the less the government sees you make, the less taxes you pay. There are many ways to accomplish this.

So you could end up with a doc who owns his own practice paying himself $300K per year, with a life-style and personal wealth of that of a guy who makes $1M working in finance.

Salaries in medicine are therefore highly variable and meaningless in reports.

What does matter is how much you like your career and your job. If you like both, how much you take home in pay becomes irrelevant.

That is, unfortunately, a very difficult concept for medical students and residents to comprehend and believe. We in America grow up believing the more you make, the happier you can be, the more "stuff" you can get, and the better quality of life you will have.

All of that is completely untrue.

IM making $400K is likely mostly due to additional sources of income - investments in ASC's and similar. PM&R can reach $400K, with lots of procedures and EMG, and very low overhead.

If you are looking for the highest income potential, go for a procedural-based practice. However, if Obama has his way, procedures will pay the same as E&M.

 

[kstarm]

Our residency is helping with the MS1 physical exam class and have been teaching with non-PM&R falculty the MSK and Neuro exam. We started with the MS1 at week 3 of their medical school training. It has been great for everyone and the non-PMR falculty have been extremely happy with the results so far as most of them are primary care/IM/Peds and are not overly comfortable with those exams. When working with the students we get to talk about PMR which is nice too. We will have to see if there is any difference in the numbers come match day 2014.

We have been trying hard for a number of years to get into the curriculum and it took a lot of emailing/meeting/and persistance. It was also very resident driven. Now that we are able to do it we have been having the falcuty that we are working with fill out evaluations of our performance to put in our portfolios and more importantly to show the course director so that in the future we can refer to them and be asked back. I would recommend this if a formal evaluation of your interactions with MS1/2 is not in place so you can keep a record of the awesomeness that is PMR and further be incorporated into the MS curriculum when course directors refer back to what you did for them.

 

[fozzy40]

What schools do you know of have PM&R as a core rotation?

Northwestern
University of Washington
UMDNJ?

Any others?

 

[Taus]

What schools do you know of have PM&R as a core rotation?

Northwestern
University of Washington
UMDNJ?

Any others?

Temple and Jefferson

 

[KCN79]

It's not a full month, but at the University of Wisconsin, the 6-week Neurosciences rotation includes 1 week of PMR and lectures from physiatrists throughout the rotation, so at least everybody gets some exposure.

 

[DOctorJay]

We teach the Mayo medical students musculoskeletal physical exam.

UMDNJ-SOM (my alma mater) has an outpatient rotation that is required but is not a full month.