Would you do it over again?

[UnicornDemon]

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Knowing what you know now, if given the option to go back all the way to undergrad, would you choose again to pursue medical school? And, if so, would you re-select PM&R as your specialty?

If no, what would you have done instead?

 

[RUOkie]

yes, and yes

 

[Kal EI]

I recently heard about this specialty.

Is this forum unpopular because there aren't a lot of PMR docs? Just curious because I was trying to read more about this specialty and there aren't many threads about it (nor activity in this forum in general).

 

[Taus]

I recently heard about this specialty.

Is this forum unpopular because there aren't a lot of PMR docs? Just curious because I was trying to read more about this specialty and there aren't many threads about it (nor activity in this forum in general).

To OP- yes and yes definitely. Every field has it's associated BS and reimbursement is being cut just about everywhere (ie not unique to us), but I truly enjoy what I do and would likely quit if I had to do what many of my friends in other fields deal with.

There is a ton of info on the field in the "stickied" threads at the top of the forum. Interest and activity on this forum waxes and wanes.... picks up a lot around interview/match time.

 

[RUOkie]

I recently heard about this specialty.

Is this forum unpopular because there aren't a lot of PMR docs? Just curious because I was trying to read more about this specialty and there aren't many threads about it (nor activity in this forum in general).

ask a question and it shall be answered. There are a few of us who check in intermittently and would be happy to help you.

 

[Supinator]

Also check out aapmr.org. It is one of the main academies of our field and has a lot of info for everyone, including those who want to know more about what physiatrists do.

 

[Kal EI]

I've read a lot on aapmr.org.

Here are some questions I've had. I realize this list is long - so if you only want to answer a few that would be great. The first few are the most important. Thx

1. Do PMR docs have to prove their value? I've found that many of my classmates have no idea what PMR is. I'm not sure about attendings. Anyway, do PMR docs have to fight to prove their value to the government, to private practice, etc.?

2. This is somewhat of a piggyback question. All doctors are facing reimbursement cuts. I'm not "in it for the money" so to speak, but I would be interested in hearing an argument of the value of PMR in the next 10-20 years. Why should medicare continue to reimburse PMR? What if they decide to cut the reimbursements in half? Does PMR play a vital role in our healthcare system?

3. Day to day activities. I've listened to the podcasts about PMR days and understand there is a rehab side and a musculoskeletal side of this field. Are you intellectually and personally satisfied with your day to day activites? In other words, are you bored with your work? Do you think it's exciting? Are you having fun?

4. Evidenced based medicine. I've heard that PMR may be less evidenced based than some other fields. Yet PMR has been around a long time. I'm curious what level of expertise is developed in residency. Would a PMR doc trained at Mayo be significantly better than someone who trained in a mid-tier program? How satisfied are you with the training? Why does PMR continue to be less evidenced based even though it's been around for a long time?

5. Physical therapist and PMR. I've read threads were these were compared and I understand there is a large difference. I'm curious though how this plays out in a hospital. Does the PMR doc assign all the therapy then not see a patient for a month or two while they do the daily therapy with PT?

6. What % of people do fellowships? How important are fellowships in this field? I'm interested in the musculoskeletal side more than the rehab side, does this mean a sports fellowship would be essential? How competitive are the sports fellowships or spine fellowships? 50%? 60%? Is there any data out there? If someone doesn't have a fellowship are the more limited further in their career?

7. Lack of competitiveness. I don't really care what others think, but I do wonder why the field lacks competitiveness and recognition. It's pretty old but still (maybe half of my class, guessing) still has little idea about what it is PMR docs actually do or who they are. This doesn't bother me - but it does cause hesitancy. Human decision making always involves a little bit of "herd theory", in that it's easy to chose something popular because everyone else is choosing it (must be good then, right?). But PMR suffers the opposite, why isn't everyone else choosing this field?

8. Collegial atmosphere. How do you get along with the other doctors you work with? Do FM docs see a need for your services? Do you get mostly referrals or do people call you directly?

9. Lifestyle. I've heard the lifestyle is good. Yet, I wonder about building a clientele, is this difficult? Are your skills in demand? Do you have to constantly market yourself in your time off to build a client base?

Anyway, thanks in advance for any help on these.

This thread was a great resource for me last year and I'm finally taking the time to add my two cents...

First a little context: I was interested in programs with strong sports/msk programs, and I hope to complete a spine & sports fellowship after residency. I had to turn down interviews at Emory and UC Davis due to scheduling conflicts, both of which I was strongly considering at the time. The only programs I did not hear from were Colorado and Baylor. I did not apply to Mayo, Pittsburgh, or MCW strictly based on location. I ended up matching at UW.

Rank List (Adjusted: my actual rank list reflected my fiance's location preferences as well. This list reflects only my preferences)

1. UW (seattle): The strongest MSK/sports/spine program I saw by far (note that I did not even consider Mayo due to location). Very friendly and outgoing atmosphere from the residents to the program directors (program organized trips to Whistler, Sporting events, etc). Particularly liked the emphasis on leadership (many residents on national committees). Brand new sports med center attached to Husky Stadium. Took us on a quick city wide tour of Seattle once the interviews were complete. Benefits include access to UW gyms. Didactics are non-repeating and class-specific on Tue/Thur mornings 730-930. Call is from home, 1 week at a time, every ~6 weeks as pgy2.

2. RIC: Everything I could say about RIC has already been said. One of my favorite interview days. If you choose the categorical year you can complete 3 intpatient rehab months and give yourself an extra 3 months of elective as a PGY2. Tons of elective time. Didactics at noon conference daily. Infrequent call (every 2-3 weeks as pgy2). New hospital in 2016. Not as Msk/sports focused as UW.

3. Stanford: Did my first away rotation hear (great rotation with 1 week experiences on Polytrauma @ VA, TBI @ VA, SCI @ Santa Clara Valley, Sports/MSK @ Stanford). Great way to get experience in everything. I absolutely loved my month in Palo Alto and I hope I can get a job there post-residency. Stanford's attendings were very young, friendly, and all great teachers (many of them trained at either Stanford, Harvard, and UW). MSK program is improving rapidly. The only reason I ranked UW/RIC higher was due to better resident placement in fellowships. Honestly, I would have been ecstatic to have dropped down to Stanford on my rank list (and was almost hoping I would). Weakness: lots of driving.

4. Spaulding: My 2nd away rotation. The residents here are crazy smart (noticeable from day 1 of didactics), but not as welcoming/social as those at most other programs (to be fair this is a generalization, there were some very outgoing and friendly people there too). Their new hospital is amazing (easily the nicest facilities of any program I saw, even more than RIC). VERY strong emphasis on doing research and reading journal articles, with assigned advisor and mentor.

5. Cornell Columbia: Good variety of exposure to inpatient/outpt including cancer rehab at sloan kettering. Brand new sports med program and fellowship under Chris Visco. Great hospital rotations (sloan K, Columbia, NYP, HSS). Weaknesses: Very little SCI and Lots of call (For example, even on outpatient rotations you have to take 1.5 overnight calls per week, including every Sunday as a PGY2). Although NYC is very expensive, the subsidized housing was actually better than expected.

6. Kessler: I wanted to like this program. My fiance is from northern NJ and it would've been very convenient to live close to her family. Yet this was the poorest interview day by far. First, I didn't like the elitist attitude which I got from everyone there (more-so than at spaulding), especially given the fact that I had interviewed at RIC two days earlier and not once did they mention their #1 ranking. Second, we never met or heard anything from the program chair (Dr. Foye, albeit he is the "interim" chair). Third, I only met two residents at their program and both seemed a bit off to me. No other program made it this hard to actually meet and spend time with their current residents (although they did encourage 2nd looks, but one was enough for me). Positives: Board review course

7. UVA: Applied here after hearing great things about their MSK program from multiple mentors. Everything I heard was true (plenty of experience with UVA athletics under Dr. Wilder, 300-400 EMGs) but the program was small (4 positions per class) and weak in inpatient SCI/TBI (although SCI will likely improve with a new attending Dr. Smith from Mayo).

8. Carolinas
9. Tufts

Feel free to message me with any questions you might have.

I saw this post in the rank list thread. What type of career does a person who is interested in spine/sports have? What does a day in practice look like for this person (outpatient clinic, 4 patients an hour? Therapy? Lots of injections? What is a typical day?) Is a spine/sports fellowship 2 years or 1?

 

[RangerBob]

I'm still an intern, so I can only answer some of your questions.

1) PM&R is not as well understood as most other specialties. But most attendings/residents I've met seem to be familiar with it (and most say they wish they had considered it!). I don't think PM&R needs to prove itself to the government at all--the VA is one of the biggest utilizers of the field, with all the new SCI centers being built (almost every VA I interviewed at had renovated or built a new SCI center), polytrauma taking off, amputee care, msk, etc. I think the government probably appreciates rehab more than the private sector, but that's just a personal opinion... Still, the need for rehab grew out of the injuries from WWII, so there's a significant history with the military/government.

When the private sector understands PM&R, physiatrists get tons of referrals from neurosurgery, ortho, FM, etc. Often physiatrists will be incorporated into ortho practices--the rehab doc does what they enjoy (MSK, injections, etc), and ortho gets to to what they really want to do (operate on the cases that fail conservative treatment).

2. I'm not sure about reimbursement, but it seems for general inpatient rehab it'll be fairly similar to inpatient IM. Physiatrists get paid very well considering their hours, but like I said, their yearly salary is close to that of hospitalists. Outpatient rehab usually pays a bit more (seems like residents were getting offers ~$200,000 or more). If you're doing interventional pain it can be a lot more, but that's where we are most likely to see cuts in the future. EMGs already took a big hit (50% cut in reimbursement). I think they main key is maintain diversity in your practice so if any one area gets hit, you can still do OK.

I think PM&R is certainly vital to the healthcare system. You'll find some inpatient units staffed by non-PM&R trained physicians (some of which might do fellowships in neuro-rehab), but PM&R does inpatient rehab the best. Outpatient PM&R is a little different because there isn't a whole lot unique to PM&R in that area--what's unique is how many things PM&R brings together. The world could probably do fine without outpatient PM&R--neuro can do EMGs and neuromuscular disorders, FM and ortho can do sports, anesthesia and IR can do pain, etc, etc. But PM&R brings all those things together and more efficiently.

3. I can't answer this, other than to say every physiatrist I've met loves their job and is very happy--it's part of what attracted me to the specialty. I figured there must be something good about the field if they're so happy--so I took a deeper look and felt it was definitely for me. I'm sure there are unhappy ones out there, and I'm sure my observations are partly due to self-selection (why go into a relatively low-paying and unknown field unless it's what you love? Kind of like with geriatrics...)

4. I haven't heard that PM&R is less evidence-based than other fields, but I suppose it could be true. Still, on my rotations we went over a lot of evidence-based medicine. As far as going to Mayo vs a mid-tier program, there will probably be as much of a difference as there would be if we were talking about an internal medicine resident.

5. It your'e talking about outpatient PM&R, then yes, often the physiatrist will prescribe PT, with or without medication, and then have the patient follow-up after about 6 weeks of PT. We try to keep our patients away from surgery (and medicine if possible) as much as we can. PT is one of the best treatments we can offer our patients.

6. I don't know how many residents go on to fellowships. It seems like a decent amount. If you want to do MSK, you definitely don't have to do a sports fellowship. Unless you go to a program with poor outpatient MSK training, you should be sufficiently trained. I'd only recommend a sports fellowship if you want to focus mostly/exclusively on sports medicine (which is very similar to, but still different than general MSK medicine). Sports fellowships are generally very competitive, whether you apply for an FM or PM&R position.

7. I think PM&R is not as competitive as most specialties because most people don't hear about it until it's too late to think about applying. But I think more medical students are hearing about it earlier.

8. I can't really answer this since I'm not in practice, but PM&R physicians seem to get along great with the other physicians they work with, and yes, FM docs (who know what PM&R is) definitely appreciate their friendly neighborhood physiatrist. Back pain is one of the most common things that brings someone to their family physician, and if it fails the first round of treatment FM is often very happy to send the patient to PM&R.

9. I don't really know about building a client base in PM&R--I'm sure someday I'll understand better. But, I'm hoping to work for one of the major VA's, in which case I'd already have an established client base.

I hope my answers/opinions help out. If you're thinking about PM&R I'd highly recommend shadowing a physiatrist (try to shadow inpatient too if you can to get a feel for the whole field).

If you really want to go into sports, it's worth shadowing an FM and a PM&R-trained sports physician. In general, if you want to specialize in the treatment of athletes (but still practice general medicine), it's better to go the FM route. If you want to specialize in the treatment of athletic injuries, PM&R might be better. If you want to operate, go ortho.

 

[RUOkie]

I've read a lot on aapmr.org.

Here are some questions I've had. I realize this list is long - so if you only want to answer a few that would be great. The first few are the most important. Thx

1. Do PMR docs have to prove their value? I've found that many of my classmates have no idea what PMR is. I'm not sure about attendings. Anyway, do PMR docs have to fight to prove their value to the government, to private practice, etc.?All doctors have to prove their value to their peers.

2. This is somewhat of a piggyback question. All doctors are facing reimbursement cuts. I'm not "in it for the money" so to speak, but I would be interested in hearing an argument of the value of PMR in the next 10-20 years. Why should medicare continue to reimburse PMR? What if they decide to cut the reimbursements in half? Does PMR play a vital role in our healthcare system?
We (the AAPMR) are actively working on cementing our role in the expected changed in healthcare delivery. There are 2 pilot programs now for working with insurers/CMS for that--one for Spine care, and one for Stroke care. CMS just DID cut reimbursement for EMG in half this past year. I am now working harder, but doing ok.
3. Day to day activities. I've listened to the podcasts about PMR days and understand there is a rehab side and a musculoskeletal side of this field. Are you intellectually and personally satisfied with your day to day activites? In other words, are you bored with your work? Do you think it's exciting? Are you having fun?I love my job. The day it gets boring will be the day I retire

4. Evidenced based medicine. I've heard that PMR may be less evidenced based than some other fields. Yet PMR has been around a long time. I'm curious what level of expertise is developed in residency. Would a PMR doc trained at Mayo be significantly better than someone who trained in a mid-tier program? How satisfied are you with the training? Why does PMR continue to be less evidenced based even though it's been around for a long time?the answer is ABSOLUTELY. We have a great disparity in how our docs are being trained. This is a point of embarrassment for some of us. The Resident review council is working on these issues

5. Physical therapist and PMR. I've read threads were these were compared and I understand there is a large difference. I'm curious though how this plays out in a hospital. Does the PMR doc assign all the therapy then not see a patient for a month or two while they do the daily therapy with PT?it depends, but I see PT and PM&R as two completely different fields that complement each other

6. What % of people do fellowships? How important are fellowships in this field? I'm interested in the musculoskeletal side more than the rehab side, does this mean a sports fellowship would be essential? How competitive are the sports fellowships or spine fellowships? 50%? 60%? Is there any data out there? If someone doesn't have a fellowship are the more limited further in their career?20 yrs ago the answer was about 10-20%. That number is rising, but their are not enough fellowships to go around. See my above post about residency training--that is an issue that should be fixed in the next 10 yrs

7. Lack of competitiveness. I don't really care what others think, but I do wonder why the field lacks competitiveness and recognition. It's pretty old but still (maybe half of my class, guessing) still has little idea about what it is PMR docs actually do or who they are. This doesn't bother me - but it does cause hesitancy. Human decision making always involves a little bit of "herd theory", in that it's easy to chose something popular because everyone else is choosing it (must be good then, right?). But PMR suffers the opposite, why isn't everyone else choosing this field?It is getting more competitive

8. Collegial atmosphere. How do you get along with the other doctors you work with? Do FM docs see a need for your services? Do you get mostly referrals or do people call you directly?I get along great with all my colleagues

9. Lifestyle. I've heard the lifestyle is good. Yet, I wonder about building a clientele, is this difficult? Are your skills in demand? Do you have to constantly market yourself in your time off to build a client base?yes

Anyway, thanks in advance for any help on these.



I saw this post in the rank list thread. What type of career does a person who is interested in spine/sports have? What does a day in practice look like for this person (outpatient clinic, 4 patients an hour? Therapy? Lots of injections? What is a typical day?) it depends

see my responses in red above.

 

[100YardDash]

I'm a 2nd yr resident. I can try and answer some of the questions.

-I don't feel like we have to prove our worth. actually, i think the ortho surgeons are the only other specialty that know as much musculoskeletal anatomy as we do. We do very well in our medicine rotations.. I have been told by numerous medicine attendings and even the program director that they are always impressed w/ our competency. I think we are top notch when it comes to finding the pain generator vs. other specialties. as far as medicine, we rotate at numerous hospitals and sometimes we get really sick patients for rehab... I have to manage their CHF, CAD, DM, etc on the rehab floor etc just like any other medicine resident... the only difference is that I don't admit a patient for CHF exacerbation etc..

I think Cancer rehab is on the rise fast. Oncologist are starting to realize how important it is to preserve function in the last year or two in these patients.

We wear many hats too.. part neuro/ortho/pain/medicine. I think we are unique and the field is growing fast... I will bet my R hand that this specialty turns into a radiology in 4-5 yrs.

hope this helps

 

[jonnylingo]

I've read a lot on aapmr.org.

Here are some questions I've had. I realize this list is long - so if you only want to answer a few that would be great. The first few are the most important. Thx

1. Do PMR docs have to prove their value? I've found that many of my classmates have no idea what PMR is. I'm not sure about attendings. Anyway, do PMR docs have to fight to prove their value to the government, to private practice, etc.?

2. This is somewhat of a piggyback question. All doctors are facing reimbursement cuts. I'm not "in it for the money" so to speak, but I would be interested in hearing an argument of the value of PMR in the next 10-20 years. Why should medicare continue to reimburse PMR? What if they decide to cut the reimbursements in half? Does PMR play a vital role in our healthcare system?

3. Day to day activities. I've listened to the podcasts about PMR days and understand there is a rehab side and a musculoskeletal side of this field. Are you intellectually and personally satisfied with your day to day activites? In other words, are you bored with your work? Do you think it's exciting? Are you having fun? Fun for me is skiing, biking, camping with my family. Work is work, but I wouldn't change fields. PMR/Pain is interesting...Spine is complex, the biopsychosocial aspects of pain are complex, and there's always more to learn and integrate into your practice. For example, recently I've been pushing sleep hygiene with my patients with chronic pain, this is in addition to PT, exercise, meds, injections, surgical referral, each of which is a complex road that can be explored.

4. Evidenced based medicine. I've heard that PMR may be less evidenced based than some other fields. Yet PMR has been around a long time. I'm curious what level of expertise is developed in residency. Would a PMR doc trained at Mayo be significantly better than someone who trained in a mid-tier program? How satisfied are you with the training? Why does PMR continue to be less evidenced based even though it's been around for a long time? PMR, as with Pain in general, may be considered less evidenced based because of the nature of pain, that the pain experience is entirely subjective, and that double-blinded placebo controlled studies are nearly impossible with the interventions we perform. There are no lab values that we can point to and say "See, you're better." Until the patient is doing better, you have not succeded in the patient's eyes. I spend a lot of time setting upt realistic expectations, that their pain may never be gone, but that we are going to work on function and managing the pain. The patients often don't want to hear this, they just want the pain GONE. This is often impossible, so you have to accept this, and get satisfaction from small improvements. Oh, and get the patients to accept this as well.

5. Physical therapist and PMR. I've read threads were these were compared and I understand there is a large difference. I'm curious though how this plays out in a hospital. Does the PMR doc assign all the therapy then not see a patient for a month or two while they do the daily therapy with PT?

6. What % of people do fellowships? How important are fellowships in this field? I'm interested in the musculoskeletal side more than the rehab side, does this mean a sports fellowship would be essential? How competitive are the sports fellowships or spine fellowships? 50%? 60%? Is there any data out there? If someone doesn't have a fellowship are the more limited further in their career?

7. Lack of competitiveness. I don't really care what others think, but I do wonder why the field lacks competitiveness and recognition. It's pretty old but still (maybe half of my class, guessing) still has little idea about what it is PMR docs actually do or who they are. This doesn't bother me - but it does cause hesitancy. Human decision making always involves a little bit of "herd theory", in that it's easy to chose something popular because everyone else is choosing it (must be good then, right?). But PMR suffers the opposite, why isn't everyone else choosing this field? Many theories on this. I see it like this... We don't have an organ system, we combine several fields into one, and do a great job of it, but still we have an identity problem. Even after a long conversation with someone, they still ask "So what is it you do?". My parents still don't have a clue. Still, I'm proud of what I do, and think our patients and referring providers "get it".

8. Collegial atmosphere. How do you get along with the other doctors you work with? Do FM docs see a need for your services? Do you get mostly referrals or do people call you directly? Mostly referrals. Fellow docs appreciate what we do. They don't have time/desire to deal with someone's chronic low back pain. Bump to the physiatrist. Then we get the patient, look at and beyond the tissue level and explore the psychosocial aspects of pain which are legion


9. Lifestyle. I've heard the lifestyle is good. Yet, I wonder about building a clientele, is this difficult? Are your skills in demand? Do you have to constantly market yourself in your time off to build a client base? With a multidisciplinary group, most referrals are in-house. Still, I'm always honing skills, and marketing to show what it is we can do.

I saw this post in the rank list thread. What type of career does a person who is interested in spine/sports have? What does a day in practice look like for this person (outpatient clinic, 4 patients an hour? Therapy? Lots of injections? What is a typical day?) Is a spine/sports fellowship 2 years or 1?

Typical day: 10-18 patients, half new, half follow up. 40 min new, 20 min f/u. 2-5 peripheral injections/day, 2-3 EMGs. Most days interesting, some days torture. It's a good job if you like working with people. And keep in mind these are people in pain, often cranky, demanding, entitled, miserable. I thought going into this that most would be athletes or your average guy who threw out his back. Now I realize the 75% are on disability, chronic painers many of whom love their Vico-soma-xanax and don't want to hear anything about lifestyle changes. They want pills and shots. I spend 90% of my time in counseling, most of which falls on deaf ears. But the ones (the minority) who DO listen and DO change, who stop smoking, start exercising, start going to bed at 11pm instead of 3am, who cut back on the pills and focus on DOING something, and who then improve, this makes the job worth it.

See red above.

 

[bronx43]

I'm a 2nd yr resident. I can try and answer some of the questions.

-I don't feel like we have to prove our worth. actually, i think the ortho surgeons are the only other specialty that know as much musculoskeletal anatomy as we do. We do very well in our medicine rotations.. I have been told by numerous medicine attendings and even the program director that they are always impressed w/ our competency. I think we are top notch when it comes to finding the pain generator vs. other specialties. as far as medicine, we rotate at numerous hospitals and sometimes we get really sick patients for rehab... I have to manage their CHF, CAD, DM, etc on the rehab floor etc just like any other medicine resident... the only difference is that I don't admit a patient for CHF exacerbation etc..

I think Cancer rehab is on the rise fast. Oncologist are starting to realize how important it is to preserve function in the last year or two in these patients.

We wear many hats too.. part neuro/ortho/pain/medicine. I think we are unique and the field is growing fast... I will bet my R hand that this specialty turns into a radiology in 4-5 yrs.

hope this helps

I'm sorry but everyone has to prove their worth, as someone else in this thread had stated. The difference for you guys is that everyone else has already proven their worth. You guys have obviously done exactly that for rehabilitation, but now you're trying to squeeze into all other musculoskeletal and neurological niches, which is a different story altogether. No one cares that you think you know MSK better than anyone save for the orthopods. You have to prove it to those providing you with referrals. If I have what I believe to be a sports medicine issue, I refer to sports med. If I think it's a neurological problem, I refer to neuro. If I have a pain patient, I refer to pain specialists, and preferably I find the anesthesia group.

And not sure what you mean by PMR will be radiology in 4-5 years. Maybe you mean derm?

 

[Gauss]

I'm sorry but everyone has to prove their worth, as someone else in this thread had stated. The difference for you guys is that everyone else has already proven their worth. You guys have obviously done exactly that for rehabilitation, but now you're trying to squeeze into all other musculoskeletal and neurological niches, which is a different story altogether. No one cares that you think you know MSK better than anyone save for the orthopods. You have to prove it to those providing you with referrals. If I have what I believe to be a sports medicine issue, I refer to sports med. If I think it's a neurological problem, I refer to neuro. If I have a pain patient, I refer to pain specialists, and preferably I find the anesthesia group.

You can't expect a 2nd year resident to fathom this concept yet, for them referrals and patients drop out of the sky onto their doorstep.

 

[Kal EI]

I'm sorry but everyone has to prove their worth, as someone else in this thread had stated. The difference for you guys is that everyone else has already proven their worth. You guys have obviously done exactly that for rehabilitation, but now you're trying to squeeze into all other musculoskeletal and neurological niches, which is a different story altogether. No one cares that you think you know MSK better than anyone save for the orthopods. You have to prove it to those providing you with referrals. If I have what I believe to be a sports medicine issue, I refer to sports med. If I think it's a neurological problem, I refer to neuro. If I have a pain patient, I refer to pain specialists, and preferably I find the anesthesia group.

And not sure what you mean by PMR will be radiology in 4-5 years. Maybe you mean derm?

Kind of figured this.

I agree with the statement that many specialties have proven their worth. When I look at Gen Surg or even Emergency, those are services in dire need. The US healthcare system will collapse with out those (and many other specialties obviously). I was basically looking for an argument, "Here's why we are essential" which a few people did give. Saying "We all have to prove our worth" isn't true. Ortho doesn't have to prove their worth.

 

[specepic]

OP-you are concerned re: impact of health care reform and rightly so. You are concerned PMR could be considered a luxury service and cut by the comrades. Look at it a bit differently. Those in PMR (many already do this) are well positioned for providing off the grid/cash services. MSK/spine issues are VERY common and everyone wants to avoid surgery. OMT/acupuncture/PRP/Prolo/TPI"s etc.

ER, Ortho, etc. will have no choice but to submit to the gov't b/c they need a hosp to work at, PMR can go off the grid if needed

 

[Kal EI]

OP-you are concerned re: impact of health care reform and rightly so. You are concerned PMR could be considered a luxury service and cut by the comrades. Look at it a bit differently. Those in PMR (many already do this) are well positioned for providing off the grid/cash services. MSK/spine issues are VERY common and everyone wants to avoid surgery. OMT/acupuncture/PRP/Prolo/TPI"s etc.

ER, Ortho, etc. will have no choice but to submit to the gov't b/c they need a hosp to work at, PMR can go off the grid if needed

Yup.

Thx for the argument. That's the kind of stuff I'm trying to learn.

 

[bronx43]

OP-you are concerned re: impact of health care reform and rightly so. You are concerned PMR could be considered a luxury service and cut by the comrades. Look at it a bit differently. Those in PMR (many already do this) are well positioned for providing off the grid/cash services. MSK/spine issues are VERY common and everyone wants to avoid surgery. OMT/acupuncture/PRP/Prolo/TPI"s etc.

ER, Ortho, etc. will have no choice but to submit to the gov't b/c they need a hosp to work at, PMR can go off the grid if needed

Again, where are you going to get your referrals? Or are you going pure private and advertise? If the market comes to that, then it's going to be a dogfight for wealthy people with MSK issues that are able to and willing to pay out of pocket. Sports med, orthopedics, and anesthesia pain medicine dominate their respective markets. Hell, even primary care physicians can skim the low hanging fruit with some joint injections and PRP. It's not hard. In fact, I know a physician assistant who does hair transplants in Florida who has people lining up for PRP. I'm afraid PMR will be the odd man out in this case. The problem I see with PM&R is that your niche is really rehabilitation, but you guys are trying to encroach into markets that are already dominated by others.

 

[Kal EI]

Again, where are you going to get your referrals? Or are you going pure private and advertise? If the market comes to that, then it's going to be a dogfight for wealthy people with MSK issues that are able to and willing to pay out of pocket. Sports med, orthopedics, and anesthesia pain medicine dominate their respective markets. Hell, even primary care physicians can skim the low hanging fruit with some joint injections and PRP. It's not hard. In fact, I know a physician assistant who does hair transplants in Florida who has people lining up for PRP. I'm afraid PMR will be the odd man out in this case. The problem I see with PM&R is that your niche is really rehabilitation, but you guys are trying to encroach into markets that are already dominated by others.

What fields of medicine do you recommend in this climate? I have a handful of specialties I'm looking at but am having trouble determining which to do (i.e. I could see myself doing any of them and don't love one more than another).

 

[bronx43]

What fields of medicine do you recommend in this climate? I have a handful of specialties I'm looking at but am having trouble determining which to do (i.e. I could see myself doing any of them and don't love one more than another).

Which ones are you looking at? I'm an internist and hopeful cardiologist, so I may be biased, but I think if you aren't going to do surgery, I would consider internal medicine due to its versatility.

 

[Kal EI]

Which ones are you looking at? I'm an internist and hopeful cardiologist, so I may be biased, but I think if you aren't going to do surgery, I would consider internal medicine due to its versatility.

Probably IM, EM, Anesthesia or PMR.

 

[bronx43]

Probably IM, EM, Anesthesia or PMR.

EM has a great job market, and some jobs are paying ridiculous numbers. However, you do have to deal with the scum of the earth on a daily basis. You also have horribly inconsistent hours and it is extremely stressful when you are on shift. Burnout rate is high and you really don't have many options outside of the ER.

Again, I am biased when it comes to IM, but it provides incredibly versatility, as you can have the option of doing something absurdly chill like allergy or something very intense like interventional cardiology... and there's everything in between. You can be outpatient only, inpatient only, or a combination of both. If you specialize, you are the king of your domain and are always in demand. The only downside I can think of is that some of the subspecialties are becoming saturated, so you can't pick and choose your perfect job like before.

Anesthesia was a great field until they allowed CRNAs to infiltrate their market. I personally would have strongly considered the field if that wasn't the case.

You already know my thoughts on PM&R. If you love inpatient rehabilitation, then I think it's a great option.

 

[Disciple]

I'm sorry but everyone has to prove their worth, as someone else in this thread had stated. The difference for you guys is that everyone else has already proven their worth. You guys have obviously done exactly that for rehabilitation, but now you're trying to squeeze into all other musculoskeletal and neurological niches, which is a different story altogether. No one cares that you think you know MSK better than anyone save for the orthopods. You have to prove it to those providing you with referrals. If I have what I believe to be a sports medicine issue, I refer to sports med. If I think it's a neurological problem, I refer to neuro. If I have a pain patient, I refer to pain specialists, and preferably I find the anesthesia group.

Agree somewhat.

Which is why I think PMR (outpatient anyway) should be described in as concise a manner a possible, instead of in abstract terms.

Something along the lines of, the same thing as Primary Care Sports med, but on a broader scale, i.e. the Physiatrist should be able to provide the non-operative care for just about every subspecialty in the Ortho practice (even though we aren't that great at the foot/ankle stuff. I still think Podiatrists do a better job at foot/ankle bracing/injections).

However, in the major markets, most physicians know this by now. The PMR MSK/Spine injection thing has been going on for 20 years now.

In my area, Physiatrists are the ones who get the referrals for spine injections and get hired to work in the Occ Med clinics (along with the Orthos). Patients then get sent to the pain clinics for opioid management and residual injections. My main competition is other Physiatrists, not other specialists.

Sometimes, there is an advantage to being a bit vague/abstract in what your specialty is. As stated, it can make it easier to branch into outside the box/cash paying services. If "what you do" is narrowly focused and well known by everyone, you may have a harder time explaining to patients why you are now offering cash based, seemingly unrelated services, other than that you need to make a little extra cash.

 

[Baritonebass]

Again, I am biased when it comes to IM, but it provides incredibly versatility, as you can have the option of doing something absurdly chill like allergy or something very intense like interventional cardiology... and there's everything in between. You can be outpatient only, inpatient only, or a combination of both. If you specialize, you are the king of your domain and are always in demand. The only downside I can think of is that some of the subspecialties are becoming saturated, so you can't pick and choose your perfect job like before.

I didn't know they were handing out Allergy and Interventional Cards fellowship like Candy. The problem with those fields for me is the 3yrs of medicine. The amount of work(40pts daily) plus why would a family med doctor refer to you???(your logic). I do what I love and people value my services. Plus I'm not afraid the practice outside of NYC, LA, SF

I think PM&R fits well in the future world of consolidation,
1 rehab Doc in multi-specialty Ortho group = Neuro(EMG and work up for hand/Spine), Primary sports(injections, non operative care), Pain(injections, RFA), plus you can sweeten the pot with sub acute, and consults

 

[Gauss]

Again, where are you going to get your referrals? Or are you going pure private and advertise? If the market comes to that, then it's going to be a dogfight for wealthy people with MSK issues that are able to and willing to pay out of pocket. Sports med, orthopedics, and anesthesia pain medicine dominate their respective markets. Hell, even primary care physicians can skim the low hanging fruit with some joint injections and PRP. It's not hard. In fact, I know a physician assistant who does hair transplants in Florida who has people lining up for PRP. I'm afraid PMR will be the odd man out in this case. The problem I see with PM&R is that your niche is really rehabilitation, but you guys are trying to encroach into markets that are already dominated by others.

referrals are irrelevant for cash based services. if you're good at the service and advertise well you'll get business, then word of mouth (or internet) is like gold. Just like any other business. It's already a dogfight against the naturopaths and chiros who are doing this stuff. Do you think they care about referrals?
I'm sports med and I definitely do not dominate the market. Do you have any idea how many people say they're sports med ? FP, DPT's, podiatrists, orthos, chiros, naturopaths, personal trainers, ATC's .....
Same in pain and neuro. All specialties get encroachment. EM jobs are dependent upon satisfaction surveys. Fun!

 

[sunshine121]

I'm a 2nd yr resident. I can try and answer some of the questions.

-I don't feel like we have to prove our worth. actually, i think the ortho surgeons are the only other specialty that know as much musculoskeletal anatomy as we do. We do very well in our medicine rotations.. I have been told by numerous medicine attendings and even the program director that they are always impressed w/ our competency. I think we are top notch when it comes to finding the pain generator vs. other specialties. as far as medicine, we rotate at numerous hospitals and sometimes we get really sick patients for rehab... I have to manage their CHF, CAD, DM, etc on the rehab floor etc just like any other medicine resident... the only difference is that I don't admit a patient for CHF exacerbation etc..

I think Cancer rehab is on the rise fast. Oncologist are starting to realize how important it is to preserve function in the last year or two in these patients.

We wear many hats too.. part neuro/ortho/pain/medicine. I think we are unique and the field is growing fast... I will bet my R hand that this specialty turns into a radiology in 4-5 yrs.

hope this helps

5 years later. Lurker here.. you still bet your R hand? Lol 🙂