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.