appeal

[IMsoJaded]

Would you say PMR has sex-appeal?

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[GQPMR]

Would you say PMR has sex-appeal?

Well the P is for Physical...

 

[IMsoJaded]

this is true. A t-shirt with the phrase "lets get physical" comes to mind (already being manufactured).

But still... does it have the same sex-appeal with the ladies as Ophtho or Rads or Ortho

 

[SSdoc33]

i have yet to meet one lady (and lord knows ive tried) who was wowed by my specialty choice. i can pretty much guarantee that most women will have no idea what PM&R is. i take that back. i can pretty much guarantee that most PHYSICIANS have no idea what PM&R is.

 

[Louisville04]

this is true. A t-shirt with the phrase "lets get physical" comes to mind (already being manufactured).

But still... does it have the same sex-appeal with the ladies as Ophtho or Rads or Ortho

If that's your criteria, you should try neurosurgery or cardiothoracic surgery. Ladies like saying they are dating a brain or heart surgeon

 

[deleted185747]

You need to already have sex-appeal in some other way... If nothing else a really nice car!!!

 

[IMsoJaded]

I started this forum as a joke of course. Hope everyone took it that way. Although I must say that I do become discouraged at times when my classmates (who have equivalent grades as me) will be making much more than I in income in the future... sigh... I mean it's not the only criteria, but when your buddy will be making 400+ compared to my measly 150.. it's heart-breaking.

 

[doctobe2]

I started this forum as a joke of course. Hope everyone took it that way. Although I must say that I do become discouraged at times when my classmates (who have equivalent grades as me) will be making much more than I in income in the future... sigh... I mean it's not the only criteria, but when your buddy will be making 400+ compared to my measly 150.. it's heart-breaking.

I sometimes feel the same way too but as long as one is not totally poor money does not equate happiness. What matters is doing what u love. BTW who says that PM&R makes a "measly 150"? I met a couple of 4th year residents on my interview trail who have already secured >200k outpatient 9-5 jobs for when they graduate. ( if outpatient is your thing)

 

[IMsoJaded]

outpatient is my thing!

I know. Best to keep your chin up. How do any of us really know what we truly enjoy though. It's probably just what you make of the situation. I'm interested in PMR fully right now, but I met a resident who said he was just like me but wound up not liking PMR after his 3rd year of it... Just don't want to end up like that guy. Things happen though...

 

[SportsMed09]

I talked with a few physiatrists after I decided that PM&R is what I want to do, to see, is what I'm going to do be a lower or higher paying field? I was told as an outpt physiatrist you can make up to $1 million. This would be if you owned your own rehab facility, but as an outpt doc you would have more time to invest in multiple locations, or have a high patient load. Also, if you got into doing interventional stuff you can make more. I didn't choose this for money, but I was pleasantly surprised that there is a high earning potential if you put in the work.

 

[Dr. Ice]

PM&R is not really a high paying specialty. If you compare the field (including interventional) to other specialties including GI, Cards...you will probably be dissapointed by the ACTUAL numbers. People that say you can make a mill, probably are either doing something illegal (and will probably be put in jail sometime soon) or are working is an "undesired" geographic location. The fact is that a lot of different specialties are doing interventional procedures, and reimbursement is probably going to go way down. Interventionalists that are anesthesia trained (not just talking about anesthesia fellowship trained), but those who actually have a background in anesthesia will get higher paying jobs than the PM&R interventionalists. Thats just the way the cookie crumbles.

Still want to go into PM&R?! Take it from a resident soon to be completing his residency...you might want to consider another field. If I could do it all over again...I would have done radiology (80% of anything that is done in medicine is based on imaging) or Anesthesia. Just something to consider....

 

[melancholy]

Well, it depends on how much making more than the average salary for the specialty means to you when you factor in other positives of the specialty including generally good hours/lifestyle and as much interaction with patients as you want. Sure, other specialties can make a ton more without spending too much time at work, but the style of practice, amount of patient interaction, etc. tends to be significantly different. Example as mentioned above.. radiology, anesthesiology.

 

[Dr. Ice]

thats true. I guess if you like working with people who dont want to work (worman's comp) or drug seekers (chronic pain) or people who cant talk (TBI) than this specialty is awesome. I forgot to mention being referred to as the "step doctor" by other services when you are on the consult service. Why? Because all you do on consults is walk around the hospital and squeeze calves and ask people how many steps they have in their house. But dont take it from me. I think its just my skewed view of the field based on my experience during residency. Im sure there are a ton of really positive people out there who think the field is great and have no regrets which basically seems to be every one else on the site. I just think that its important for a medical student to make an informed decision based on personal experience, likes/dislikes, and different viewpoints...

 

[doctobe2]

thats true. I guess if you like working with people who dont want to work (worman's comp) or drug seekers (chronic pain) or people who cant talk (TBI) than this specialty is awesome. I forgot to mention being referred to as the "step doctor" by other services when you are on the consult service. ...

It seems you are pretty disilussioned / dissapointed in PMR. What exacty were your expectations going into this field and how do they differ from the reality you discovered. Did you know enough about PM&R before applying? or was it more of an after thought/back up kind of gig?

 

[paindefender]

Everytime I asked for PT a physiatrist shows up does a consult suggesting PT

 

[Dr. Ice]

I think its interesting that a medical student is suggesting that a senior resident in the field is "disillusioned." Thats just kinda funny. That being said, I guess I just thought the field was going to be different. I was burnt out after med school and wanted to take the "path of least resistence." Unfortunately, it back fired. All the attendings I talk to make it seem as though they have to "***** themselves out" to get business in the outpatient setting. My own attendings even tell me the same thing. If you join an orthopedic or neurosurgical practice, they will never make you partner. If you join a physiatric practice, it might be ok, but referrals will probably always be an issue. If you think about it, our field overlaps a lot of other fields. Chances are that orthopods have better MSK skills than us, neurologists are better at diagnosing neurological disorders, and psychiatrists are probably better at identifying malingerers/drug seekers. It kinda makes you wonder, what the need for us really is.

Im sure people on this site will write all kinds of nasty things to me now that I am saying all this stuff. Again, its all about perspective. This is just my view of the field. Im sure others are having a great experience and wouldnt dream of doing anything else.

Having gone through three years of training in this field, however, I do question how anyone can truly have a passion for rehab medicine. I personally think that is a little weird.

 

[SSdoc33]

Dr. Ice, i completely see your point. residency is not post-residency, however, and your perspective might change.

it is true that we have an identity problem. thats not going away any time soon. however, if you do good work, your value will be recognized by your colleagues, and you will be compensated relatively well for the amount of time and effort that you put it in.

here's another thought: do you honestly believe that people in rads or anesthesia, or ortho arent disillusioned? no field will tell you that everyone in it is happy or completely satisfied. if those fields can offer more money in the long run, and hats the over-arching goal, then there are other ways to make money outside of medicine.

 

[lobelsteve]

I think its interesting that a medical student is suggesting that a senior resident in the field is "disillusioned." Thats just kinda funny. That being said, I guess I just thought the field was going to be different. I was burnt out after med school and wanted to take the "path of least resistence." Unfortunately, it back fired. All the attendings I talk to make it seem as though they have to "***** themselves out" to get business in the outpatient setting. My own attendings even tell me the same thing. If you join an orthopedic or neurosurgical practice, they will never make you partner. If you join a physiatric practice, it might be ok, but referrals will probably always be an issue. If you think about it, our field overlaps a lot of other fields. Chances are that orthopods have better MSK skills than us, neurologists are better at diagnosing neurological disorders, and psychiatrists are probably better at identifying malingerers/drug seekers. It kinda makes you wonder, what the need for us really is.

Im sure people on this site will write all kinds of nasty things to me now that I am saying all this stuff. Again, its all about perspective. This is just my view of the field. Im sure others are having a great experience and wouldnt dream of doing anything else.

Having gone through three years of training in this field, however, I do question how anyone can truly have a passion for rehab medicine. I personally think that is a little weird.

Wow, this is not a good CV / personal statement. I think your training may be suboptimal because of your institution.

You come across as lazy and disheartened. What do you want to do with your life is the question you should have asked before residency.

Hang in there and find your niche.

 

[Myofascist]

Dr Ice is a very fitting name for you. Your people skills must be at a minimum. "brain-injured pts that cant talk" Wow, you really did pick not only the wrong specialty but just picking medicine in general was absolutley foolish for you. I guess it must have been the challenge of taking the MCAT that lured you in. You may want to try an entirely different field such as... a mortitian or accountant perhaps (sorry for those who know nice accountants). Good luck with your new career, the field of PM+R is the last place you should be.

 

[agdoc04]

I don't think it is fair to say that a physician that does not enjoy the challenges of dealing with Brain injured patients shouldn't be a doctor.
on those lines of thought 90% of doctors probably shouldn't be doctors.
Also, the "You are lazy" line is kind of out of place. Is going through med school and residency possible for a "lazy" person? Do you have to work 80+ hours per week to be a hard worker?

He is posting his honest feelings on the field as they stand after 3 years of residency. I much rather hear those opinions than the half truths that we usually hear. Most people want to know a few things about a field.
1. What do you do for a job
2. Where are the best places to train
3. How do you interact with other fields
4. What are your job opportunities later
5. Do you like your job.

doctorice is posting what his feelings are. We don't bash you for saying the field is perfect.

 

[doctobe2]

I think its interesting that a medical student is suggesting that a senior resident in the field is "disillusioned." Thats just kinda funny. .

Dr. Ice, accept my apology, I did not mean to be disrespectful to you by suggesting that you may be disilusioned, I was just interpreting the undertone of your previous posts and I wanted to know if you were well informed about the field before going into PM&R and the field just happened to fail you. I also believe that this is an open forum where members should be free to express their opinions without fear of harassment.

I was burnt out after med school and wanted to take the "path of least resistence." Unfortunately, it back fired

Well thanks for answering my question. It seems that your decision to pursue rehab may have not been well thought out if at that time you were burnt out and thought that you were "taking the path of least resistance" and therefore the field of PM&R may not actually be the one to blame for your current situation.

However, I do respect your speaking out and expressing your feelings and you may actually be doing a service to other students that may be in the process of going into PM&R for the wrong reasons.

I wish you the best in whatever you do and wish you can find a field that you enjoy and hopefully go into it for the right reasons after you've done your research.

 

[JiminyCricket]

Is it difficult to find a job position in general PMR after residency?

 

[Dr. Ice]

I had a feeling that people were going to take my opinions and turn them into some kind of personal attack.

Myofascist...judging by your post...I think it is you who are completely devoid of people skills. No one has ever thought that about me. Quite the contrary in fact. My people skills are probably the only thing that may actually help me survive in this field. I was merely posting my personal opinion of the field after being in and almost completing a residency training program. I also did state that Im sure there are an abundance of people on this site who can describe the exact opposite experience/impression of the field.

I have done very well in this residency. I have also been accepted into a very sought after fellowship after Im finished, so its not as though I havent made the best of the situation.

My views are based on what I see, and what I hear from attendings who have been practicing for quite some time.

This is a forum to post opinions and experiences and perhaps provide some mentoring to medical students. I hope you all didnt take my comments as personally as Mysofascist and that you will take my posts and the posts of others with a "grain of salt."

Good luck to all of you persuing PM&R. Just make sure you know exactly what you are getting youself into...

 

[doctobe2]

Is it difficult to find a job position in general PMR after residency?

No, I don't believe so but if you search the forum, you should be able to get a more comprehensive answer since this question has been asked several times before.

 

[Myofascist]

So the Dr Ice name is in reference to your typical treament for patients and not your personality. Sorry about that. I just think your earlier post misrepresents to impressionable medical students the typical patients we see. A large majority are not drug seekers, workman comp pts, or brain injury pts that cant talk. Most are your average every day folk that need some help w/ pain or disability and when treated appropriately are very happy with the care we provide. Compare these pts to other specialties. Take some Cardiology pts for example. They have had 3 AMIs and are still smoking and eating fast food. That must be fun to deal with. I think every specialty has there ups and downs and you just have to find the one with the least amt of downs and the most amt of ups. Personally I would rather saw off my own great toe with a butter knife then go into a field like Radiology spending day after day in the dark reading room with a cup of coffee in one hand and a tape recorder in the other. But I am a people person and like spending time with patients, which in itself can make a big difference in their lives.

 

[Dr. Ice]

Dude...why are you so obsessed with my username. Its kinda weird. I have been named several times by patients and even honored by the medical director of my hospital for the compassionate care I give my patients. So, Dr. Ice is infact, just the username.

 

[ShrikeMD]

"Chances are that orthopods have better MSK skills than us, neurologists are better at diagnosing neurological disorders, and psychiatrists are probably better at identifying malingerers/drug seekers. It kinda makes you wonder, what the need for us really is.

Im sure people on this site will write all kinds of nasty things to me now that I am saying all this stuff. Again, its all about perspective. This is just my view of the field. Im sure others are having a great experience and wouldnt dream of doing anything else.

Having gone through three years of training in this field, however, I do question how anyone can truly have a passion for rehab medicine. I personally think that is a little weird.[/QUOTE]"

Controversial statements, to be sure. I won't attack you, Dr. Ice. As you said, you are just sharing your view of the field at this point in time in your career. I won't attack your residency program either. I have heard similar doubts about the field muttered by residents at "elite" programs.

Having said this, I don't know of any field of medicine that doesn't have some shortcomings. I specialize in caring for patients with acquired brain injury, and BI medicine certainly has its challenges. While my residency program is considered "top 5/elite'" (whatever), I can assure you that my brain injury rotation (during residency) was not. However, I had enough exposure to find aspects of BI medicine interesting enough to wonder whether I could be satisfied taking care of these patients after I left residency. Further, I felt that if my rotation was indicative of the field, then the specialty needed help, and perhaps I could make a niche in this field, and make things better than the way I found them. After graduating, I participated in a BI fellowship, and subsequently have devoted my career to advancing BI Medicine and caring for these patients. While there have been some challenges, I am very happy and fulfilled with my career choice. I publish extensively, and take some satisfaction in seeing my work cited in physiatry, neurology and neurosurgery journals. More importantly, I honestly believe that I provide meaningful assistance, whether in direct care or advice, to the patients I serve.

My point is NOT to brag, nor to urge you to go into brain injury medicine. Rather, consider the breadth of exposures that we see in Physiatry, and ask yourself whether there is any aspect of the field where you could take professional satisfaction/fulfillment in becoming an expert practitioner. Then make yourself that expert practitioner. Your residency training will only take you so far. Yes, payors may reimburse other specialists more than what a physiatrist will earn for seeing the same patient. Ultimately, the patients/families/referring docs generally come looking for the doctor who can help them the most. I believe this is a major factor in the growth of our specialty. If you can take satisfaction in providing great care for a specific patient population (or a broad range of patient diagnoses), I think you may look back and find this field is deserving of some of the passion that you alluded to earlier.

Character is destiny.

 

[Disciple]

I mean it's not the only criteria, but when your buddy will be making 400+ compared to my measly 150.. it's heart-breaking.

If 150 is the best you can find, you're not trying very hard.

 

[Disciple]

Interventionalists that are anesthesia trained (not just talking about anesthesia fellowship trained), but those who actually have a background in anesthesia will get higher paying jobs than the PM&R interventionalists. Thats just the way the cookie crumbles.

There is more to this than meets the eye.

Starting salaries are typically a modest base plus productivity bonus. If you have a full set of interventional skills, then your productivity will be similar to your anesthesia colleague.

Things that mess up the averages:

1. Working for surgeons (salaries will be lower-self explanatory), anesthesia pain docs rarely work for surgeons, in part because surgeons don't want pain patients lingering around the practice after they have been deemed non-surgical and injections have been exhausted

2. Working in a traditional PM&R practice (f/u visits are longer, volume and varitey of procedures generated in less, thus less in billing/collections)

Eliminate these 2 situations and the averages will even out.

Data needs to be collected 10 years from now after PM&R has evolved a little further before a more accurate comparison can be made.

 

[Louisville04]

I had a feeling that people were going to take my opinions and turn them into some kind of personal attack.

I have done very well in this residency. I have also been accepted into a very sought after fellowship after Im finished, so its not as though I havent made the best of the situation.

Good luck to all of you persuing PM&R. Just make sure you know exactly what you are getting youself into...

Why do you want to further your training in pm&r by doing a fellowship if you are so disillusioned? Let someone with more passion do the fellowship. Why not try to pursue a different aspect of medicine such as administration? I understand they get a fairly good salary with regular hours. Money is nice but if you are miserable it is not worth it.

 

[Dr. Ice]

Thanks for the advice. I think I will keep my position however.

 

[IMsoJaded]

I guess we strayed beyond the topic of "sex-appeal". I'm glad that we're getting different opinions and experiences on the field however. Dr. Ice, thank you for sharing your honest opinion. We often get way too much of the "good" on these forums so it's nice to hear some balance.

To be honest, Dr. Ice's disapproval of the field is what a lot of medical students fear. We don't normally learn about PMR during our usual rotations or even during the first two years of medical school. Why are fields such as Cardio, GI, and Radiology more "comfortable choices"?... (besides the money and prestige of course)... well it's because students know what they are getting into. We learn about these fields in our 1st, 2nd, and 3rd year of medical school well before our focused rotations. PMR is just foreign to us and is most often likened to Physical Therapy.

My interest seems to wax and wane more and more each day. I want to believe the "brightly-painted picture" that most of you portray, however a little bit of Dr. Ice's experience haunts me. Most of the medical community do not concern themselves (or regard) PMR so how can this instill confidence in any medical student! I"m posting this out of concern and not our of maliciousness so please don't respond with negative replies.

 

[lobelsteve]

Much of the aura of PMR comes from years of weak leadership nationally and at the local levels. PMR has gotten the reputation of bottom feeders and spineless docs who do what they are told. I recall a rehab unit where the consults were done by a nurse whose job was to stuff the beds. Folks would come over in a coma or septic. It was good for the census, but many of the folks would fail at rehab or transfer to acute (ICU).

I learned nothing about Pain Medicine in residency and had exposure for a few weeks with an outpatient and undertrained physiatrist injecting the L-spine and SIJ. It was not until I heard Rob Windsor come down and lecture on disc pain that I realized PMR docs had balls, skills, and commanded respect. I was lucky to get 2 months with Karen Barr in reidency before she bolted to UWashSeatle so i learned how to perform a MSk exam.

So now Press and Cifu are up there and I hope they can carve a piece of the future of medicine for PMR. If I were stuck inpatient, I'd be despondent about the lack of respect, the lack of opportunity, and the lack of contribution I'd be making towards getting patients better. Outside of TBI, SCI, P&O - the 3 combined never accounted for more than 3-4 patients on the unit - it was IM + bowel/bladder, DVT proph, GI proph, and geting FIM scores in a chart from the therapists.

 

[medicineman1]

So Steve,

would you go the PM&R route again? Did you know that you wanted to do pain before even starting?

 

[lobelsteve]

So Steve,

would you go the PM&R route again? Did you know that you wanted to do pain before even starting?

I knew pain was right for me before finishing my Intern year. I interviewed at Vermont Anes and EVMS PM&R as well as some other places. PM&R was a better fit what I wanted to do in private practice.

Either way, you throw out a lot of education when you stop the primary field and focus on PMed.

 

[Disciple]

Much of the aura of PMR comes from years of weak leadership nationally and at the local levels. PMR has gotten the reputation of bottom feeders and spineless docs who do what they are told. I recall a rehab unit where the consults were done by a nurse whose job was to stuff the beds. Folks would come over in a coma or septic. It was good for the census, but many of the folks would fail at rehab or transfer to acute (ICU).

I had some similar experiences to Steve during residency. One of my most enduring memories, being on call at a private rehab hospital with a TBI patient on Imipenem and septic. I told the nurse I was going to bed and to wake me up when I needed to call the ambulance.

To the disillusioned residents out there, yes, residency requirements need to be changed to stop turning residents and med students off to the field.

There is a silver lining, however.

No one says you have to make your private practice resemble your residency training. Don't like call? Don't like paperwork? Hire midlevels. Become a medical director.

Part of the beauty of PM&R is its ambiguity. Take the term "functional restoration". How ambiguous is that? Physiatrists (mostly in the outpt setting) incorporate alot of the best parts of other specialties. We do EMGs, but not the complex inpt ones. We do spinal injections, but often times do not prescribe opiates. Now we do ultrasound.

Think of other specialties. What happens when their reimbursements go down. Do they have other options? Often times no. If they start practicing outside of their specialty, it often looks weird and other physicians and the public takes notice.

Physiatry is not nearly as deep as it is wide. Diversity is key in today's health care market, and you can have that with PM&R.