PM&R v. FP

[HealingDoc]

Hi Everyone,

Have any of you ever debated over whether to go the FP or PM&R route when you were thinking about residency as a med student? I am trying to weigh the pros and cons of these specialties because both are feeling like a good fit for me.

Also, a friend of mine brought up the idea of applying to both kinds of residencies, ranking both, and letting fate do the rest. I am not sure this would be a good idea because I think I might spread myself too thin during the application process/audition rotations/interviews- any thoughts?

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Background on me:

I'm a third year DO student and I'm in the midst of scheduling my audition rotations while I complete an elective rotation in PM&R. I started medical school with the intention of going the FP route because of the emphasis on prevention and continuity of care. It seems like family physicians are in such high demand and I want to go through with my initial intentions based on that need alone. BUT.... My current PM&R rotation is turning my world upside-down because I realize that this is something I like just as much as primary care, if not even more. I think the reason I am attracted to PM&R is because it is very much like family medicine in the continuity of care aspect (in outpatient settings), but it also emphasizes musculoskeletal/neuro. I can see myself being able to perform OMT and manage patients on a long term basis in both specialties. It also seems like both specialties offer a good lifestyle, 8-5 work day, and I have heard that they both pay relatively the same depending on how hard you work. Any insight would be greatly appreciated!

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[turquoiseblue]

PMR gets paid way more than FP I think, if you want more $ in your life. Life style is much easier in PMR. FP physicians see everyone and treat DM, HTN, make referrals, have to know a lot,whereas PMR sees mainly those who need physical rehab and work like physical therapists at a higher level. they are 2 totally different fields. you should do a rotation or shadow some physicians to make the best decision on what suits you best.

 

[Ludicolo]

PMR gets paid way more than FP I think, if you want more $ in your life. Life style is much easier in PMR. FP physicians see everyone and treat DM, HTN, make referrals, have to know a lot,whereas PMR sees mainly those who need physical rehab and work like physical therapists at a higher level. they are 2 totally different fields. you should do a rotation or shadow some physicians to make the best decision on what suits you best.

I’d like to clarify the statement bolded above. Physiatrists are not “physical therapists at a higher level”. PM&R is not PT at all, although we work very closely with PT and the other members of the rehab team, and there is some knowledge overlap. Unfortunately, “PM&R = PT plus” is a common misconception, usually made from individuals with very limited exposure to our field. Kudos to the OP for learning more about the specialty.

The paycheck at the end of it all depends a number of different factors: location, performing procedures, type of practice (inpatient/outpatient/private/academic), etc. I will submit that lifestyle during residency is generally nicer in PM&R compared to other specialties. But lifestyle after residency, regardless of specialty, will depend on how you practice. So it’s important to enjoy the work itself, not just life outside of work. While it is important to get paid, money and lifestyle shouldn’t be the predominant factors in choosing a specialty. There’s a quote floating around SDN that sums it up quite nicely: “I would rather do anesthesia for FM money, than FM for anesthesia money”.

OP – During med school I also flirted w/ FM before finally falling in love w/ PM&R. Both FM and PM&R are very broad fields, but at the time I was primarily interested in Sports Medicine, and I knew that either field would allow me to pursue that interest. Like you, I loved both my PM&R and FM rotations. My personality seemed to fit well with either specialty. Ultimately, what sold me were the non-sports aspects of PM&R. Things like spinal cord injury, brain injury, neuromuscular medicine, pain medicine. I liked helping and being inspired by motivated patients overcome or adapt to their disabilities. I found that I could use a good mix of practicality, rationality, resourcefulness, creativity, motivation, and inspiration – across all subspecialties of PM&R. And yes – the interactions between the neuro and musculoskeletal systems and how they translate to function are kinda cool. Even if I didn’t do sports, I could see myself doing almost any other area of PM&R as a career, and enjoying it. In the long run, I didn’t see myself enjoying the non-sports aspects of FM as much.

Epilogue: I don’t practice sports medicine. And I still love my work. For the most part.

 

[HealingDoc]

Ultimately, what sold me were the non-sports aspects of PM&R. Things like spinal cord injury, brain injury, neuromuscular medicine, pain medicine. I liked helping and being inspired by motivated patients overcome or adapt to their disabilities. I found that I could use a good mix of practicality, rationality, resourcefulness, creativity, motivation, and inspiration – across all subspecialties of PM&R.

This is really what draws me to PM&R- very inspiring! Thank you so much for your input!!

 

[newbie04]

Thanks, Ludicolo...another great post!

I’d like to clarify the statement bolded above. Physiatrists are not “physical therapists at a higher level”. PM&R is not PT at all, although we work very closely with PT and the other members of the rehab team, and there is some knowledge overlap. Unfortunately, “PM&R = PT plus” is a common misconception, usually made from individuals with very limited exposure to our field. Kudos to the OP for learning more about the specialty.

The paycheck at the end of it all depends a number of different factors: location, performing procedures, type of practice (inpatient/outpatient/private/academic), etc. I will submit that lifestyle during residency is generally nicer in PM&R compared to other specialties. But lifestyle after residency, regardless of specialty, will depend on how you practice. So it’s important to enjoy the work itself, not just life outside of work. While it is important to get paid, money and lifestyle shouldn’t be the predominant factors in choosing a specialty. There’s a quote floating around SDN that sums it up quite nicely: “I would rather do anesthesia for FM money, than FM for anesthesia money”.

OP – During med school I also flirted w/ FM before finally falling in love w/ PM&R. Both FM and PM&R are very broad fields, but at the time I was primarily interested in Sports Medicine, and I knew that either field would allow me to pursue that interest. Like you, I loved both my PM&R and FM rotations. My personality seemed to fit well with either specialty. Ultimately, what sold me were the non-sports aspects of PM&R. Things like spinal cord injury, brain injury, neuromuscular medicine, pain medicine. I liked helping and being inspired by motivated patients overcome or adapt to their disabilities. I found that I could use a good mix of practicality, rationality, resourcefulness, creativity, motivation, and inspiration – across all subspecialties of PM&R. And yes – the interactions between the neuro and musculoskeletal systems and how they translate to function are kinda cool. Even if I didn’t do sports, I could see myself doing almost any other area of PM&R as a career, and enjoying it. In the long run, I didn’t see myself enjoying the non-sports aspects of FM as much.

Epilogue: I don’t practice sports medicine. And I still love my work. For the most part.

 

[Llenroc]

PMR gets paid way more than FP I think, if you want more $ in your life. Life style is much easier in PMR. FP physicians see everyone and treat DM, HTN, make referrals, have to know a lot,whereas PMR sees mainly those who need physical rehab and work like physical therapists at a higher level. they are 2 totally different fields. you should do a rotation or shadow some physicians to make the best decision on what suits you best.

Christ, stop giving advice to people if you don't know the first thing about the topic being discussed.

 

[riverbear]

bump.

I'm a 3rd year med student in a similar dilemma as the OP. I'm nearing the end of 3rd year and it's come down to FP vs. PM&R. I love the diversity of each specialty, and enjoy the outpatient setting more than the hospital.

I would just like to hear if others have had to choose between these 2 specialties, and if so, what sold you on one specialty over the other.

Thanks in advance.

 

[34140]

what kind of stats are needed for PM&R?

 

[fozzy40]

According to the 2009 NRMP Charting outcomes data, the average USMLE step 1 and step 2 scores were 214 and 220 respectively. About 4.3% of those who matched are AOA members.

Overally, PM&R is one of the fields that definitely looks at more than "the numbers." I think if you have average grades and boards, good clinical skills, and generally well rounded you should match without difficulty.

 

[fozzy40]

Those who would like to know more please feel free to PM me.

 

[fozzy40]

bump

 

[Winged Scapula]

bump

Why?

 

[fozzy40]

Why?

It's that time of year where students are starting to think about future fields. Clinical interests often cross both fields. It's a great time to start a discussion!

 

[DD214_DOC]

If you want to be an over-educated referral machine who is likely to be completely displaced by the encroachment of mid-level providers, apply to FM

If you want to be a specialist who practices in a niche area and deal with neurological and neuromuscular stuff, apply to PM&R.

 

[smq123]

If you want to be an over-educated referral machine who is likely to be completely displaced by the encroachment of mid-level providers, apply to FM

If you want to be a specialist who practices in a niche area and deal with neurological and neuromuscular stuff, apply to PM&R.

 

[smq123]

Not all FM attendings want to be, are, or even can be "referral specialists."

I can't refer my patients anywhere, except for the 30% that we see that have Medicaid or Medicare. The rest are uninsured or have local county insurance that does not allow referrals except for acute conditions. No referrals for screening colonoscopies, even. Can't refer to GI for ostomy care, because that's a chronic condition. Can't refer to ENT for chronic trach care - again, that's a chronic condition. So one of the attendings here does it. Can't refer severely depressed patients or patients with PTSD (which we have a surprising number of) to psych for long term care - they get 2 visits and that's it. Can't refer unusual lesions to derm, either, so we do our own skin biopsies...again, there's no one else to do it.

So ignore the negative comments about FM that you see on SDN. Because FM is so varied that it depends on your practice setting, and what you choose to make of it. If you want to be the hands-off, referral specialist who has a cushy practice in a nice part of town, you can do that. If you don't, you will be eagerly courted by inner city or rural practices, full scope suburban practices (which yes, do exist) or even teaching programs. The job market is good, the loan repayment programs are helpful, and the lifestyle's not so bad. And as Blue Dog likes to say, if you think you can be replaced by a midlevel, you should. Plus, there are midlevels encroaching in all fields - Anesthesia, Pain (which can be a subspecialty of PMR), psychiatry, peds, OB, everywhere.

 

[Top Gun]

Not all FM attendings want to be, are, or even can be "referral specialists."

I can't refer my patients anywhere, except for the 30% that we see that have Medicaid or Medicare. The rest are uninsured or have local county insurance that does not allow referrals except for acute conditions. No referrals for screening colonoscopies, even.

So who does your screening colonoscopies, then? You're actually trained to do those?

 

[smq123]

So who does your screening colonoscopies, then? You're actually trained to do those?

We give them 3 guiac cards. We barely have the funds to keep sterile surgical gloves in stock; there's no way we could stock an endoscopy suite.

One of my classmates from residency, though, works in a practice where the other 3 FM physicians do do their own colonoscopies, though. He's in a rural practice in the south.

 

[lowbudget]

If you want to be an over-educated referral machine who is likely to be completely displaced by the encroachment of mid-level providers, apply to FM

If you want to be a specialist who practices in a niche area and deal with neurological and neuromuscular stuff, apply to PM&R.

If you want to: train broadly, apply your med school knowledge to the fullest extent, always have a job, have the freedom to work anywhere and not be tied down to a facility, apply to FM.

If you don't mind smoozing PCP's for referrals, take leftovers from neuro/ortho, having to explain over and over again what PM&R "is", apply to PM&R.

 

[lowbudget]

We give them 3 guiac cards. We barely have the funds to keep sterile surgical gloves in stock; there's no way we could stock an endoscopy suite.

One of my classmates from residency, though, works in a practice where the other 3 FM physicians do do their own colonoscopies, though. He's in a rural practice in the south.

I send out my colonoscopies. They're a pain in the ass.

 

[fozzy40]

If you want to: train broadly, apply your med school knowledge to the fullest extent, always have a job, have the freedom to work anywhere and not be tied down to a facility, apply to FM.

Also applies to PM&R.

If you don't mind smoozing PCP's for referrals, take leftovers from neuro/ortho, having to explain over and over again what PM&R "is", apply to PM&R.

Like family medicine, PM&R is a great field. I'm not sure what all the field bashing is about.

 

[DD214_DOC]

I actually like rural FM. You guys are pretty awesome. I do not care much for FM in a larger, urban or suburban area as they do nothing but refer for anything beyond the basic stuff that any NP or PA could competently manage.

Granted, I have also seen hospitalists who consult for everything, which I found very annoying. During my internship on medicine, I always wanted to at least do something before consulting a subspecialty.

 

[diagonal]

If pragmatism counts for anything, PM&R sounds like a better gig.

 

[DrAwsome]

If pragmatism counts for anything, PM&R sounds like a better gig.

For the $, I would say PMR, although primary care is on an upswing these days but it's uncertain how long it will stay financially fit per se. PMR has potential if one is entreprenurial, and if you go into pain, possibilities are very profitable. Also setting up a rehab center dealio also has potential. But PMR I would say even in its basic form is less work, less frustration, on avg than FM.

 

[diagonal]

For the $, I would say PMR, although primary care is on an upswing these days but it's uncertain how long it will stay financially fit per se. PMR has potential if one is entreprenurial, and if you go into pain, possibilities are very profitable. Also setting up a rehab center dealio also has potential. But PMR I would say even in its basic form is less work, less frustration, on avg than FM.

Yes. Even ignoring money (which would be stupid), the lifestyle and paucity of headaches seem a much better fit with sanity.

 

[DrAwsome]

Yes. Even ignoring money (which would be stupid), the lifestyle and paucity of headaches seem a much better fit with sanity.

Indeed, given why I also said in its basic work it's less frustration and work. It takes a truly dedicated soul to do FM.

 

[fozzy40]

I was between family and PM&R. I too really enjoyed family in a rural and military setting. Everyones scope of practice changes but I always saw MSK as major component. This ultimately drew me towards PM&R.

 

[kumar28]

What about job market?? Doesn't fm have way more jobs? How's the job market for pmr? Are u limited geographically by pmr?

 

[RangerBob]

What about job market?? Doesn't fm have way more jobs? How's the job market for pmr? Are u limited geographically by pmr?

I don't think you'll find any specialty with better job opportunities than FM--everyone needs one and there aren't enough to go around, so you can be picky with where you want to live/work.

PM&R limits you a bit more geographically, depending on whether you sub-specialize or not. If you don't, you can practice in, say, rural Montana (I know a resident who said 2 out of his 3 job offers in Montana, his home state, were in the more rural/small town parts of the state). And clearly he can find jobs in the major metropolitan areas, though the job market will be more saturated there, as it is with any specialty. Granted, that's just a sample of 1, and the likelihood is if you go into PM&R you won't be able to practice in a national park--that would be my dream

Still, I think you'll find a job whatever you go into. Like everyone always says, go into what you love, and you won't regret it. Of course, if where you live contributes more to your happiness than what you do, then maybe consider FM if you want that flexibility. Some people take certain jobs entirely based on where they're located... I wouldn't recommend it, but you know what makes you happy better than any of us.

 

[VA Hopeful Dr]

I actually like rural FM. You guys are pretty awesome. I do not care much for FM in a larger, urban or suburban area as they do nothing but refer for anything beyond the basic stuff that any NP or PA could competently manage.

Granted, I have also seen hospitalists who consult for everything, which I found very annoying. During my internship on medicine, I always wanted to at least do something before consulting a subspecialty.

Anecdotal and not true, but nice work anyway.

 

[fozzy40]

What about job market?? Doesn't fm have way more jobs? How's the job market for pmr? Are u limited geographically by pmr?

Having just gone through residency and through the job process, I can tell you that the job market is excellent for PM&R! Despite being a relatively small field, PM&R actually doesn't limit you geographically. Because you have a unique skill set, I think this actual makes you quite marketable in a non-metropolitan setting. The field as a whole has been rock solid in for the past 25 years without any dips in the job market and/or graduating residents. Very few number of spots have gone unfilled over the past couple of years. All in all, it's a stable field!

 

[lowbudget]

I think another approach is to take the 3-year FM residency curriculum and lay it out against the 3-4 year PM&R residency curriculum and ask yourself if 80-90% of what you see is interesting or useful, either as a stand-alone rotation or as a contributing rotation to your field. Pick the one that appeals to you the most.

 

[MedBronc23]

Agree with low budget. For example if you want to do MSK why would you choose FP vs if you want to deliver babies you wouldn't and couldn't choose PMR

 

[fozzy40]

I think another approach is to take the 3-year FM residency curriculum and lay it out against the 3-4 year PM&R residency curriculum and ask yourself if 80-90% of what you see is interesting or useful, either as a stand-alone rotation or as a contributing rotation to your field. Pick the one that appeals to you the most.

Completely agree.