Regret Choosing PM&R?

[klumpke]

To all the attendings, or even residents, out there- Do you ever regret choosing to go into PM&R? Why or why not?

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[runfastnow]

Some days I wish I could do knee scopes or straight forward laminectomy or microdiscectomy cases when that patient is on my schedule and I can't help them right away. Then I remember how much ortho/neuro surg training sucks and the disasters that my surgery partners see and I'm happy that I do what I do.

 

[Iamnew2]

To all the attendings, or even residents, out there- Do you ever regret choosing to go into PM&R? Why or why not?

I don’t. After going into Rads initially and hating it, I am glad I chose PM&R. In the past few years it has also grown, expanded etc a great deal. There are so many things you can do within the field that you can find your niche. It’s also a type of field where you can work full time, you can do part time if you find yourself in the need to cut back some, have side options etc. lots of options to chose from. Our specialty is not glamorous for sure but as our population gets older the opportunities are significant.

 

[RodofEbullience]

Opposite. I'm glad I didn't get swayed by the med school/academic world's proclivity for "prestigious" specialties. And on that note, I'm glad I didn't force myself to do a fellowship after residency either (best financial decision I've ever made BTW, especially well-timed with the COVID student loan forbearance)

 

[DMBandFan86]

I would think most people who regret going into PM&R would also regret going into medicine as a whole.

You can do lots of IM and primary care inpatient. Lots of opportunities for psych. Fellowships are available for procedures if not comfortable out of training. Sports, spine do minor surgeries, with future possibly looking more like same-day surgical. Plenty of research and academic opportunities. If that doesn’t float your boat there are also opportunities in administration and also with insurance companies. Can get into neurology-type practice, PEDs, disability, workers comp, brain or spine injury, SNFs, etc. There definitely are some boring parts in PM&R for all of us, but we each find our niche and stick with it for the most part.

I’ve worked a lot of jobs in my time. PM&R is by far the best and hopefully final career for me. Sometimes I do still consider a spine/pain fellowship one day, but really hard to give up 1 years pay to go back into training. There is also a lot about spine that gives me hesitation. Occasionally, I think about Orthopedics, but I am overall glad I didn’t go into that. Ultimately I’d rather not work, but got bills to pay and PM&R gives me the opportunity for lifestyle and reasonable pay.

Now if I had a job where I had to do EMGs all day I’d quit and run as fast as I could.

 

[j4pac]

Nope. There are times I miss my kids important events and I wonder if a simpler life would be happier. But it has nothing to do with the specialty and it’s always a fleeting thought

 

[Iamnew2]

I would think most people who regret going into PM&R would also regret going into medicine as a whole.

You can do lots of IM and primary care inpatient. Lots of opportunities for psych. Fellowships are available for procedures if not comfortable out of training. Sports, spine do minor surgeries, with future possibly looking more like same-day surgical. Plenty of research and academic opportunities. If that doesn’t float your boat there are also opportunities in administration and also with insurance companies. Can get into neurology-type practice, PEDs, disability, workers comp, brain or spine injury, SNFs, etc. There definitely are some boring parts in PM&R for all of us, but we each find our niche and stick with it for the most part.

I’ve worked a lot of jobs in my time. PM&R is by far the best and hopefully final career for me. Sometimes I do still consider a spine/pain fellowship one day, but really hard to give up 1 years pay to go back into training. There is also a lot about spine that gives me hesitation. Occasionally, I think about Orthopedics, but I am overall glad I didn’t go into that. Ultimately I’d rather not work, but got bills to pay and PM&R gives me the opportunity for lifestyle and reasonable pay.

Now if I had a job where I had to do EMGs all day I’d quit and run as fast as I could.

If I had to do EMGs all day, I would join you in quitting and run faster than you! Lol. Sorry I couldn't help myself!

 

[j4pac]

If I had to do EMGs all day, I would join you in quitting and run faster than you! Lol. Sorry I couldn't help myself!

Oh man I love EMGs (assuming it’s legit academic EMG)…but to each their own

 

[Iamnew2]

Oh man I love EMGs (assuming it’s legit academic EMG)…but to each their own

I can respect that. I trained under the guru of EMG - literally the man that wrote the big book (which we got for free! during residency) but man was that rough. No thank you.

 

[JBM16BYU]

If I had to do EMGs all day, I would join you in quitting and run faster than you! Lol. Sorry I couldn't help myself!

If you had that job and quit... let me know so I can sign up! I love EMG

 

[Iamnew2]

If you had that job and quit... let me know so I can sign up! I love EMG

haha!

 

[odyssey2]

I don’t. After going into Rads initially and hating it, I am glad I chose PM&R. In the past few years it has also grown, expanded etc a great deal. There are so many things you can do within the field that you can find your niche. It’s also a type of field where you can work full time, you can do part time if you find yourself in the need to cut back some, have side options etc. lots of options to chose from. Our specialty is not glamorous for sure but as our population gets older the opportunities are significant.

What didn’t you like about rads?

 

[MusicalMed]

Haha, I also love doing EMGs! But yes, I think it's one of the very few specialties where you can change your interests mid-career with all the awesome things that it offers. Regret is always pretty transient for me, and I don't have to look far to see my fellow cohort of residents in other specialties who aren't envious of my training schedule/flexibility.

 

[Czech777]

I was nervous about this. I am very happy that I chose it. I’m doing Pain now and happy with my lifestyle, salary and my ability to use both specialities at work.

 

[Slowpoke]

I don't regret going into PM&R, but I would probably not choose it again if I had an opportunity to go back in time. Hindsight is 20/20 as they say.

 

[PainDoc2025]

I was nervous about this. I am very happy that I chose it. I’m doing Pain now and happy with my lifestyle, salary and my ability to use both specialities at work.

Happy to hear, current PGY2 PM&R applying Pain next year. Can you talk more about your salary structure? Private or Academic? 5 days a week?

 

[Czech777]

Academic

Happy to hear, current PGY2 PM&R applying Pain next year. Can you talk more about your salary structure? Private or Academic? 5 days a week?

Under academic umbrella, but community hospital. Salary is overwhelmingly a healthy base with a small incentive. 4.5 / week, .5 research.

 

[cowboydoc]

I’m not sure I’d do medicine if I had to start over. I would definitely do PM&R if I had to choose residency again.

 

[Momentum70]

Sure there are a few times here and there when I sometimes wish I had done a surgical specialty, but those times pass really quick and 98% of time or greater im happy I chose PM&R.

 

[DMBandFan86]

I guess one thing I do like less about PM&R can be the location. Harder to pick a certain city or area to practice in. If you were a hospitalist or primary care it is much easier to find a practice based on location. But general PM&R is a smaller field and generally needs bigger cities to have enough patients. There is also some saturation in high demand areas. So if you want to practice in your home town, it may take years for a position to open up, or have to take a salary cut, or try to start your own practice. Not impossible, but harder to do.

 

[90sportsfan]

Interesting thread. I was between Neurology, Radiology, and PM&R. Ultimately decided on Neurology. PM&R was really intriguing and seems like a cool specialty but ultimately I was more interested in the brain.

Lots of people I know were interested in PM&R but ultimately chose something else. I think for me (and others), it’s such a mysterious field (I never even knew the term “Physiatrist” before medical school) and it was hard to understand what your typical day looks like in PMR since it overlaps with so many fields (PT, Neuro, non surgical Ortho, etc).

I wish medical schools would give us more exposure to this field because it seems really cool. But myself and others were a little suspicious as to whether it’s sports medicine, rehab, combination, or what.

Although, my specialty of Neuro is kinda the same way with so many different sub specialties. But bread and butter general Neuro in private practice is pretty clear what your day to day practice is like.

 

[lejeunesage]

You're better off looking at surveys than getting a small and necessarily skewed sample on SDN.
Here's what Medscape found last year:

Burnout is pretty high in PM&R, especially for women.

The main complaint seems to be bureaucratic headaches:

And the effect on people's personal relationships is really not good:

That's a scary high number!
Now, this survey was also non-random but at least it was a large number of people.
If you're wondering, I can't relate to this at all. I'm not sure I'd pick medicine if I had to start from scratch (though I'm not sure what else I'd do either) but I would definitely pick PM&R. This specialty is really broad and you can tailor it to you needs.

Personally, I was never in love with procedures. If neurology had better residency hours, that's probably what I would have chosen, though at various times I flirted with Psychiatry and IM. Today, my practice is 80% inpatient rehab, 20% SNF. I love medical management, so that's what I do 90% of the time. I'm like an internist who just happens to work with the rehab population. The most rehab-heavy thing I do is manage spinal cord injury patients. I wouldn't say I want to marry my job and have children with it, but I can't imagine any other line of work I'd dislike less.

 

[DMBandFan86]

Those surveys literally ask, are you burnt out yes or no? It’s not some high complex process. It’s more shock value than anything in my opinion.

Burn out is really bad. You really can’t function well as a physician when you are burnt out. You make bad decisions, aren’t nice to people, cut patients off, don’t work well as a team, leave early, don’t finish tasks, make mistakes and miss things, ect. I don’t believe 50% of PM&R docs are doing that. I think they are overwhelmed, not doing what they thought they would be doing, bored with current tasks, tired, frustrated, ect.

What people don’t realize is that you’re going to basically work the same job for 20-40 years, doing relatively the same things over and over, day after day. After 6 months-1 year after training you pretty much know what you are doing and what you are seeing as a provider. Then it is just a job like any other, except you get paid well.

If you really are burnt out you need to stop what you’re doing and find a fix. Whether that is getting out of medicine, going back and doing a fellowship, or switching something up to make your work life better (see different patients, go part-time, take a pay cut, relocate). The fact that the physician burn out surveys stay the same or trend up every year leaves me skeptical.

 

[PMR2008]

"find a fix" is not that easy. Many are stuck in contracts, have to be in a certain area or have limited knowledge of the breath of our specialty. Significant number are waiting for things to improve or are on an academic track. As part of my job I have literally talked to 2000+ Physiatrist the last 10 years. The burnout in our specialty is real and is getting worse IMO.

 

[JBM16BYU]

"find a fix" is not that easy. Many are stuck in contracts, have to be in a certain area or have limited knowledge of the breath of our specialty. Significant number are waiting for things to improve or are on an academic track. As part of my job I have literally talked to 2000+ Physiatrist the last 10 years. The burnout in our specialty is real and is getting worse IMO.

Do you think there are areas of PM&R that are experiencing more burnout than others? Inpatient vs. outpatient? Certain subspecialties?

 

[PMR2008]

Pain and inpatient. Academic not far behind. Inpatient with IM coverage or small units in smaller towns are an exception. Pain in an ortho practice also an exception typically. Some docs are just more prone to burning out. I think as Physiatrist we tend to be very compassionate and team players but that can lead to compassion fatigue and people expecting us to do a lot more than the typical doc.
I have created boundaries in my practice (No opioids in my clinic, I pick my medlegal cases and I work in the subacute setting where I am a consultant). But if I did all of that and had a crappy EMR, bureaucracy and got paid 200k/year I would still be burnt out.

 

[PMR2008]

I should add I have been seeing a lot of PM&R sports docs getting burnt out. Not fun to do unpaid week night and weekend coverage for sports, see 40 patient a day with only a handful are athletes and the rest are OA, get paid less than 250k in bigger towns and no chance of becoming a voting partner. Most sports fellows don't know the reality of non academic private practice sports med.

 

[cowboydoc]

I should add I have been seeing a lot of PM&R sports docs getting burnt out. Not fun to do unpaid week night and weekend coverage for sports, see 40 patient a day with only a handful are athletes and the rest are OA, get paid less than 250k in bigger towns and no chance of becoming a voting partner. Most sports fellows don't know the reality of non academic private practice sports med.

Glad I rotated in an elite sports med practice as a resident and saw this first hand. No way the “prestige” and free team gear make up for that beat down.

 

[Iamnew2]

Glad I rotated in an elite sports med practice as a resident and saw this first hand. No way the “prestige” and free team gear make up for that beat down.

I saw this first hand too where the pmr doctor would do a ton of coverage almost every weekend for the Orthopods. That’s not a life that sucks big time. I don’t see how or why medicine is one of the few fields where free labor is ok after years and years of training

 

[cowboydoc]

I saw this first hand too where the pmr doctor would do a ton of coverage almost every weekend for the Orthopods. That’s not a life that sucks big time. I don’t see how or why medicine is one of the few fields where free labor is ok after years and years of training

I think we went to the same residency?

 

[Iamnew2]

I think we went to the same residency?

Probably not but I think it’s a common trend sadly.

 

[runfastnow]

If your goal is to do PM&R sports and be head team doc at a big place (i.e. SEC/Big10/Big12/PAC12/ACC) or professional team it will be a tremendous uphill battle compared to FM/IM people. If you chose PM&R sports solely to do that you will likely regret your decision.

I started down that road - head team doc at SEC school somewhat fell in my lap. It was a ton of unpaid work. Politics made that job go away post-COVID and it has been a huge blessing. For better or worse I have equal interests in spine+sports (and made sure my fellowship covered both) so I am happy/capable doing either ... plus spine pays way better than sprained ankles and concussions and diagnostic US.

There are small parts of big time sports I miss but 90-95% of it is un-glorious grind and can/will take away a lot of free time. Doing my local high school stuff is enough to scratch the itch and stay current for now. Maybe when my kids are out of the house I'll try to get back in the game covering big stuff if the right gig is available.

 

[PMR2008]

To answer the OP. I have zero regrets. 14 years since I started residency and I am grateful to be a Physiatrist every day. We are unique, get paid decently well for the work that we do and are very cost effective when used appropriately.
PM&R is too broad for its own good at times. Every PM&R subspeciality will have pros and cons. For med students or residents it is important to keep an open mind, figure out what you specifically love about PM&R and find the right practice setup(Notice I did not mention compensation). Its okay if it takes a few years to find out what you really like. Most of us will practice for 30+ years and will change 4-5 jobs. What keeps me going is the relationships with the patients and being the best at what I do with the intention to keep improving.

 

[Momentum70]

I do have one PMR regret, in residency I did not like EMGs. So I actively took jobs that I would not have to do them, one thing I like about being 100% inpatient is they are never required as they dont get reimbursed like they would outpt. My regret is that now I sort of wish I still knew how to do them. 10+ years without doing something will lose a few skills.

 

[lobelsteve]

I do not understand how a PMR doc gets burnt out. Plenty of money and relaxation.
I get the whole what's a Physiatrist thing.
I regret the complete lack of marketing from AAPMR/AAP in getting a message out to the public and other doctors on what a Physiatrist is and what we do. I have had patients think I was Psychiatry, PT, and Pain Medicine (there to just get drugs). Most PMR docs are too meek/mousy. We need voices. It is good working 7:30-3:30 M-F and not needing to look at charts/deal with issues on nights and weekends and out earn most folks.

 

[sloh]

Eh taking debt into account, I wouldn’t say it’s plenty of money

 

[cowboydoc]

I do not understand how a PMR doc gets burnt out. Plenty of money and relaxation.
I get the whole what's a Physiatrist thing.
I regret the complete lack of marketing from AAPMR/AAP in getting a message out to the public and other doctors on what a Physiatrist is and what we do. I have had patients think I was Psychiatry, PT, and Pain Medicine (there to just get drugs). Most PMR docs are too meek/mousy. We need voices. It is good working 7:30-3:30 M-F and not needing to look at charts/deal with issues on nights and weekends and out earn most folks.

Some people have empathy and compassion, so seeing endless patients with difficult circumstances could be quite wearing.

Also, the meek nature of most physiatrists make them easy victims for medical admin types to dump on.

I’m loving the $ and relaxation relative to other physicians.

 

[Bostonspine]

I do not understand how a PMR doc gets burnt out. Plenty of money and relaxation.
I get the whole what's a Physiatrist thing.
I regret the complete lack of marketing from AAPMR/AAP in getting a message out to the public and other doctors on what a Physiatrist is and what we do. I have had patients think I was Psychiatry, PT, and Pain Medicine (there to just get drugs). Most PMR docs are too meek/mousy. We need voices. It is good working 7:30-3:30 M-F and not needing to look at charts/deal with issues on nights and weekends and out earn most folks.

I wouldn't say a complete lack of marketing since I sit on the Specialty branding committee for AAPM&R. We have a consensus problem in our specialty some say they are pain, some sports, some brain injury, and no one can agree on the pronunciation of Physiatrist . We'll be Dropping a media Kit to help out members market themselves next year.

I love being a physiatrist and feel that I genuinely make a difference every day. I do think the practice environment and job flexibility is a greater factor in burnout than specialty choice. Being able to choose who you treat, how you treat them, and When you treat them while being compensated fairly I think is the goal. PM&R has provided me with that opportunity and a set of skills that are diverse to survive the coming changes

 

[lobelsteve]

I wouldn't say a complete lack of marketing since I sit on the Specialty branding committee for AAPM&R. We have a consensus problem in our specialty some say they are pain, some sports, some brain injury, and no one can agree on the pronunciation of Physiatrist . We'll be Dropping a media Kit to help out members market themselves next year.

I love being a physiatrist and feel that I genuinely make a difference every day. I do think the practice environment and job flexibility is a greater factor in burnout than specialty choice. Being able to choose who you treat, how you treat them, and When you treat them while being compensated fairly I think is the goal. PM&R has provided me with that opportunity and a set of skills that are diverse to survive the coming changes

We don’t need help marketing ourselves. We need help in the public. No other specialty has this disgusting lack of anyone knowing who we are and what we do. Try and name any other specialty that any doctor can’t tell you what they do.

 

[PMR2008]

Palliative. They had a similar problem as us but have been able to do a lot of education and lobbying. But again they are not split off in many pieces like us with numerous sub specialists. Public knowledge might be important locally or regionally but nationally we need the payors/hospital systems to know our value. But they do hand in hand.

 

[Bostonspine]

We don’t need help marketing ourselves. We need help in the public. No other specialty has this disgusting lack of anyone knowing who we are and what we do. Try and name any other specialty that any doctor can’t tell you what they do.

I think need both grass roots effort and public effort. It’s easy blame the Acadamy but if the people in you hospital don’t know the difference between a PT or PM&R, or if the Ortho doc thinks they can replace you with a PA with extra training then you can’t blame the academy for not letting them know.

 

[90sportsfan]

Palliative. They had a similar problem as us but have been able to do a lot of education and lobbying. But again they are not split off in many pieces like us with numerous sub specialists. Public knowledge might be important locally or regionally but nationally we need the payors/hospital systems to know our value. But they do hand in hand.

True, but Hospice and Palliative Care is a “Sub-specialty” rather than a “Specialty.” In other words, you need to do IM, FM, Peds, EM, etc before fellowship training in Palliative. There are a ton of obscure sub-specialties that the general public and in some cases many physicians have no clue exist. But most people in these types of subspecialties have a “parent specialty” that is known by the general public and physicians (Internal Medicine, FM, Pediatrics, Neuro, Surgery, etc etc).

What is so odd about PM&R, is that it is a parent specialty that is so unknown and obscure to the general public. Although, I personally could care less about lack of prestige (in terms of the public not knowing/ understanding what your specialty is) or the awkward dinner party conversation of trying to explain to people what it is.

What I was most confused about as a med student (and other students were too) was what “bread and butter” PMR practice looked like since it seems like it overlapped with so many different specialties, and how that would impact job opportunities, patient base, etc. The only thing that I would slightly care about in terms of public/physician knowledge about the specialty is how it impacts patients/referrals, although it seems like it’s not that big of a deal.

I personally think medical schools should provide much more exposure to PMR. From my experience it has a lot of intrigue from medical students, but many in my class who had an interest, ultimately ended up choosing the other more traditional specialists, and I think it was mostly due to just greater exposure.

 

[Iamnew2]

True, but Hospice and Palliative Care is a “Sub-specialty” rather than a “Specialty.” In other words, you need to do IM, FM, Peds, EM, etc before fellowship training in Palliative. There are a ton of obscure sub-specialties that the general public and in some cases many physicians have no clue exist. But most people in these types of subspecialties have a “parent specialty” that is known by the general public and physicians (Internal Medicine, FM, Pediatrics, Neuro, Surgery, etc etc).

What is so odd about PM&R, is that it is a parent specialty that is so unknown and obscure to the general public. Although, I personally could care less about lack of prestige (in terms of the public not knowing/ understanding what your specialty is) or the awkward dinner party conversation of trying to explain to people what it is.

What I was most confused about as a med student (and other students were too) was what “bread and butter” PMR practice looked like since it seems like it overlapped with so many different specialties, and how that would impact job opportunities, patient base, etc. The only thing that I would slightly care about in terms of public/physician knowledge about the specialty is how it impacts patients/referrals, although it seems like it’s not that big of a deal.

I personally think medical schools should provide much more exposure to PMR. From my experience it has a lot of intrigue from medical students, but many in my class who had an interest, ultimately ended up choosing the other more traditional specialists, and I think it was mostly due to just greater exposure.

Given the stats of how little difficulty PM&R has in filling the residency spots every year I think there is a much greater exposure to PM&R now than when I was in med school - I got no PM&R exposure I think whatsoever and my med school despite being one of the biggest schools in the nation had no PM&R program. But for the last several years PM&R has filled100% of its seats during the match and it's much harder to match PM&R. I think the word is progressively slowly getting out to the public but more education and marketing to the public is needed I agree.

 

[runfastnow]

We don't have an organ system that we truly own. That makes it tremendously hard to the lay person. Even in the outpatient ortho world they view us all (non-op and operative) the same, "Why can't the spine injection guy do my knee replacement. Aren't you a doctor???"

I think we need to drop the name and change to Rehabilitation Medicine or Functional Medicine as these encompass what we do above and beyond a single organ system. If we are insistent on keeping PM&R we need to change to Pain Medicine & Rehabilitation as every single sub-specialty deals with conditions that cause pain and we offer management for that (even if you aren't doing injections or opiate/med management). I'm still not sure what physical medicine is ... or who does it.

 

[cowboydoc]

We don't have an organ system that we truly own. That makes it tremendously hard to the lay person. Even in the outpatient ortho world they view us all (non-op and operative) the same, "Why can't the spine injection guy do my knee replacement. Aren't you a doctor???"

I think we need to drop the name and change to Rehabilitation Medicine or Functional Medicine as these encompass what we do above and beyond a single organ system. If we are insistent on keeping PM&R we need to change to Pain Medicine & Rehabilitation as every single sub-specialty deals with conditions that cause pain and we offer management for that (even if you aren't doing injections or opiate/med management). I'm still not sure what physical medicine is ... or who does it.

I don’t think you’re wrong, but this makes the gray beards tremble.

 

[runfastnow]

I don’t think you’re wrong, but this makes the gray beards tremble.

Brother/Sister - there may not be a single group in the world that I care less about than the AAPMR/RIC/Spaulding/Mayo/UW gray hairs.

They'd rather try to own "long COVID" than advance the specialty.

Then again I'm just your community sports & spine doc. What the **** do I know?

 

[DMBandFan86]

But everyone has long Covid. Big money

 

[runfastnow]

Dozens and dozens of 99214s for AAPMR to fight for and our journals to pontificate about.

 

[j4pac]

But everyone has long Covid. Big money

Change physiatrist to COVIDologist?

 

[runfastnow]

I still went to my friendly allergy/asthma doc when I got some worsening asthma post-COVID.

I'm not repping the PM&R Long-COVID™ brand hard enough.