Truth About Physical Medicine & Rehabilitation (PM&R)?

Discussion in 'PM&R' started by doczhivago, Aug 12, 2001.

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  1. doczhivago

    doczhivago New Member

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    Aug 11, 2001
    New York
    I am in the 4th year of medical school, going through the gruelling process of electives and specialty decision. I basically want what many others do: good lifestyle/income, intellectual stimulation, patient care satisfaction, and flexible career independence. I have ruled out Surgery (not conducive to the lifestyle I desire), Radiology and Anesthesia (too much hospital based and not enough patient contact), Medicine (too much patient contact, "dime a dozen", treating the numbers and not the patient). So now after some research, I have come across a specialty that I know little about: Physical Medicine and Rehabilitation.

    So my question is the what are the lowdowns of this field? I have heard that the lifestyle is second only to Derm (too competitive for me and boring), the wide variety of intellectual pursuits, the field is wide open, and the income potential (stories of million dollar earners in rehab gym ownerships and procedures-EMG, interventional injection). Any input would be most appreciated.
     
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  3. Devdas

    Devdas Senior Member 7+ Year Member

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    Jun 15, 2001
    Yankee Town
    There are no regretable "low downs" in the PM&R field.You might miss the excitement seen in the Trauma and surgical field.You are not directly involved in the life saving business.(You would get chance to lead the code blue in the inpatient rehab)

    In some PM&R subspecialities like Spinalinjury rehab and Brain injury rehab you will not see the results as expected in your treatment.Many other medical specialities the results are often seen pretty quick.In rehab it takes long time to see the result.

    You will miss the "On-Call" tension when you are spending your private time with your family.
    I think Sports medicine is cool!
     
  4. Ludy

    Ludy Senior Member 7+ Year Member

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    Jun 29, 2001
    A few of the negatives I've read about PM&R:
    --it can be frustrating because patients tend to recover slowly. Also both patients and families are often angry after suffering an acute disability and may be hard to deal with.

    --there can be a lot of administrative and legal work, depending on the setting. Some specialists handle a lot of personal-injury cases, for example (and then of course, there's the downside of dealing with personal injury lawyers :)).

    --some feel that they don't get much respect from physicians in other specialties and/or that physicians are unaware of the breadth of services physiatrists provide. One book also mentioned that some doctors may view phsyiatric referrals as admissions of failure.

    However, as you said, there are a lot of advantages as well (you did ask for the negatives :)).
     
  5. drusso

    drusso Moderator Emeritus Lifetime Donor 10+ Year Member

    5,487
    1,220
    Nov 21, 1998
    Over the rainbow
    Many believe that PM&R (plenty of money and relaxation or physical medicine and rehabilitation depending upon your point of view) is an up-and-coming field. The pros are has you have mentioned: Relatively easy to match into, good hours, **potential** for cool and lucrative procedures with the right training, good income, reasonable hours, diverse patient population.

    On the con side: Many students think that PM&R is boring. The bread and butter of rehab is basically the leftovers from the neuro, ortho, and trauma services: Okay, so say you're a T9 paraplegic with a severe traumatic brain injury. "We can't do anything more for you," say the neurologist. "The spine column is stable, you're not an ortho case," says the orthopod. Psych. has already given you an SSRI for you PTSD, but frankly feels like you SHOULD be depressed---I mean you're a wreck! Your primary care doctor audibly groans every time you roll in the door...so off to rehab you go. Most student feel like there is little satisfaction working with a patient population that "you can't do anything for." Others feel uncomfortable around the disabled or don't like the "touchy-feeliness" of rehabilitation medicine. Rehab doctors have a reputation for being optimistic, good team players, and "treating the whole patient." A lot of people and other physicians don't know about the field so it kind of suffers from an "invisibility syndrome." On the other hand, "physiatry" is a great scrabble word.

    I personally think that the field rocks. I like working with a variety of health professionals, don't mind "whiney" patients, and don't have to be "Johny-on-the-spot" when the new MVA's or strokes roll in. Also, PM&R is good match for D.O.'s because it is the only specialty with such comprehensive training in musculoskeletal, neuro, and pain management. Many PM&R programs offer their residents (MD and DO alike) opportunities for training in manual medicine.

    Here's some info to get you started:
    http://www.physiatry.org/education/index.html

    Roadmap to Physical Medicine and Rehabilitation
    Answers to Medical Students' Questions About the Field

    ABSTRACT
    Ogle AA, Garrison SJ, Kaelin DL, Atchison JW, Park YI, Currie DM: Roadmap to physical medicine and rehabilitation: answers to medical Students' questions about the field. American Journal of Physical Medicine & Rehabilitation 2001; 80: 218-224.

    Medical specialty training has undergone dramatic changes in the last 5 years. This article was prepared by the Undergraduate Education Committee of the Association of Academic Physiatrists in an attempt to help guide medical students who are considering a career in physical medicine and rehabilitation. This report is an update of two previous articles addressing medical students' questions to assist them in making educated decisions about residency training and medical practice.

    Key Words: Specialty Training, Residency Training, Physiatrist, Physiatry, Graduate Medical Education, Career, Rehabilitation.

    Reprints:
    All correspondence and requests for reprints should be addressed to:
    Abna A. Ogle, MD
    Department of Rehabilitation Medicine
    University of Kansas Medical Center
    3901 Rainbow Boulevard
    Kansas City Kansas 66160-7306


    This is also a good link:
    http://www.aapmr.org/medstu/article.htm
     
  6. FoxyDoc

    FoxyDoc Senior Member 10+ Year Member

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    Nov 18, 2000
    USA
    Drusso, Quite an insightful response! I whole-heartedly agree with the fact that PM&R is indeed where patients go when no one else knows what to do with them. Recently I have been shadowing a doc in PM&R and have been observing precisely this occurence. Depending on your perspective, this can be a good or a bad thing. For example, you are the patients' last hope because all of the other specialties have done all they can and/or given up on them. In the same respect it is the job of PM&R to be the supurb puzzle solver and determine a course of treatment that will advance the patients' recovery. Depending upon one's personality, this facet of PM&R can either be very rewarding or extremely frustrating.

    I've also noticed an extreme lack of arrogance and pretentiousness among the docs in PM&R. This was quite refreshing to discover, given that many of my previous interactions have been with neurosurgeons. I agree with Drusso that this field does indeed rock and it is a good match for D.O.'s because PM&R not only allows, but actually necessitates that the doc treats the whole patient because in many cases the patient has so many complex problems it would be impossible to look at each one separately.

    Also, after residency one can consider specializing in a particular area of PM&R so they can avoid dealing with such a mixed bag of patients. For example, subspecialties that I am aware of exist in the areas of traumatic brain injury, stroke, and spinal cord injury. Hope I've helped someone with my ramblings!
     
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  7. Shernick

    Shernick

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    Apr 17, 2017
    I'm currently studying PM&R as a post-graduate resident. For me, I've chosen PM&R as my specialty because I don't want to face a lot of life and death situations in clinical life. I'd like to do everything step by step and thoroughly. Working with rush is not my flavour. For the kind of doc like me, PM&R is a suitable carrier. Though some of the emergenices could be encountered in PM&R life, these are quite few and easy to be solved. The most frustrating thing for our carrier is very prolonged period of patient care. Yes, that's what most doc say 'Boring'. May be there are a little progress in your patient's status or no progress at all. But we usually do not dissapoint for those situations. We, actually, train our patients to be able to cope with the diseases even though full recovery could not be possible. At least, quality of life of the patient will eventually be increased. This is what we are doing and what PM&R is all about. Indeed, it's not boring that much and it's usually a quite interesting one.
     
  8. Butterfly23

    Butterfly23 7+ Year Member

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    Jul 7, 2007
    I am currently pgy 4. Overall, I will trully admit that PM&R is not glorious specialty and many of us end up doing things you do not imagine that doctors will do. For example, I never imagined that i had to learn details of wheel chair modifications. But, it is still cool that no other docs will do these jobs except us.
     

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