PM&R has lousy board scores, but I wouldn't say it's uncompetetive. In fact, the low board scores belie the true difficulty in getting a PM&R spot. I'm not trying to claim here that program directors reject all the 250 Step 1 applicants that they get and instead take the 190 scorers because they ran ball at State-U or whatever. I'm just saying a lot of the "other factors" do count for a lot in PM&R. Personal connections, program experience, letters, and actual knowledge of the specialty matter relatively more in PM&R. I myself was surprised by how competetive it was when I applied.
In my mind, less competetive specialties are ones like Family Medicine, Psychiatry, and the community programs of Internal Medicine. PM&R is not in the same boat as those. Very few unmatched positions in PM&R nowadays. Despite the high number of DO's, there's not all that many foreign grads in PM&R compared to the above fields either.
Main reason why PM&R isn't *more* competetive is in large part due to name recognition, IMO. A surgeon called me up the other day and demanded that I come do PT on his patients. I had to explain to him that I was in fact a doctor.
But then again, I hadn't heard of PM&R until halfway through med school. It's very hard to explain to someone what PM&R is in one sentence, unless you say something like "we focus on neuromuscular functional improvement" which means nothing. Then you talk about "inpatient rehab" they then either ask you about "the crazies" (they think you're some kind of psychiatrist) or they ask you about physical therapy, like the surgeon did. If you talk about the outpatient side, it just takes to long to cover botox, EMG's, sports med, joint injections, back injections, prosthetics, etc.
Also most medical students, including sadly a lot of the smart ones, have rather immature notions of how medicine is about insantly "curing" people. One guy I know in surgery said that he sees a problem and then likes to "fix it". Well, that's not true in medicine, not even for most kinds of surgery really. But dealing with any kind of chronic issues is seen by medical students these days as unhip. Well, PM&R doesn't really have cures. It also doesn't have the exciting trauma codes and pancreaticojejunostomies that medical students crave, but don't realize aren't that fun once you have to do them over and over again. EMG's and prescriptions for shoe inserts aren't that exciting. It goes without saying that inpatient rehab. definitely isn't the most interesting rotation you'll do as a med student.
But like I said a lot of the students just aren't smart enough or mature enough to realize that what's fun on a 4 week rotation isn't necessarily what you'd want to do for a career. The general lack of excitement and predictability of inpatient rehab. is why I prefer that kind of inpatient experience to something like ICU or Cardiology.
There's a few other factors too. Students infrequently rotate on PM&R. I've seen this now at a number of institutions. In San Antonio, you can do PM&R as a Surgery elective during med 3. Why haven't PM&R departments in the rest of the country also pushed for this as the med school cirriculum policy? <-- Not at San Antonio, BTW. If that makes you feel guilty that students will be robbed of valuable retracting and waking up at 4:30 experience, then PM&R should at least in my mind qualify as a month of Neurology. PM&R attendings should also be playing a bigger role in Med 1 and Med 2 student lectures by volunteering to teach during either Ortho or Neuro blocks, during which they can also sell their specialty (which everyone does).
