PM&R: The Holy Grail?

Hi, kids! I'll be tackling two questions today:

My name is Brittany, and I am a third year medical student obsessing daily about what kind of doctor I should be. I struggle daily because I have loved mostly all of my clinical experiences thus far and could truly see myself in a variety of different fields. All around me my classmates are making decisions about career choices, and it just does not seem like an easy choice to me! Considering family life and how it will factor into whatever choice I make makes the decision even more difficult.

So, my question is how did you choose the specialty you went into? Was there a moment or a series of choices or did it just make sense? How much did family factor into this decision?

I realize that everyone says, "do what you love and you'll be alright." However, I love medicine as a whole and different specialties for various reasons, sometimes completely unrelated--there are other factors that influence this decision, and I am curious how others dealt with them.

And more specifically:

My name is Alli and I'm an MS 3 who is in search of the holy grail in medicine-- a profession that provides both financial stability and flexibility. Here's my story: I live with my boyfriend, and future fiance, on Long Island and as I get deeper into looking into residency I am petrified. I love my boyfriend, and want nothing more to have a family (why didn't I want to be a math teacher again??) but I'm really concerned, not only about juggling being a mother and wife with being a doctor, but about finances. I am SO in debt and my boyfriend is a firefighter and doesn't make much money, meaning I would be the primary breadwinner (shudder). Is there a medical field that exists that would allow me to provide for my family while also being a dedicated wife/mother? Don't get me wrong, I'm not trying to get out of working hard and I honestly love what I do. I'm just afraid that years later I will burn out and realize that I wasn't there for my family and that I could have made just as much money doing something else. I have already ruled out certain specialties that I have an interest in because I'm afraid they demand too much (i.e. surgery, ob/gyn) and others because while they might be low key they don't have enough financial stability (i.e peds). I honestly love pediatrics, and was considering it up until I discovered physiatry. Physiatry is a great field, and certainly a strong second choice. I was just wondering your thoughts on my situation, if you have any input about physiatry programs in NY and physiatry salaries in general for a future Mother in Medicine.

OK, since I just blew a bunch of space posting those questions, I'm going to cut right to the chase and be brutally frank here:

For many graduating med students, lifestyle matters. A lot. When we applied to med school, we all had a convincing story about how we want to help people, blah blah blah. And maybe at the time, we meant it. Or at least, some of us did. But when it comes time to decide what specialty we want to do for the rest of our lives, other things become more important than just "helping people" and generally doing good. We've all got loans, rent, children or potential children, future alimony payments, etc., so money is important. And many of us have gone through waking up at 4AM for surgery rotations (on Saturday! horrors!) and decided that's not so much for us.

I'm going to continue to be brutally frank. Get ready:

I don't like to work that hard. I don't particularly like to wake up at 4AM. In fact, even 7AM is a bit early for me. And that whole going to work on weekends thing? Not a fan. Or staying up the entire night on call? Also, not my favorite thing. When I was entrenched in my third year of med school, I realized that I desperately wanted a 9 to 5 type of job. Lots of people have 9 to 5 jobs. Why not me? Why?? Why did I have to suffer through 3+ years of a horrible lifestyle in residency just to possibly have an equally busy practice after residency? I had already worked SO HARD in med school. It wasn't fair. IT WASN'T FAIR DAMMIT!

There were specialties out there that could have catered to the lifestyle I wanted. Dermatology residents have it pretty good. But my grades weren't good enough for that. My grades were good enough for radiology perhaps, if I was willing to go anywhere. But I wasn't. I was following my husband where he wanted to go for his career. (Yes, I was one of THOSE women.)

The brutal frankness continues below...

If you want an eas(ier) lifestyle during residency and your options are limited by your grades and/or geography, there are two options: psychiatry and PM&R.

Psychiatry: Everyone knows what a psychiatrist is. I know this, because people accidentally call me a psychiatrist about five times a day. In any case, psychiatry wasn't for me. I won't get into the reasons, but I was pretty sure about that.

So that left PM&R, which stands for either Physical Medicine & Rehabilitation or Plenty of Money & Relaxation, depending on who you talk to. I did a rotation as a med student, expected to be bored, but actually really liked it. I did my residency in PM&R and it was.... easy. It was rare that I had to wake up before 7AM. I got home most days around 5PM. I spent maybe one or two nights in the hospital during my entire residency. I had a life like a normal human being. Amazing.

The field itself is a hodgepodge of different things. One day you're directing the care of a 24 year old with a new spinal cord injury, the next day you're treating a 60 year old stroke patient. I injected a lot of knees, shoulders, and spines. I performed hundreds of electromyography studies. I got to see young patients who couldn't run two marathons next week because of knee pain. I did acupuncture as part of my residency. I worked races. I had fun.

Even though I was a mother for most of my residency, I was still able to be a great resident. I knew my shit, I was responsible, I was enthusiastic (and I was also modest). I was able to fulfill all my work responsibilities and beyond, had free time to study, time to spend with my daughter, and even *gasp* time for myself. In most other residencies, I would have had to sacrifice something.

On graduation, there were definitely job opportunities, although you may have to be a little flexible about geography. Also, for people interested in research, PM&R is wide open, especially compared with older fields. Now for the salary: according to the Medical Group Management Association's Physician Compensation and Production Survey in 2007, the median salary for physiatrists after 1-2 years in practice is $213,701. A lot of my class ended up doing one year fellowship to specialize in Pain, which commands a much higher salary.

The worst thing about the field is that nobody knows what I do. Even my parents don't know. I mean, nobody here is writing a post called "What is a Pediatrician?" It gets tired to keep explaining to patients what a physiatrist is, especially since the answer requires a few paragraphs.

Let me be totally clear though:

Do NOT do PM&R just because it's easy. We hate it when med students say that and it's always a big mistake to go that route. PM&R is a really fun field with lots of procedures and a chance to really develop relationships with your patients. It's got a good lifestyle, which is something I love about it, but is only one of many things I love about the field. If you work in a field you love, you'll never work a day in your life. (I never really could have been a dermatologist.)

Also, please check out my FAQ on PM&R.