Why I chose not to go into Physiatry

http://www.rankenjordan.org/Stories/PatientStories/AlbertsStory.aspx
Video @4:30: "It wasn't enough to fix his broken neck, it wasn't enough to give medicine to control his spasm,  it wasn't enough to put him on the ventilator so he could breath, we were able to look at the whole patient, his whole person, to address his medical needs, his rehab needs, his therapy needs, his psychological needs, his nutritional needs, and bring it all together to give him a chance to get better."

Top reasons to go into physiatry from physician attending according to Studentdoctor.net:
http://forums.studentdoctor.net/showthread.php?t=519852
Best -
1) EMG's - Diagnostic, usually no follow up as most are referrals, pays well.
2) Injections, when they work well
3) Helping someone disabled by pain or impairment to get more functional
1) Teaching. Helping baby docs take their first steps and watching them blossom into competent, hopefully outstanding physiatrists provides me with a lot of vicarious enjoyment and personal fulfillment. 
2) Agree with the EMGs. For me, this was the point of residency where it all came together. Better understanding of anatomy and pathophysiology. Mastering the neuromuscular history and examination, generating a differential diagnosis (yes – actually diagnosing!) and performing a procedure that either confirms your diagnostic acumen – or tells you to get a clue.
3) Outpatient practice. No weekends. No call. ‘Nuff said.
4) OTOH - watching truly motivated patients and family improve and regain functional independence, and when they express their gratitude – priceless.

1) Lack of awareness of the field. I’ll admit it gets tiring explaining to patients, new doctors every July, what it is we do. It is nice though when patients (and doctors) ultimately say, “I wish I had known about your specialty sooner.”
2) Patients with a pathologic sense of entitlement. They want everything done for them immediately, but are not willing to help themselves. Demanding specific pain medications. Mad at you and the world even though they don’t follow through with your recommendations. These people don’t do well within the rehab care model. 
3) Paperwork.
1. Interesting work (neuroimaging, managing neuromedical complications, spasticity/motor impairment intervention)
2. Helping people deal with devastating circumstances (come on, that should count for something, even among my outpatient MSK colleagues)
3. Developing my own learning curve to take care of patients better the next time that problem shows up.
3a. Publishing a cool paper sharing something about what I have learned to my other colleagues in the field.
1) I like helping people with chronic conditions/disabilities, great patient experiences.
2) Not a bad lifestyle in outpatient.
3) Epidemiologically, there is an increasing need especially for quality MSK and pain care as the population ages. I feel I'm working on problems that are going to very important to healthcare. I envision a day when pts with back pain see a physiatrist or sports med FP first, before getting a referral to ortho or chiropractor.
1) What you do really helps people.
2) Hours/no call.
3) Relatively low stress problems.
1. Interesting with broad range of possible employment opportunities (maybe only FM and IM have more)
2. Lifestyle and lifestyle
3. Laid-back, team approach to medicine with good patient and staff relationships

Worst -
1) Patients who are convinced they just need vicoden and nothing else
2) Personality disorders - they're attracted to pain docs like moths to flames
3) Egotistical docs in other fields who know nothing about PM&R but put it down anyway.
1. Paperwork (disability forms, insurance forms, etc.)
2. Maladaptive family dynamics
3. Paperwork (BTW, did I mention how much I hate the paperwork?)
1) The glaring lack of Level 1 evidence in most fields of PM&R, especially musculoskeletal. Many of the splints, physiotherapy, steroid injections we do are based on very few studies. (This is why I plan on future clinical research.) Some fields are further along (ie spine >> hand arm vibration syndrome), but regardless we have very far way to go.
2) There are some attendings (esp in community, non-academic settings) who do not keep up with the latest developments in neurology or internal medicine, and are practicing outdated medicine.
3) lack of recognition from other fields
1) 'What the heck is a physiatrist' from docs and lay people.
2) Jack of all trades, master of none in many cases.
3) 'What the heck is a physiatrist'. Did I mention that?
1. Narc seekers
2. Sometimes frustratingly slow improvements with possibility for zero improvement and the subsequent questioning of 'what am I really doing here?'
3. Explaining your specialty to OTHER DOCS . . . although many are wishing they had made the same choice after I talk to them for a bit
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From http://www.rankenjordan.org/OutpatientCare/Physiatry.aspx
Summarizes the functions that I will be doing 
1) Physiatrists emphasize:
 prevention, diagnosis and treatment of patients 
who experience limitations in function 
resulting from any disease process, injury or symptom. 
2) The Physiatry Clinic focuses on multidisciplinary, 
non-invasive pain management treatment. 
3) The goal is to restore 
optimal medical, social, emotional and vocational function.
4) Physiatry services may include:

• Medical assessment
• Medical guidance in goal setting and treatment
• Orthotic (splint) recommendations
• Spasticity management
• Botox injections
• Baclofen pump adjustments
• Pain management

Physiatrists coordinate the child’s care by working with the family and other physicians. The physiatrists may recommend that other specialists (e.g., orthotist, therapist, equipment vendor) participate in the clinic visit to provide the most comprehensive assessment and plan.