Physical Therapy vs. PM&R
By Thea Swenson, MD, @doctor.thea
I am debating pursuing PM&R or physical therapy. I know I like the field of rehabilitation from shadowing out-patient physical therapists, but I wonder if I would like the wider scope of physiatry more. What are your thoughts?
The field of PM&R and the field of physical therapy are often lumped into one but are vastly different! As a physiatrist, you are a medical doctor. Meaning, you are the designated leader of the healthcare team. You diagnose the medical disease, and you prescribe physical therapy. In addition, you prescribe other non-surgical therapies such as injections and medications. You also manage medical issues related to rehabilitation (such as pain and spasticity) and co-morbid conditions (such as asthma and high blood pressure). As a physical therapist, you execute the therapies prescribed by the medical doctor. You do not perform injections nor do you prescribe medication nor do you manage the co-morbid conditions.
Physical therapy is a three-year post-graduate degree with an emphasis on the musculoskeletal and neurologic systems. On the other hand, physiatry is a four-year medical degree plus four years of residency training plus possibly one year of fellowship. There are things that you learn in physical therapy school that you do not learn in medical school–such as how to design an individualized exercise routine. There are things you learn in medical school that you do not learn in physical therapy school–such as how to treat diabetes, heart failure, and COPD.
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Do you think applying for medical school purely for one specialty is a compelling reason, or a naive one (given that I would still need to match into PM&R)?
It’s admirable to be set on one specialty–and many medical students are–but honestly, you would need to think deeply about how interested you actually are in the other aspects of medicine you would have to learn in addition to physiatry. You should also consider the sunk cost of going to medical school.
For one, medical training is very expensive in terms of dollars but also in terms of time. If your interest is specifically in musculoskeletal medicine, for example, why waste four years of your life (and that’s a LONG four years of the best years of your life!) learning cardiology, pulmonology, obstetrics, pediatrics, everything else when you could be dedicating your time to advancing your musculoskeletal medicine?
I knew roughly in 2013 that I wanted to be a sports medicine physiatrist. It was about four or five years before I was able to practice general medicine, and it will be at least another four or five years before I actually get to focus on sports medicine. In total, it will be about ten or eleven years from when I started until when I get to focus on what I want to do.
Ultimately, the real benefit of getting a medical degree is that you have a medical degree. And there is a lot to be said and desired in that. At the end of the day, a physician may not know as much as a therapist or an engineer, or a lawyer, but a physician is very respected. Prior to medical school, when I was an engineer considering working in medical devices, I was told that if I wanted to go far in anything medically related, I needed an MD. Even though the two skillsets and degrees–engineering and medicine–are vastly different, my mentor (who was an engineer and not a medical doctor), advised me that having a medical degree would earn me the respect to sit at the head of the table.
If you want to change healthcare, do unique or interdisciplinary things in healthcare, or need to be a leader in healthcare, then you will regret not going to medical school. However, if you are okay being a teammate rather than a team captain and would rather focus your ten or so years on mastering one or two skillsets, then physical therapy is a great option. I wouldn’t have wanted to be anything other than a doctor, but it does come with constant sacrifices.
Thea Lananh Swenson, MD is a second-year PMR&R resident at Vanderbilt University. She is passionate about lifestyle medicine, healthcare technology, and medical student education. She hopes to specialize in sports medicine.
Follow her on Instagram, @doctor.thea, to follow her journey through residency and into sports medicine.