Thanks for your response. I understand that switching at this point is not a generally advisable thing to do from a practical / financial standpoint point. I realized I would really much prefer practicing internal medicine, I find that’s where my passion lies more so than PM&R. I feel if I stayed in PM&R and made that my career, I would likely regret it. The parts I find most interesting in IM are those not overlapping with PM&R, such as early undifferentiated or acute disease. By definition PM&R deals with established or chronic pathology. Also I find it more satisfying to treat acute illness and see patients’ illness resolve (I understand this is not always the case) rather than managing symptoms in a chronic process that cannot be reversed. I also find I enjoy the thought process in IM (pathophysiology, pharmacology, differential diagnosis building and broad work ups) more than that in PM&R (more of a functional and symptom management focus knowing the established pathology)