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Physical Medicine & Rehabilitation FAQS and residency tips

Discussion in 'PM&R' started by Spine&SportsMD, 06.20.07.

  1. Spine&SportsMD

    Spine&SportsMD SDN Mentor

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    I'm a board certified PM&R physician who currently works in an academic hospital. After finishing my residency, I completed a 1 year PM&R ACGME accredited Pain Medicine fellowship. I have been out practicing for approximately one year. I hope to give medical students and residents a perspective on PM&R, and answer questions that cannot be answered in either the PM&R or Pain Medicine forums.

    Standard Questions

    1. What do you enjoy most about your specialty?
    The multidisciplinary approach to patient care.

    2. Is there anything you dislike about your specialty?
    That more fields haven't fully appreciated what their "friendly neighborhood physiatrist" can offer their patients. We do a lot more than just write physical therapy orders.

    3. How many years of post-graduate training does your specialty require?
    1 yr internship/transitional + 3 yrs of PM&R residency. Optional fellowships in: Pain Medicine, Sports Medicine, Spinal Cord Injury Medicine, Pediatric Rehabilitation, Spine, Electrodiagnostics, Traumatic Brain Injury, and Multiple Sclerosis.

    4. What is a typical schedule like for your specialty? Mostly 8a-5p, Monday-Friday. Some home call on the weekends if you are responsible for covering an inpatient unit.

    Are the hours/shifts flexible?
    Very much so.

    5. Where do you see your specialty going in five years?
    Interest in the non-surgical aspect of musculoskeletal medicine, including pain medicine and interventional spine injections has been on the rise. With the returning veterans of war, more emphasis and research will be focused on rehabilitation of musculoskeletal injuries, traumatic brain injury management, and amputee rehabilitation.
  2. Spine&SportsMD

    Spine&SportsMD SDN Mentor

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    Hello southpawcannon.

    That is an interesting question and I think it ultimately comes from the fact that many people think that all PM&R physicians deal with only chronic pain patients. On the contrary, our field has a very wide range of patients that we see. From the acute spinal cord injury patient to the traumatic brain injured patient, to the pediatric amputee. Our field is varied. So if you take into consideration the entire field of PM&R, I would say very few are drug seeking.




    .Workers Compensation(WC) patients are no doubt challenging. That is why it is important to establish a multidisciplinary approach to these patients. It is imperative that any WC program implement functional goals with the patient. That's what most WC insurance companies expect. If there are issues with psychosomatization, then a referral to Psychology services that deal specifically with chronic pain patients is helpful.

    .
  3. Spine&SportsMD

    Spine&SportsMD SDN Mentor

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    Hi PBandJ! Thanks for the kind words.

    With the unfortunate consequences of the Iraq war, PM&R is now coming to the forefront in research and post-war care of our young amputee veterans. These brave young men and women, would like to get back to an active lifestyle(and some want to return to military duty). That being said, some of our biggest growth in the PM&R field will come as a result of our collaboration with biomechanical engineers. This will be in both in gait analysis as well as prosthetics.

    I'm not involved in any research at this time, but fortunately the Association of Academic Physiatrists, is actively involved in supporting residents who are interested in careers in research and how to get funding through NIH. I would consider a summer experience or medical rotation at one of the many PM&R programs across the country, and particularly those that are well known for promoting research at their institution: such as UW-Seattle, Mayo, Kessler, Baylor, and RIC. Seek out an attending who is working in an area that you are interested in. PM&R attendings are notoriously easy going and it shouldn't be hard to latch onto a research project.
  4. drusso

    drusso Moderator Emeritus Lifetime Donor

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    Nasrudin,

    I thought that I'd jump in and help S&SMD (not that he actually *NEEDS* my help...but you know...)

    You seem to have an exceedingly common problem. And, because it is impossible for me to fully know the details of your condition via the Intranet I can't make specific recommendations and no information in my response to your question should be construed as medical advice or an acknowledgment or endorsement of a physician-patient relationship between you and me; nor should it be construed as advice or endorsement from SDN. In fact, buyer beware...

    There are a number of physiatrists and non-surgical spine specialists in the Boston area. The best resource available to you is the "Find a PM&R Physician" on the Academy web-page at www.aapmr.org

    Recently, the SPORT study, out of Dartmouth published by Weinstein, et al addresses the issue of early versus late surgery for radicular back pain due to herniated discs without significant neurological deficit.

    http://www.dartmouth.edu/sport-trial/publications.htm

    The bottom line is that patients with this condition who have sugery, may have better symptomatic relief EARLIER compared to those who don't, but after two years both groups are essentially the same. Perhaps, the thing to do is to familiarize yourself with the SPORT study and bring a copy of it to your doctor's appointment and ask your physician to what degree they believe it applies to YOUR condition.

    Good luck.
  5. Spine&SportsMD

    Spine&SportsMD SDN Mentor

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    PM&R residencies have traditionally been considered one of the more non-competitive residencies. Over the last 5 yrs however, especially as more medical students are trying to balance career with family life, PM&R programs have become more selective. And even more so, now that Pain Medicine fellowships have been opened to PM&R applicants and those that would like to be more procedurally oriented.

    Most applicants will agree however that the "elite" programs will always be difficult to get into. But if you truly show an interest in PM&R, did well in medical school(no academic difficulties-which is a red flag for any residency program in any field), and you cast your net wide enough, you'll get a spot somewhere.

    Many people have differing opinions on how you should approach 4th year of medical school. Some see the opportunity to refine the skills you need before starting your residency, and others encourage you to take rotations in fields that you would never otherwise get the chance to experience. I actually encourage a combination of both.

    Elective rotations that would help you in the field of PM&R include:
    Orthopedic Surgery
    Rheumatology
    Neuro, Spine, or MSK Radiology
    Sports Medicine
    Pain Medicine

    Choosing where to do 4th yr rotation will depend on a few factors. One is which geographic are you would like to live because doing a rotation at that program increases your chances of matching. And two, which area of PM&R would you like to focus during your elective. Some programs are known for having certain strengths, whether it be in SCI, TBI, or MSK. Choosing a program that has a strong component in your interests will make the rotation more worthwhile and enjoyable.
  6. Spine&SportsMD

    Spine&SportsMD SDN Mentor

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    My interest in PM&R was a result of a combination of factors. As an undergrad the Neuro system fascinated me tremendously, and ulimately it was a Physiological Psychology class that prompted me to pursue medical school.

    While in medical school, I enjoyed my neuroscience course. Over my first summer of medical school, I completed a Neurology research project at the university. As you can see, my career was heading undeniably to Neurology at that point.
    It was during my 3rd year of medical school however, when I first learned about PM&R. And it was actually from a Neurology resident. Not having a residency program at my home school, I did an away rotation at a well known PM&R program.

    I found that the I enjoyed the continuity of care with my patients, it was still neuro oriented, and I felt that I was making a difference in my patient's lives that was satisfying to me.

    It wasn't an easy decision, but I am happy in PM&R. It has afforded me a rewarding career, a pleasant lifestyle, and it is constantly growing and changing which makes me excited to be a part of it.
  7. Spine&SportsMD

    Spine&SportsMD SDN Mentor

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    Hello Breethe,
    1. I think ultimately, you should pick the one which you are most interested in. Medical school requires only a handful of core prerequisite classes. I've had medical school classmates that were Theater majors. What is important to medical school admissions committees is that you've shown that you can handle the rigorous academic courseload required in medical school(which most times entails taking more than just the prerequisites), as well as your committement to the field of medicine in the way of research, volunteering, etc. You will soon realize once you get into medical school, that much of what you learned in undergraduate does not get into the depth, pace, and volume of information that you will encounter in medical school. And by the time you chose residency, which may or may not be in PM&R, no matter what your college degree was in...you'll likely acclimate very quickly and become a good doctor regardless.

    So, to make a long winded answer short. Chose what interests you the most, but do well in whatever you do.

    2. I'm sure drusso(moderator extraordinaire) could answer this question better than me, as I'm not a DO, and I don't do any OMM in my practice.

    3. I would recommend shadowing a doctor that works and teaches in an academic hospital. That allows you see the full spectrum of the field, you can attend lectures/grand rounds, and you would get the opportunity to interact with PM&R residents who could answer any questions as they are in the trenches and can give you the most current info on what it's like to be a resident and how they like their program.

    Good Luck!
  8. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    I am a PM&R, graduated in the 90's. Did a solo practice out of residency - 50/50 inpt/outpt x 2yrs, then a pain clinic 100% x 3 yrs, now in a group practice - multispecialty. I am available for questions on PM&R, med school or whatever you want to know from me.

    Questions they tell me to answer first -

    1. What do you enjoy most about your specialty?
    Diverse patients, lifestyle

    2. Is there anything you dislike about your specialty?
    Lack of understanding of what we do by other docs.

    3. How many years of post-graduate training does your specialty require?
    4 - 1 yr internship, 3 yrs PM&R

    4. What is a typical schedule like for your specialty? Are the hours/shifts flexible?
    I work roughly 8 - 5 M - F, but see pts a little less than that - rest of the time is documentation, paperwork, etc. I do not take call, but have my pager 24/7 for my own pts. The field is as flexible as you want it - you can work 10 - 100 hours/wk.

    5. Where do you see your specialty going in five years?
    More and more to outpt musculoskeletal medicine and pain magement.
  9. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    I learned about PM&R when I started working as an aid for the disabled in college - it paid room & board a left a little extra for beer. I started looking into it more and more. When I did my first rotation in PM&R as a 4th year student, I knew it was definately for me.

    As a student interested in PM&R, I would learn as much as I could about the muscular, skeletal and neurologic systems, both normal and in disease states. Most of that will come with time, but learn as much as you can about them as soon as you can.

    Also, look into working with and/or volunteering time working with the disabled - such as disabled sports teams, a local rehab hospital, or a local disability-assistance program. Also look up local PM&R docs and see if you can spend a day or two "shadowing" them. That can give you more of an idea if that's what you really want to do.

    You get referrals in PM&R by going out and meeting the referring sources - mainly other doctors, shaking their hands and telling them what you can do for them. As their patients come back to them with positive feedback, you'll get more referrals and they'll tell other docs about you. You also stay in frequent contact with them - call them when they refer someone top report back to them, send a report, etc. If you do good work, word will get around. I also get a lot of referrals from patients I've helped previously - they refer freinds and family members.
  10. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    PM&R might be a good option for you. We tend to be more into the psychological aspects of pain that the anesthesiologists, but that's more of a generalization - anesthesiologists have more of a reputation as "block jocks" but many are very involved in multi-disciplinary pain management - the "Holy Grail" many clinicians strive for. Psychiatrists sometimes do pain management, but mostly just psychotherapy and psychopharmacology for it.

    I do basic pain procedures - joint, ligament, tenon and nerve injections, trigger point injections, botox for spasticity, and the simpler spine injections such as epidurals and facet joint injections. I don't do the more advanced procedures such as IDET and percutaneous discectomies, pump and stims.

    For pre-med, just focus on getting into med school - you still need to have excellent grades in the hard sciences - bio, chem, physics, etc. Study your butt off for the MCAT - takes practice tests, courses if you need 'em. Once you get in, spend your first 2 years doing as well as you can in class. You generally don't get to fully explore your options until 3rd year, and that's when you need to have the biggest impact on others to have your best chance at your ideal residency. By the time you finish residency, you'll likely want to do a fellowship, as Pain is going toward only fellowship-trained phsyicians being able to do anything.
  11. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    There are differences b/w anesth and PM&R pain fellowships. Most, if not all, PM&R pain fellowships are non-ACGME certified. Many anesth are ACGME certified. That can make a difference in board certification and hospital privileges. Also, anesth fellowships tend to be much more weighted toward higher-end pain procedures, such as pump and stim placement, perc-D and vertebroplasties, while PM&R tends toward bread-and-butter procedures like epidurals, facets and sympathetic blocks. If you read some of the recent threads in the pain forum, you'll see a lot of debate about this issue.

    PM&R remains wide open. You can do any aspect of inpatient work - general, SCI, TBI, CVA, etc, or you can go more outpatient. Outpatient PM&R can be solo, group, multi-specialty. Many groups are looking for PM&R to add dimension to their practice and bring in more revenue - through EMG's, procedures, additional radiology and PT. The thing right now is outpatient PM&R tends to pay more with no call, inpatient carries call - for your own patients, and weekends usually. Theoretically, the job market for PM&R looks pretty rosy for the foreseeable future.

    Other fellowship opportunities in PM&R include EMG, TBI, SCI, Sports Med and Spine (some are invasive, some not).
  12. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    We do more with these patients than just about anyone. For a stroke pt, they get admitted to the hospital, diagnosed by neuro typically, and then when stable, sent to rehab, where PM&R takes over for pretty much the rest of their recovery - inpatient and outpatient.

    For SCI, it's about the same, except the usualy start by being admitted by neurosurgery, then off to rehab and PM&R.

    We help them by not only prescribing appropriate PT, OT and speech therapy, but also by helping prevent problems such as DVT, atelectasis, skin ulcers, and manage their medical problems. As outpatients, we help guide them further through their recoveries, often seeing them monthly.
  13. GQPMR

    GQPMR Fellow SDN Advisor

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    Hello everyone. I am very happy to become a mentor for the field of Physical Medicine & Rehabilitation. Just a quick background on me: went to osteopathic medical school, am the current Chief Resident of the residency program and have been accepted to ACGME accredited Pain Fellowship.

    Here are some questions I have to answer for you guys:

    1. What do you enjoy most about your specialty?

    I love the diversity of field of PM&R and that your experience of the field can be dictated by your interests and enthusiasm. Self motivation is key...

    2. Is there anything you dislike about your specialty?

    Obviously, knowing that alot of practitioners out there still are not versed in what we do. This can be an opportunity to use to your time to educate these practitioners to use you to their full advantage.

    3. How many years of post-graduate training does your specialty require?

    The program is 1+3 (total of 4 years). Typically programs require you to complete an internship in internal medicine, transitional year, prelim surgery, etc. and then you have to complete 3 years in the PM&R residency program itself. Some residency programs build the internship into the training program and you just enter into a 4 year program from the get go.

    4. What is a typical schedule like for your specialty? Are the hours/shifts flexible?

    Well, each residency program is different, so I will give basic guidelines of what to expect. Typically your inpatient rotations will be on the longer side as far as hours go. Maybe, like 8-6pm. Some days you might get out before 6pm and some days you may not get out until 8 or 9pm (for those late admissions). This can be dictated by various issues, such as if they have a consult service or not and do you also admit from outside hospitals or not.

    Your outpatient rotations may be full day clinics or can be half day clinics. Hours vary and you could be done by Noon some days and other days it maybe that you are in clinic until 5 or 6pm.

    Again these are basic guidelines and I can answer more specific questions regarding schedules and what to expect when you start.

    5. Where do you see your specialty going in five years?

    The current trend in field of PM&R is towards outpatient MSK/Pain/Spine. I feel that although this may be the "in" thing to do right now and for the future, there still will be a growing need for stroke, brain injury, spinal cord injury and general orthopedic management on the inpatient side as our baby boomer generation continues to get older. In fact, given the trends for outpatient MSK/Spine/Pain endeavors by our current PM&R graduates there may even be a shortage of practitioners versed in dealing with patients on the inpatient side. All in all, the specialty is gonna be in high demand for a long time to come no matter where your interests lie.

    I know that there are 2 other mentoring threads on the field of Physical Medicine & Rehabilitation, so I would prefer to not repeat posts from those threads. I request you all to read those threads first and if your questions have not been answered please do not hesitate to contact me. Also, I will answer any questions about what to look for in a residency program based on your interests, what are key things to note when you visit a residency program you are considering or how to approach the match process in general. Good luck and I look forward to hearing from you.
  14. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    No, but most PM&R docs are willing to let someone shadow them. Just find a local rehab hospital, or find out if a local hospital has a rehab floor with rehab docs. Alternative, just look up Physiatry in the local phone book. If you have trouble finding someone in you area, contact me.
  15. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    Local hospitals usually have a rehab floor/ward run by physiatrists. Many med schools have PM&R as electives. I've had several med students shadow me to see what I do. Most are quite pleased with the experience. Find local Physiatrists and see if you can spend some time with them.

    Pain will remain on option for PM&R - it is much of what we do, no matter what subspecialty you do in PM&R. It is harder to do a fellowship in PM&R as the ACGME felowships are lacking.
  16. drusso

    drusso Moderator Emeritus Lifetime Donor

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    Applying to residency can be a daunting endeavor. With increasing competition for a relatively stable number of slots, many applicants are interested in knowing what they can do to make the best of their residency application and interview day experience.

    The following document was provided to me for broader dissemination by a group of academic physiatrists with several decades of combined experience interviewing and selecting PM&R applicants. While not intended to be an all encompassing manual, the tips and hints contained within are sure to help every applicant optimize their chances of matching into the program of their choice.

    Enjoy!

    Attached Files:

    Last edited: 03.30.09
  17. DarkKing12

    DarkKing12

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    I am currently an FMG in my last year of medical school. To get a PM&R/Sports Medicine residency, would it be more beneficial for me to do an internship back in the states rather than staying abroad and finishing it here?
  18. PMR 4 MSK

    PMR 4 MSK Large Member SDN Advisor

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    Probably

    BTW, there is no Sports Medicine Residency, just fellowships
  19. pain free

    pain free

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    I will be starting my PGY2 after 4 months and would like to know:

    - The name of the pocket book that I will use while in hospital/on call (like the intern survival guide for interns)

    - Also good book about basics of PM&R simple and not big in volume.

    Please feel free and tell me what I should do to prepare myself before I start. I want to start in very good shape. I hav a lot of time to do what you will say.

    Thank you
  20. SweetD2014

    SweetD2014

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    Thank you for your help!
    Last edited: 01.29.13
  21. MedBronc23

    MedBronc23

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    PM&R Pocketpedia it's pretty good.
  22. judasreznor

    judasreznor

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    How does a medical student interested in PM&R who doesn't have a residency program near their school get involved in research projects?
  23. DOctorJay

    DOctorJay

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    Do research in any field and get it published. Try to get something related like EMG with your Neurologists or MSK with Ortho sports. Get creative. It's more important to show you can do research/publish something than that it be related to PMR at this point. Good luck.
  24. DrMattOglesby

    DrMattOglesby Grand Master Moderator Emeritus

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    Very good question. I ran into this problem from day 1 of first year. I approached my school's PM&R department and asked around for possible projects but was told nothing was going on. I checked back in every so often over the next couple of years without any luck. Without any viable PM&R opportunities, I eventually opted to take a research year in a related field (e.g. ortho, neuro, urology, neurosurgery, etc...). In my personal experience, I elected for an orthopaedic spine surgery research fellowship position (salaried) and have found it quite rewarding. While this has been advantageous for myself, I also recommend looking into summer research opportunities that are well-advertised here on SDN (e.g. RIC's externship). Additionally, I believe the AAPM&R website has a mentor program that could potentially link you up with a nearby physiatrist-researcher.
    Last edited: 02.11.13
  25. judasreznor

    judasreznor

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    Thank you both for your responses. I'm at a newer DO school that doesn't have any residency programs associated with it and is not within immediate driving distance of a residency program. The only real departments that we have are FM and OMT. I should also note that there is no current research going on at my school in any department. Where should I search for research in my area?

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