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PM&R vs. FM/sports medicine

Discussion in 'PM&R' started by 308gt4, 08.05.05.

  1. 308gt4

    308gt4 New Member

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    I am a 4th year med student wanting to do sports medicine. I have heard a lot of different opinions as to what the best route to take is. What are the advantages/disadvantages of doing PM&R with a sports medicine fellowship vs. family medicine with a sports medicine fellowship? Aside from sports medicine, PM&R is much more interesting to me than family medicine, but my ultimate goal is sports medicine. What about salary differences? Any differences in how competitive one would be upon entering the job market?
  2. macman

    macman Senior Member

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    I guess my answer depends on why you are interested in sports med.

    If you are interested in the MSK system and want to learn as many non-surgical approaches both from a diagnostic and treatment perspective, I feel PM&R is the way to go.

    Personally, I'm not sure why someone would do three years of peds, OB, and FP clinic tx'ing HTN, DM ,etc. if want you really want to do MSK.

    So if you really like FP but also happen to like doing some sports med, then don't go for PM&R....otherwise, why do a residency in something you don't like?

    As far as I understand, PM&R residents cannot do a sports fellowship (please correct me if I'm wrong) but why could you not tailor a MSK PM&R practice to a sports clientel (sp)
  3. melancholy

    melancholy 1K Member

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    In addition to your good question about why 308gt4 wants to do sports med, another useful question would be to what extent you would want to do sports medicine. I can see there would still be people who enjoy the wide range of care that a family practitioner provides and in addition, would like to become more involved in sporting events. The funny thing is that so many specialties can do "sports medicine" whether it is something like being a team doctor for a high school team and helping with sports physicals all the way to being a professional sports team doc.

    You could also make the case of doing sports medicine in other specialties such as ortho, emergency medicine, etc. so it is important to differentiate what you envision yourself doing in the future.
  4. melancholy

    melancholy 1K Member

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    I forgot to mention that as far as PM&R sports fellowships go, they do have PASSOR msk/sports fellowships which I think would be the closest thing.
  5. staydin

    staydin Member

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    As said already, you can do sports medicine from a lot of different routes. The question you have to answer for yourself, is what do I want from the residecny specialty I am going into, and what do you see yourself doing for practice 5 years from now everyday, till you retire?

    I know you can do sports from ortho, ER, FP, PMR, and IM. However, which fellowships are for which field I'm not exactly sure about. I don't think sports fellowships are like pain fellowships, where PMR, IM, Psych, Neuro, and Anesthesia can all do the same fellowships. So you might want to look into that more closely, and pick the specialty that gives you the most options.

    Just a word of caution, if you choose to go into PMR, you should be clear that PMR does not equal sport medicine for you. Programs will see right through that. I know of many applicants who didn't make the effort to diversify their PMR experiences, interests, or appllication with the other parts of PMR (P/O, SCI, TBI, Stroke, EMG, Inpatient Rehab, etc) and ended up not matching at all. So make sure when you send you application in, and the PD picks it up it doesnt have SPORTS MEDICINE or PAIN MEDICINE written all over it, you won't get to far...from my personal experience.

    Good luck.

    ____________
    PGY1 - Union Hospital - NYCOM '05
    PGY2 - UMDNJ - Kessler Insitute for Rehabilitation '06
  6. Disciple

    Disciple Senior Member

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    Advantages: While FP practitioners do a 1-yr sports med fellowship, physiatrists may do the same, plus the possibility of substantial MSK training during residency. Physiatrists are more likely to be well versed in anatomy and functional biomechanics, which when you think about it, makes them an ideal choice to address issues of injury prevention, overuse injuries, rehabilitation to previous level of ability/performance and ultimately athletic performance enhancement. Additionally, if you're interested in pro sports, these teams are often linked to large ortho groups or single orthopaedic practicioners. These same ortho groups often take physiatrists into their practices or have close affiliations with them. No practioner can base their practice 100% on sports. Physiatrists, however, can base their practice on 100% sports/MSK, if so desired.

    Disadvantages: Physiatrists currently cannot obtain subspecialty board certification in sports medicine. I believe the academy is working hard to change this. Additionally, as physiatrists may be superior with regards to kiniesiology, etc., FPs/ER docs will have an edge in handling medical conditions associated with sports e.g acute management of fractures, cardiac irregularities.
  7. axm397

    axm397 SDN Moderator Moderator SDN Advisor

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  8. fozzy40

    fozzy40 Senior Member

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  9. rehab_sports_dr

    rehab_sports_dr Member

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    > I found a Primary Care Sports Medicine Fellowship that takes PM&R residents. Does anyone know of any others?

    University of Alabama-Birmingham does, and they took a great resident from Emory this past year.

    Stanford does in theory, but they haven't as far as I know

    The Michigan St. one is excellent. In addition to the family medicine sports experience, Michael Andary is a physiatrist who is an awesome guy, and very well regarded as an electrodiagnostician.
  10. rehab_sports_dr

    rehab_sports_dr Member

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    > Just a word of caution, if you choose to go into PMR, you should be clear that PMR does not equal sport medicine for you. Programs will see right through that. I know of many applicants who didn't make the effort to diversify their PMR experiences, interests, or appllication with the other parts of PMR (P/O, SCI, TBI, Stroke, EMG, Inpatient Rehab, etc) and ended up not matching at all.

    I am hesitant to disagree with staydin, since he is one my favorite colleagues, but ....

    In my personal experience, I think you should be as honest as possible about what interests you. I came into residency wanting to do sports medicine, and was very explicit with my interviewers about this. It didn't hurt me in terms of matching.

    I think it helps, though, to have a consistent CV that documents your interest. I had some quality sports medicine research and volunteer activities, so I think it was pretty easy to gauge the sincerity of my interest.

    I would agree with staydin, however, that you should NOT be dismissive of the value of a comprehensive PM+R education. First of all, athletes commonly get TBI injuries, and sports injuries are a common etiology of SCI injuries. So even if your interest is primarily in sports, PM+R residents benefit from the comprehensive training.
  11. DrRobert

    DrRobert Day or Night

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    I just had a lengthy conversation about this with my PM&R attending today.

    Needless to say, he is steaming mad about the poor care that FM/Sports Medicine physicians provide. About 30% of his business comes from patients that were mismanaged by FM/Sports Medicine docs.

    As a physiatrist, you are trained for 3 years in musculoskeletal disease/management. This directly correlates to the conditions treated in sports medicine. A one year fellowship is simply not adequate to properly diagnose/treat many sports medicine problems.

    Of course he had a lot more to say on the issue, but that about sums it up.


    Disclaimer: The above views are those of my attending; I'm going into anesthesiology and have no opinion on the matter.
  12. fozzy40

    fozzy40 Senior Member

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    Is it possible for a PM&R doc to be trained in fracture care? If so, where would you learn? I've heard of primary care sports medicine fellowships that train specifically in this area.
  13. rehab_sports_dr

    rehab_sports_dr Member

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    > Is it possible for a PM&R doc to be trained in fracture care? If so, where would you learn? I've heard of primary care sports medicine fellowships that train specifically in this area.

    My impression is that this is NOT a poiint of emphasis of most PASSOR sports medicine fellowships.

    If fracture care is important to you, that would be one reason to consider the family medicine based sports medicine fellowships instead of a PASSOR fellowship. What you miss out on in terms of spine injections and EMGs (and possibly on msk ultrasound, depending on the fellowship) you might gain in acute fracture management.
  14. fozzy40

    fozzy40 Senior Member

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    Can someone elaborate on the difference b/w a PASSOR Sports vs. Primary Care Fellowship? I tried going to the AAPMR.ORG site but it appears to be down.
  15. rehab_sports_dr

    rehab_sports_dr Member

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    > Can someone elaborate on the difference b/w a PASSOR Sports vs. Primary Care Fellowship? I tried going to the AAPMR.ORG site but it appears to be down.

    Disclaimer: I am a senior PM+R resident about to start a PASSOR fellowship, coming from a residency program that has 2 seperate PASSOR fellowships.

    PASSOR is the Physiatric Association of Spine, Sports, and Occupational Rehabilitation. They were originally created at a time when most of PM&R was focused on rehabilitation to give representation to musculoskeletal doctors. Some of the docs prominent in PASSOR started taking on apprentices to train them in the basic of physiatric musculoskeletal practice, and these apprenticeships have evolved into the current PASSOR fellowships.

    Today, PASSOR has a set of guidelines to be classified as a PASSOR fellowship, including things like a minimum number of journal clubs, and certain percentages of spine and sports coverage within their practice. The goal was to create some uniformity as to what was meant by a PASSOR fellowship.

    My impression, primarilly for the interview process, is that these criteria are largely in name only, and that the fellowships pretty much do whatever they want to do. That is not neccessarily a bad thing, but just means that you should realize their is a great deal of heterogeneity amongst the PASSOR fellowships.

    In my opinion, when you match at a PASSOR fellowship, what you are really doing is matching with a mentor, and learning from their skills set. So if you do a fellowship with Michael Fuhrman at York, PA, you will be doing a fellowship focused on cutting edge interventional spine procedures, whereas if you do a fellowship with Heidi Prather at Wash U in St. Louis, you'll get a mix of lumbar interventional procedures, EMG, musculoskeletal ultrasound, and sports biomechanics as part of the mix. and if you work with Jay Smith and Karen Newcomer at Mayo, you get more emphasis on pure sports and musculoskeletal ultrasound. The biggest variability is primarily in how many spinal procedures you get exposed to, and it how much true sports (as opposed to general musculoskeletal) exposure you have.

    The family med fellowships often have ACGME accreditation. As PM+R residents, you currently cannot sit for the board, so from an accreditation standpoint, that is meaningless for the residents in PM+R. What it does mean, though, is that you get more homogeneity. They tend to have more of a pure sports focus, but with far less emphasis on physiatric skill sets (EMG, interventional spine).

    If you are considering sports medicine, I have two pieces of advise:
    1. Do some soul searching to determine which aspects of sports medicine are important to you, because that will help you choose whether to go the PASSOR or family medicine route
    2. Try to get to the ACSM meeting. The American College of Sports Medicine is, by far, the best meeting I've been too, and exposes you to the full spectrum of sports medicine. It can help you determine which aspects of sports medicine are the most interesting for you. I met my future fellowship mentor there, for example.

    Hope that helps

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