EMG fellowship advice

[topwise]

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I feel like coming to the end of my residency, the thing I have enjoyed most by far has been EMGs, with general msk being a close second. (Surprise! I thought I was going to do inpatient rehab.)

I've done a respectable but not huge number of EMGs (have passed 200 and optimistically hope to get close to 300 by the end), but they've mainly been CTS or radic studies. I've done a handful of more interesting stuff like brachial plexopathy wkups, myopathy, ALS, etc. Never done a repetitive stim study or SSEP. The thing is, I think I would like to learn these studies and get good at them.

There is a fellowship at NYU (and some others) that advertises a mix of spine/msk/EMGs, which is aimed more at PM&R, whereas there are a few other neurophysiology EMG-centered fellowships that are mostly neurologists but will occasionally accept PM&R docs. My question is: should I try for the PM&R fellowships and enhance the training I have? Or should I try for a neurophysiology fellowship with all the neurologists?

Even if I do a neurophysiology fellowship, will I ever be a respected EMG-er who gets referred the complicated studies? Did I blow it when I picked PM&R over neurology?

 

[Disciple]

It sounds like you can already do the basic MSK EMGs. If this is the case, go to the Neurology fellowship so you can get the cases you're looking for.

Fellowship or no fellowship, you will need to put some effort into marketing yourself as a complete electrodiagnostician.

In private practice, referring physicians will not assume that you can do all these different studies and make these diagnoses, as they would a Neurologist.

 

[SSdoc33]

I feel like coming to the end of my residency, the thing I have enjoyed most by far has been EMGs, with general msk being a close second. (Surprise! I thought I was going to do inpatient rehab.)

I've done a respectable but not huge number of EMGs (have passed 200 and optimistically hope to get close to 300 by the end), but they've mainly been CTS or radic studies. I've done a handful of more interesting stuff like brachial plexopathy wkups, myopathy, ALS, etc. Never done a repetitive stim study or SSEP. The thing is, I think I would like to learn these studies and get good at them.

There is a fellowship at NYU (and some others) that advertises a mix of spine/msk/EMGs, which is aimed more at PM&R, whereas there are a few other neurophysiology EMG-centered fellowships that are mostly neurologists but will occasionally accept PM&R docs. My question is: should I try for the PM&R fellowships and enhance the training I have? Or should I try for a neurophysiology fellowship with all the neurologists?

Even if I do a neurophysiology fellowship, will I ever be a respected EMG-er who gets referred the complicated studies? Did I blow it when I picked PM&R over neurology?

doing a neuro-based fellowship may be difficult, because these are often "clinical neurophysiology" fellowships, and you spend a good portion of your time doing/interpreting EEGs. Goo!!!! im sure thats.....easy...... be sure to check that out while you are looking.

also, you will be light-years ahead of the typical neurologist who is in these fellowships in terms of EMG skills. but, their knowledge of neuromuscular diseases would probably be better. best of luck.

 

[Hemisphere]

First define the type of practice you want, what type of EMG's do you want to do?

These are the different ways to take it that I can think of:

1) PM&R spine/sports fellowship that includes EMG's
2) PM&R or neurology-based EMG/neuromuscular disease fellowship
3) PM&R sports med fellowship that includes EMG exposure.

option 1 probably provides the least EMG time. It will give you interventional proceudure and sports med training. you probably won't get the training in SSEP's/rep stim/intraoperative EMG monitoring etc, since they aren't seeing the neuromuscular patients or running an "emg lab." of course I'm not aware of all programs so if you know differently please post about it.

option 2 is probably gonna provide the most breadth and depth of EMG training if you are at a large EMG lab for an institution which gets referrals from multiple specialities. It is not traditionally a physiatritic subspecialty but recently neuromuscular medicine is a new subspecialty board certification sponsored by both neurology and PM&R so potentially you could be double boarded in PM&R and neuromuscular medicine by going this route. There will be no sports medicine or interventional training, so either you will have to do 2 fellowships or rely on the musculoskeletal exam and injection skills you learned in residency. but you will probalby be better positioned for a wider variety of EMG referrals, if your skills were known to those referral sources. If you lament you should've been a neurologist this is the way to go lol, but rather than lamenting, bring the physiatry skills to the neuromuscular disease realm including ADL's, functional assessment, bracing, botox, etc. You would be an excellent asset to an MDA clinic from both diagnosis and managment persepectives. Or if not interested in that angle, would be well-versed to teach physiatry residents EMGs in an academic setting. Some of these fellowships include an inpatient component so look into that as well.

option 3 probably has more EMG time than option 1 depending on the fellowship since you are not taking time out to go do spinal procedures. you will be well-versed in peripheral injections. it's still probably mostly plexopathy, radiculopathy, or neuropathy, and not rep stim, SSEP, or intraop monitoring. and you better like to cover sports events too. you could potentially be dual boarded in PM&R and sports medicine.

so depending on what you like to do, choose one of the options. that's the hardest part, lol.

 

[topwise]

I think Option 2 sounds the most appealing to me. I was always on the fence about the neurology vs. PM&R decision and I sometimes wonder if I went the right way (although I love PM&R so I think I did).