FM or PM&R for Sports Medicine

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engin33ring

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I start DO this summer and am trying to get some advice about FM and PM&R when it comes to sports medicine fellowships.

Is one preferred over the other? Would I be more competitive if I chose PM&R over FM? And lastly, are sports medicine fellowships highly competitive?

I have read A LOT of the forums that have been posted on SDN on the matter, but many of them are 8-10 years old. Trying to get some updated information if possible.

Thanks

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I personally think PM&R is the way to go if you are interested in working up MSK issues associated with sports injuries. The entire residency revolves around biomechanics and optimizing restoration of function.
PLUS, Sports Medicine Fellowships that were previously exclusive to graduates of Family Medicine residencies, are now scheduled to become available to all-comers eligible for training in non-surgical sports medicine.

To me, it came down to what residency I wanted to do, and if there were other possible things I could see myself doing within that residency if it turned out I didn't like a particular fellowship. For example, I would not choose to go the route of Internal Medicine to Rheumatology (even though I like rheum a lot)--because I don't see myself as satisfied being an internist as I would being a general physiatrist.
 
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Agree that you have to decide what you want as your primary specialty, so with that FP no question. PM&R sports med is a referral specialty, while FM sports med is the point of first contact for patients. Most sports partnerships are seen with Ortho & FP's (pro & college). There are way more FP fellowships than PM&R, and unless PM&R does a procedure that FP doesn't, FP can handle most cases, depending on your training.

However, if I have an athlete with a biomechanical issue that Ortho, athletic trainers, PT, nor I can figure out, PM&R is next. Most of the time however, I'm more apt to call on PM&R Spine/Pain Management than I would PM&R Sports Med because if I want specialty care, I'll ask for specialty care instead of PM&R trained in primary care sports medicine.

Last point to make, there's more to sports medicine than neuro & MSK...
 
Agree that you have to decide what you want as your primary specialty, so with that FP no question. PM&R sports med is a referral specialty, while FM sports med is the point of first contact for patients. Most sports partnerships are seen with Ortho & FP's (pro & college). There are way more FP fellowships than PM&R, and unless PM&R does a procedure that FP doesn't, FP can handle most cases, depending on your training.

However, if I have an athlete with a biomechanical issue that Ortho, athletic trainers, PT, nor I can figure out, PM&R is next. Most of the time however, I'm more apt to call on PM&R Spine/Pain Management than I would PM&R Sports Med because if I want specialty care, I'll ask for specialty care instead of PM&R trained in primary care sports medicine.

Last point to make, there's more to sports medicine than neuro & MSK...

Great breakdown. It really helped figure out the difference between the two post residency.

Does anyone know how competitive sports medicine is? I am an older student and won't finish my residency until I am 37. Will I be at a disadvantage? Any advice/ideas are welcome.
 
Age isn't a factor. Nor is time. Fellowship is 1 year, it goes by fast. You're job hunting 6-8 months in.

Match is fairly competitive in the sense that most fellowships only have 1 seat. So it's not like residency where you can rank your #1 program and hope to be one of their 6 or 10 rank-to-match candidates. You can be the #2 candidate at every program you interview and go unmatched. You can look on FRIEDA to see how many interviews are given per seat.

Key thing is getting sports med experience during residency through your required rotations and extracurriculars.
 
I did notice that there are only a few spots open for SM. OH well, looks like another cycle of stress.

Thanks for all of your information. Helped a ton
 
I start DO this summer and am trying to get some advice about FM and PM&R when it comes to sports medicine fellowships.

Is one preferred over the other? Would I be more competitive if I chose PM&R over FM? And lastly, are sports medicine fellowships highly competitive?

I have read A LOT of the forums that have been posted on SDN on the matter, but many of them are 8-10 years old. Trying to get some updated information if possible.

Thanks

I would advise going the PMR route. If you choose to go PMR, you can do all sorts of other cool stuff in addition to sports med. You are also eligible to apply for a chronic pain fellowship after PMR residency.

PMR is one of the best kept secrets of medicine.
 
I would advise going the PMR route. If you choose to go PMR, you can do all sorts of other cool stuff in addition to sports med. You are also eligible to apply for a chronic pain fellowship after PMR residency.

PMR is one of the best kept secrets of medicine.

To respectfully take the counter position,
1. Procedures or not, chronic pain isn't exactly my idea of cool.
2. Best kept secret is exactly the problem that faces PM&R. Nobody knows what they do and it's a problem. A marketing problem when you leave the academic medical centers and go into the community.
 
We talked about adding a PM&R doc to my group recently, and decided to pass. We already have orthopedics, sports medicine, physical therapy, and pain management. We couldn't figure out what we'd do with him.
 
To respectfully take the counter position,
1. Procedures or not, chronic pain isn't exactly my idea of cool.
2. Best kept secret is exactly the problem that faces PM&R. Nobody knows what they do and it's a problem. A marketing problem when you leave the academic medical centers and go into the community.

I'm not sure what your point is, exactly.

If you don't dig on chronic pain, then that's fine. Don't see this population ?

Ortho seems to frequently be on the lookout for PMRs.

Lots of opportunity to do third party assessments / IMEs ( cash payors ).

Significant variety of MSK medicine involved with PMR, if that's your bag.

If the med student is interested, they should do an elective - only way to find out.
 
The important thing is to think about the primary field you want to enter. As noted there are many avenues into sports: EM, ortho, PM&R, FP, peds, int med. For each you must consider if sports were taken away would enjoy doing X. For example would you enjoy being a general orthopod, physiatrist, etc.

There is no "best path" into sports, rather a "best fit" for base specialty that allows you enter sports. No one can tell you what is the best path, you have to figure which specialty best fits your personality and interests.
 
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I for one chose PM&R for its expertise in MSK medicine. As previous people have alluded it provides a wealth of bio mechanical and functional knowledge. Many residency programs (like mine) have dedicated MSK and anatomy didactics in addition to hands on training with MSK injections and spine/axillary injections.

I totally disagree that FP is the only primary point of entry for sports injuries. PM&R can prescribe exercises, detailed PT recommendations, do diagnostic MSK Ultrasound, do guided and blind MSK injections and spine procedures, and we are experts on spinal cord and brain injury two important sports emergencies. Additionally, we have a wealth of MSK knowledge to know when to refer to Ortho if surgery needed.
 
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I for one get extremely annoyed at medical specialties putting each other down. In the academic setting you'll hear people call ER docs glorified triage nurses, physiatrists glorified PTs, orthopods dumb trees, gen surgeons jerks, OBs whiny b***es, etc.

Frankly it's a bad look. Not saying that there is not some truth to certain stereotypes in certain situations but it seems like people spend more time focusing on the negative apsects of specialties and not enough on the positives. For example, appreciating ER docs for having to make quick, life and death decisions all while trying to clear ER beds, or appreciating how physiatrists have to integrate multiple facets of medicine in an expert manner to create rehabilitation plan for patients, or how orthopods have an incredible understanding of the MSK system unmatched by other specialties (except for PM&R) whilst maintaining expertise in the surgical management of MSK injuries, or how general surgeons literally are medicine's life savers and bar none, work harder than any other specialty, or how OBs are experts in a particular area of the body that most clinicians would rather not be concerned with.

It's a bad look for one's specialty when you put down other specialties. It just makes you and your colleagues look stank. In response to Medbronc, yes, if you are looking for the specialties that will give you the best training in MSK medicine, look to PM&R and ortho. But there are many benefits to being a FP trained sports doc. One of them is getting to be a family physician, which is a very rewarding specialty. FP docs form closer bonds with patients and families than any other specialty. Now, for many, FP is not their cup of tea (it's not mine) but there are rewards to being a FP doc. Also, physiatrists are certainly NOT as qualified to handle primary care issues in athletes as FPs.
 
I for one get extremely annoyed at medical specialties putting each other down. In the academic setting you'll hear people call ER docs glorified triage nurses, physiatrists glorified PTs, orthopods dumb trees, gen surgeons jerks, OBs whiny b***es, etc.

Frankly it's a bad look. Not saying that there is not some truth to certain stereotypes in certain situations but it seems like people spend more time focusing on the negative apsects of specialties and not enough on the positives. For example, appreciating ER docs for having to make quick, life and death decisions all while trying to clear ER beds, or appreciating how physiatrists have to integrate multiple facets of medicine in an expert manner to create rehabilitation plan for patients, or how orthopods have an incredible understanding of the MSK system unmatched by other specialties (except for PM&R) whilst maintaining expertise in the surgical management of MSK injuries, or how general surgeons literally are medicine's life savers and bar none, work harder than any other specialty, or how OBs are experts in a particular area of the body that most clinicians would rather not be concerned with.

It's a bad look for one's specialty when you put down other specialties. It just makes you and your colleagues look stank. In response to Medbronc, yes, if you are looking for the specialties that will give you the best training in MSK medicine, look to PM&R and ortho. But there are many benefits to being a FP trained sports doc. One of them is getting to be a family physician, which is a very rewarding specialty. FP docs form closer bonds with patients and families than any other specialty. Now, for many, FP is not their cup of tea (it's not mine) but there are rewards to being a FP doc. Also, physiatrists are certainly NOT as qualified to handle primary care issues in athletes as FPs.

What "primary care issues" are you referring to in the sports / MSK setting ?

Anxiety / depression / subtance abuse , etc ?

Family medicine is a great specialty , as it offers tremendous diversity.

However, Physiatry is a specialty that , well , specializes in physical disabilties. I have a hard time seeing how a family med doc with another year in training would be a better asset in the sports med arena than a physiatrist. Maybe that's just me.
 
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I think you guys misread my post to a certain extent. This was my point: 1. It's not cool to put down other specialties. Ever. It just breeds resentment within the physician community and leads to the lack of solidarity we see among many current physicians. No one specialty is teh ahwsomest in the world!1!1! Every one has it's pluses and minuses and we all must find the one that bet's fit our interest, skill set, and desired lifestyle. 2. There IS role for FP docs within the sports arena. When dealing with primary care issues such as heart/lung disease among athletes, sports trained FP docs are your go to guys.

I am not arguing from the standpoint that FP docs are somehow to "superior" to physiatrists when it comes to the medical management of athletes. In fact, I agree that the role of FP docs are mostly best suited for the management of primary care issues in athletes and not primary MSK issues. For example, managing the adolescent athlete with asthma or managing Ryan Clark and his SCD fits well within the realm of the FP sports doc's expertise.

Trust me, I don't need any convincing of the physiatrist's expertise on MSK medicine. If anything, I think this expertise is under appreciated by many in the medical and lay public. And yes, I agree when it comes to MSK medicine the training physiatrists and orthopedists receive FAR surpasses that of what FP docs receive. So yes, when it comes to MSK pathologies, physiatrists and orthopedists are your experts as physiatrist receive 3-4 years of MSK training plus fellowship and orthopods 5 years plus fellowship while the FP guys only get one year MSK training and maybe a one month rotation with a FP sports guy in residency.

PM&R and ortho differ in the fact that ortho offers operative management and PM&R offers advanced non-operative treatments such as US and fluoro guided procedures (compared to most sports FP docs who only offer basic joint injections). Also, physiatrists in general, I believe, have a better understanding of the NEURO-muscular system and spine medicine compared to ortho (except for of course, ortho-spine guys). Orthopods spend more time thinking about whether or not to operate since the bread in ortho is made in the OR and the operative management of MSK injuries is a whole other beast. Meanwhile, physiatrists spend a lot more time thinking about the patient's problem and developing a long-term plan for recovery that may or may not include interventional therapy
 
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What "primary care issues" are you referring to in the sports / MSK setting ?

Start with the prevention of sudden cardiac death. That's the mother of them all. Why else do we do sports physicals?

I've reduced fingers and shoulders on the field and Colles in clinic before. I credit my MSK training for those skills.

I've coded a couple of athletes. Both pulseless. One I intubated when paramedics arrived. Both made it. I credit my FM training for those skills (and, of course, someone upstairs looking out for me).

Yes, on the sideline, I can suture a lac faster than a PM&R doc I've once watched fumble, and I can stick an IV faster than an ortho doc can during half-time. But that's nothing to brag about since any monkey can do that... then again, all you need is 1 monkey sideline instead of having to schedule 4 monkeys.

I manage fractures non-operatively. I do MSK ultrasounds to diagnose and I do guided and blind injections just like every other new generation of sports medicine family physicians. I'm all about the physical exam as much as I can be and yes I read my own MRI's, X rays as much as I can because I have the benefit of knowing what the physical exam was.

And yes, I can help you run faster and farther if I regulate your menstrual cycle. I can tell you why your those supplements you're taking to get big is causing your chest pain. I can help you figure out how to manage your insulin during exercise, even though you've had diabetes since you were 9 years old.

I'm a collegiate team physician and my athletes are on scholarship. Yes, I know which pimple medicines will cause you to sunburn. And, yes, I know which antibiotic to give you after you win the conference championship.

I know very well that your shoulder pain has nothing to do with your shoulder, but in fact is due to your GI system. I also know well and good that your cough and cold is going to hold you out from contact sports for 3 weeks. And that chest pain you're feeling now is related to the cough and cold you had 2 weeks ago, because I have the EKG to prove it and that's why you're done for the next 6 months.

I know that your shoulder hurts because I watched you throw every week and you throw like an idiot.

I also know that despite what you think, you don't have ADHD, so quit bugging me for Adderall. Why not let me help you with your dyslexia or anxiety, and maybe you can keep your scholarship?

The most rewarding part of my job is that all the athletes know that I care more about them than I do about their sport. Even for athletes, sports is one part of their lives. So if they can come to me with anything sports related, they can come to me with anything going on in their lives.

And, now that these kids are out of school and working for an accounting firm, I'm still their go-to guy. You want to know what's even more rewarding? Yes, it's taking that HTN and DM and making them athletes.

I don't think I'm really doing anything that's all that brilliant or hard or amazing, even though somedays people think that I do or I feel like I do.

The truth of the matter is that I'm a family doctor first. If any of that sounds worthwhile, you should go by way of FM.
 
Ok if you want to handle Adrian petersons cough and sniffles than go the FP route. If you want to make his knee better go see an orthopedic or physiatry trained physician who has more than a fellowship of seeing MSK and sports injuries.

Again pap smears pimples diabetes

Vs.

Spine injury joint injuries brain injuries

As a gentle reminder:

While it's ok to disagree with someone's position, it is NOT ok to go into another specialty's forum and bash it. FM trained sports med docs DO help successfully rehab knees, whether you want to admit it or not. And implying that all we do are cough, sniffles, paps, pimples, and diabetes, is unfair. I don't go into the PMR forum and bash you guys; please don't come into the FM forum and bash us.

No, I don't have any particular vested interest in this. I don't plan on focusing on sports med; it was never an interest in mine. But, generally speaking, SDN frowns upon people going into other forums and making fun of that specialty.

Let's have some mutual respect, here. Thanks.
 
I don't think it's insulting. The growth in sports medicine isn't in MSK. Everybody does MSK and if you want to be involved in sports you have to have proficiency in evaluating and managing MSK issues. That's basic. But if you want to talk about value-add (i.e. what else can you offer), there's a huge advantage in bringing in primary care into sports medicine.

One reason is because sports medicine historically has been dominated/saturated with people who's only interest and expertise is in MSK, but another reason is that sports medicine is medicine and in medicine there's a shortage of primary care and people who are interested in primary care. That kicks up your value exponentially when you knock on someone's door armed with a variety of skills and knowledge.

That being said, as a sports medicine family doctor, I'm the most utilitarian physician in the training room. My schedule is packed with people who need to see me because I'll take all comers. I have 2 PM&R guys in the community and I rarely... very rarely call on them for help. If I call on a physiatrist to be involved in a patient's care, sports is the last thing on their mind. It's because they've suffered a brain injury so severe that we're worried about whether he'll be able to write his name again or walk again. You don't need 4 years of residency or an MSK ultrasound to diagnose rotator cuff tendinitis. There's no question that sports medicine (like sports and much like medicine) is a team effort. But as the most utilitarian physician on the floor, we serve the greatest good for the greatest number of people.

But even if you don't get the opportunity to bring primary care to sports medicine, there's a great advantage in bringing sports medicine into primary care. MSK complaints make up a huge portion of the reason for primary care visits. Unfortunately, many medical schools who's curricula are dominated by internists and surgeons don't successfully teach those skills to medical students and students become residents with very limited skills. The disparity between a student's ability to diagnose and manage a cardiac problem cardiology way surpasses their ability to do the same for an MSK problem. This disparity is even worse when you consider the primary care residencies that don't build in outpatient medicine, sports medicine, or orthopedics into their standard curriculum (... internal medicine, pediatrics, and ob/gyn). Even PM&R residents at some programs complain that they are too inpatient heavy and get little exposure and teaching in outpatient MSK medicine, because they are too busy doing other things in the world of PM&R. How is it possible that a specialty devoted to physical medicine can not have enough teaching to MSK medicine? I don't understand that... but I hear it and read it and I know that medical students who are interested in sports medicine PM&R will cherry pick residency programs that provide better MSK training. So, to me, it's not a given that all PM&R doctors are the best at MSK. Much like everything in medicine, it all depends on training.

Another consideration is that most fellowships in PM&R that deal with sports are unaccredited. Most fellowships are Pain Management fellowships or Spine fellowships that tack on "Sports". I don't know why it's like that, but it is.

The accredited fellowships that are out there for PM&R residents are the primary care sports medicine programs. It's the American Board of Family Medicine that accredits programs and write the exams. It's the community of family physicians that recognize that sports medicine benefits when there is multiple players contributing to the field from multiple backgrounds. That is why PM&R residents are allowed into our fellowships and to sit for our board.

Bringing primary care into sports medicine is just part of the fun. The best part of my job is bringing sports medicine into primary care...
 
However, Physiatry is a specialty that , well , specializes in physical disabilties. I have a hard time seeing how a family med doc with another year in training would be a better asset in the sports med arena than a physiatrist. Maybe that's just me.

By the time an athlete is disabled, you're pretty far down the protocol and you've got bigger problems to deal with.
 
FP are great high school and small level docs but I think you will see ER PM&R take over nonoperative sports care from FP and IM because our training simply translates better.

Also, majority of PM&R residencies have required MSK and Sports rotations. I know mine has both

Not true.

ER docs aren't interested in the primary care, and unless they trained at a program where people use the ER for primary care, most ER docs are pretty bad at primary care. We've talked about PM&R already. Most IM programs have dropped sports medicine as a fellowship (you won't find any IM sports medicine fellowships out there anymore. They're mostly sponsored by FM programs and many IM docs are uncomfortable dealing with pediatric population).

Regarding the first, it is true that FP's make great high school and small level docs. They also are great team members of the sports medicine team for higher level athletes. The issue here is that there really aren't that many elite athletes and they truly only represent a small number of the total population in the US (I mean, for real... every athlete thinks they are an elite athlete; and every mom thinks their child is an elite athlete... but let's get real here, people.)

Many professional teams have easy access to medical care, so there are almost always 5000 physicians ready to serve 20-30 athletes. That means nothing to me. To me, it is more meaningful (and makes more economic sense) to be one of the 20-30 doctors who serve 5000 athletes.

Lastly, most professional/collegiate team physicians aren't the "best" physicians out there. Most professional/college team physicians PAY the team to be their physician... Think about it. When was the last time you paid your patient to be their doctor?

And yet, that's how it's done in sports medicine. Most high level sports medicine doctors are part of a huge hospital/university system because the hospitals pay the team "marketing" dollars in return that they are the "official health care provider" for that team. Most small groups can't afford to buy out a team like that. And, in order for you to get in on that, you MUST work for the hospital, you MUST operate all your cases in their OR, and you MUST send all your PT and MRI's to that hospital, EVEN if the hospital is the worst in town or the MRI is 15 years old. Why? Because a hospital isn't going to spend millions of dollars paying for marketing if the doctor is going to send the business elsewhere.

So, what that means, as a doctor, is that the team AND the hospital got you by the gonads.

And if you are a real doctor with any real courage to advocate for your patient and practice medicine independent from influence and say, no, this elite athlete really needs to go down the street because they are better at this than we are, then your time as a professional/elite doctor will be short because the people who paid your way in will get tired of you breaking their bank.

So, to me, there is more honor to being a small time sports medicine doctor, because at the low level, that honor still means something. At the elite level, you bribe your way in. This is well known in the world of sports medicine. The biggest perks in being a physician on the elite level are 1) having that marketing capability to say that you take care of elite athletes (even when you don't "really" do) so that you can pull in star-gazing low-level athletes into your practice (if they have insurance...) and 2) having bench side tickets to some pretty neat games.

The downside in sports medicine for the elites is that money and politics talk. And you can have the highest USMLE score, the best medical degrees, but when it's time for the team to drop you for whatever reason (usually money), they'll drop you because to them there are 5000 doctors waiting to work for them. Don't think that just because you rub elbows with an elite athlete that it makes you an elite doctor. These teams can afford to ship Kobe Bryant to Europe to get a stupid injection, so don't think they won't second guess you. At that point, nobody really cares what residency you matched into...

Let's call it for what it is, right? In the world of professional sports, people tune in and buy tickets to watch the athlete. Not the doctor. Nobody cares about you, the doctor. In the eyes of the rest of the world, all you do is support the behind the scenes for their athletes. You're no different than the trainers, the equipment manager, the bus driver, or the water boy because at the end of the day, everything is in place to elevate and spotlight the athlete. Many doctors have a problem understanding that, because they're so used to being in the spotlight themselves. And the sooner doctors understand that's the reality in sports medicine, the happier they will be and they'll spend more of their time enjoying their ride until they get canned instead of being cutthroat, territorial, paranoid, obnoxious, and unhappy. And, if you can't handle being treated like a medical janitor, then professional sports is not for you.
 
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Lastly, most professional/collegiate team physicians aren't the "best" physicians out there. Most professional/college team physicians PAY the team to be their physician... Think about it. When was the last time you paid your patient to be their doctor?


Let's call it for what it is, right? In the world of professional sports, people tune in and buy tickets to watch the athlete. Not the doctor. Nobody cares about you, the doctor. In the eyes of the rest of the world, all you do is support the behind the scenes for their athletes. You're no different than the trainers, the equipment manager, the bus driver, or the water boy because at the end of the day, everything is in place to elevate and spotlight the athlete. Many doctors have a problem understanding that, because they're so used to being in the spotlight themselves. And the sooner doctors understand that's the reality in sports medicine, the happier they will be and they'll spend more of their time enjoying their ride until they get canned instead of being cutthroat, territorial, paranoid, obnoxious, and unhappy. And, if you can't handle being treated like a medical janitor, then professional sports is not for you.

This was an excellent post. Highlights quoted above. Mostly for the uninitiated here I think it bears repeating the point that most groups/docs that are "team doctors" for professional teams PAY the teams in one form or another to be their medical providers. "Team doctor" sure sounds real sexy to a lot of med students and many residents but at the end of the day it becomes a JOB and you have to truly enjoy spending UNPAID time dealing with the politics, money, and egos of professional sports.

I've always thought consultant roles a la James Andrews is the best way to go. You get the cachet of treating elite athletes, the athletes/teams actually PAY you for services, you can get a lot of the perks that team docs gets (such as tickets), but you don't have the hassle of being the team's whipping boy and having to cover dozens of games a season. Sitting behind the dugout may seem really cool at first, but when it becomes your JOB in which you have to be there even if you don't want to, and you have to miss your own kids' baseball games because of it, it ain't so fun any more.

Doesn't mean being a team doctor for elite college/pro teams isn't rewarding in some aspects, more so that it's not the dream many in the lay and uninitiated medical world like to make it out to be.
 
Sports med isn't just being a team doc, that's a very small part of my practice. Orthos want all that for themselves and will fight over it.
 
Start with the prevention of sudden cardiac death. That's the mother of them all. Why else do we do sports physicals?

I've reduced fingers and shoulders on the field and Colles in clinic before. I credit my MSK training for those skills.

I've coded a couple of athletes. Both pulseless. One I intubated when paramedics arrived. Both made it. I credit my FM training for those skills (and, of course, someone upstairs looking out for me).

Yes, on the sideline, I can suture a lac faster than a PM&R doc I've once watched fumble, and I can stick an IV faster than an ortho doc can during half-time. But that's nothing to brag about since any monkey can do that... then again, all you need is 1 monkey sideline instead of having to schedule 4 monkeys.

I manage fractures non-operatively. I do MSK ultrasounds to diagnose and I do guided and blind injections just like every other new generation of sports medicine family physicians. I'm all about the physical exam as much as I can be and yes I read my own MRI's, X rays as much as I can because I have the benefit of knowing what the physical exam was.

And yes, I can help you run faster and farther if I regulate your menstrual cycle. I can tell you why your those supplements you're taking to get big is causing your chest pain. I can help you figure out how to manage your insulin during exercise, even though you've had diabetes since you were 9 years old.

I'm a collegiate team physician and my athletes are on scholarship. Yes, I know which pimple medicines will cause you to sunburn. And, yes, I know which antibiotic to give you after you win the conference championship.

I know very well that your shoulder pain has nothing to do with your shoulder, but in fact is due to your GI system. I also know well and good that your cough and cold is going to hold you out from contact sports for 3 weeks. And that chest pain you're feeling now is related to the cough and cold you had 2 weeks ago, because I have the EKG to prove it and that's why you're done for the next 6 months.

I know that your shoulder hurts because I watched you throw every week and you throw like an idiot.

I also know that despite what you think, you don't have ADHD, so quit bugging me for Adderall. Why not let me help you with your dyslexia or anxiety, and maybe you can keep your scholarship?

The most rewarding part of my job is that all the athletes know that I care more about them than I do about their sport. Even for athletes, sports is one part of their lives. So if they can come to me with anything sports related, they can come to me with anything going on in their lives.

And, now that these kids are out of school and working for an accounting firm, I'm still their go-to guy. You want to know what's even more rewarding? Yes, it's taking that HTN and DM and making them athletes.

I don't think I'm really doing anything that's all that brilliant or hard or amazing, even though somedays people think that I do or I feel like I do.

The truth of the matter is that I'm a family doctor first. If any of that sounds worthwhile, you should go by way of FM.


Wow. That was awesome.
 
Start with the prevention of sudden cardiac death. That's the mother of them all. Why else do we do sports physicals?

I've reduced fingers and shoulders on the field and Colles in clinic before. I credit my MSK training for those skills.

I've coded a couple of athletes. Both pulseless. One I intubated when paramedics arrived. Both made it. I credit my FM training for those skills (and, of course, someone upstairs looking out for me).

Yes, on the sideline, I can suture a lac faster than a PM&R doc I've once watched fumble, and I can stick an IV faster than an ortho doc can during half-time. But that's nothing to brag about since any monkey can do that... then again, all you need is 1 monkey sideline instead of having to schedule 4 monkeys.

I manage fractures non-operatively. I do MSK ultrasounds to diagnose and I do guided and blind injections just like every other new generation of sports medicine family physicians. I'm all about the physical exam as much as I can be and yes I read my own MRI's, X rays as much as I can because I have the benefit of knowing what the physical exam was.

And yes, I can help you run faster and farther if I regulate your menstrual cycle. I can tell you why your those supplements you're taking to get big is causing your chest pain. I can help you figure out how to manage your insulin during exercise, even though you've had diabetes since you were 9 years old.

I'm a collegiate team physician and my athletes are on scholarship. Yes, I know which pimple medicines will cause you to sunburn. And, yes, I know which antibiotic to give you after you win the conference championship.

I know very well that your shoulder pain has nothing to do with your shoulder, but in fact is due to your GI system. I also know well and good that your cough and cold is going to hold you out from contact sports for 3 weeks. And that chest pain you're feeling now is related to the cough and cold you had 2 weeks ago, because I have the EKG to prove it and that's why you're done for the next 6 months.

I know that your shoulder hurts because I watched you throw every week and you throw like an idiot.

I also know that despite what you think, you don't have ADHD, so quit bugging me for Adderall. Why not let me help you with your dyslexia or anxiety, and maybe you can keep your scholarship?

The most rewarding part of my job is that all the athletes know that I care more about them than I do about their sport. Even for athletes, sports is one part of their lives. So if they can come to me with anything sports related, they can come to me with anything going on in their lives.

And, now that these kids are out of school and working for an accounting firm, I'm still their go-to guy. You want to know what's even more rewarding? Yes, it's taking that HTN and DM and making them athletes.

I don't think I'm really doing anything that's all that brilliant or hard or amazing, even though somedays people think that I do or I feel like I do.

The truth of the matter is that I'm a family doctor first. If any of that sounds worthwhile, you should go by way of FM.

This post is $. I'm starting med school in a few months (finishing up an SMP now)... and I'm saving this post in my documents to go back and read every time I start feeling like $#!+ during marathon study sessions. Thanks Doc!
 
Robostep.

Btw. PM&R can suture....at least this one can (learned in medical school, perfected on ER rotations intern medicine year)...did it the last hockey tourney I covered without trouble.

PM&R can interpret EKGs.....we do it daily managing stokes, LVADs (yes LVADs), and SCI patients on inpatient rehab.

ACLS and BLS and PALS certified...could intubate if I had to. Or bag mask or LMA or cric if needed. I also bet I could clear a c-spine before any FP doc could. Just a different skill set.

Know how to cast and splint from ER too.

See we learn all the same stuff FP does during our four years, plus we have the brain injury, spine, and MSK experience. We take care of all the same primary care problems FP and IM do on all our patients on inpatient rehab, plus we have to know all stuff mentioned above.

I could also probably deliver a baby on the field if needed, but I might tap out to my FP colleague for that one.
...

Thoughts?

I think this is probably very program dependent.

I did a PMR rotation with residents from Temple; a friend did his PMR rotation with residents from Jefferson.

Neither were accustomed to managing inpatient rehab issues. They liberally consulted medicine, psych, surgery. Moss Rehab actually had a dedicated inpatient hospitalist service that medically managed the patients; the PMR residents did not do any of that.

It was frightening how little the PMR residents remembered about basic medicine. The resident I worked with could not remember what test to diagnose a patient with HIV, and didn't know that the lab reflexively does a Western Blot if the ELISA is positive. A fellow student was told to pick out an antihypertensive for a patient because "I don't know which one to pick."

My friend who rotated with Jefferson residents told me that the PMR resident ordered an X-ray to rule out a DVT. Another resident called a code on a patient who tripped on the floor and fell - no LOC; he didn't even hit his head.

A Temple resident mentioned that there was a code on the floor during rounds; she stood aside and waited for the nurses to come and run the code. In her words, "I don't know what else to do in a code."

If any of those residents were able to correctly read and interpret an EKG, I would have fallen out of my chair in surprise.

Finally, inpatient problems are NOT primary care problems. I don't think that primary care means what you think it means.

How much outpatient pediatrics do you get? That was one thing in your post that you don't mention.

You missed the point of lowbudget's post. Yes, you get more dedicated MSK in PMR....but his point is that Sports Medicine isn't just MSK.
 
Speaking of painting w/ a broad brush......

As a Temple/Moss resident, that speaks more to you unfortunately working w/ what sounds like a a dud of a resident than of a program or field as a whole.

When I get my next referral for an EMG from an FP and the patient just clinically has a tendonopathy or referred pain I'll remember to make sure I say or imply that everyone in his/her program and the field itself is poorly trained and inadequate....not just that the individual doc was a dumba$....


I think this is probably very program dependent.

I did a PMR rotation with residents from Temple; a friend did his PMR rotation with residents from Jefferson.

Neither were accustomed to managing inpatient rehab issues. They liberally consulted medicine, psych, surgery. Moss Rehab actually had a dedicated inpatient hospitalist service that medically managed the patients; the PMR residents did not do any of that.

It was frightening how little the PMR residents remembered about basic medicine. The resident I worked with could not remember what test to diagnose a patient with HIV, and didn't know that the lab reflexively does a Western Blot if the ELISA is positive. A fellow student was told to pick out an antihypertensive for a patient because "I don't know which one to pick."

My friend who rotated with Jefferson residents told me that the PMR resident ordered an X-ray to rule out a DVT. Another resident called a code on a patient who tripped on the floor and fell - no LOC; he didn't even hit his head.

A Temple resident mentioned that there was a code on the floor during rounds; she stood aside and waited for the nurses to come and run the code. In her words, "I don't know what else to do in a code."

If any of those residents were able to correctly read and interpret an EKG, I would have fallen out of my chair in surprise.

Finally, inpatient problems are NOT primary care problems. I don't think that primary care means what you think it means.

How much outpatient pediatrics do you get? That was one thing in your post that you don't mention.

You missed the point of lowbudget's post. Yes, you get more dedicated MSK in PMR....but his point is that Sports Medicine isn't just MSK.
 
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I think this is probably very program dependent.

I did a PMR rotation with residents from Temple; a friend did his PMR rotation with residents from Jefferson.

Neither were accustomed to managing inpatient rehab issues. They liberally consulted medicine, psych, surgery. Moss Rehab actually had a dedicated inpatient hospitalist service that medically managed the patients; the PMR residents did not do any of that.

It was frightening how little the PMR residents remembered about basic medicine. The resident I worked with could not remember what test to diagnose a patient with HIV, and didn't know that the lab reflexively does a Western Blot if the ELISA is positive. A fellow student was told to pick out an antihypertensive for a patient because "I don't know which one to pick."

My friend who rotated with Jefferson residents told me that the PMR resident ordered an X-ray to rule out a DVT. Another resident called a code on a patient who tripped on the floor and fell - no LOC; he didn't even hit his head.

A Temple resident mentioned that there was a code on the floor during rounds; she stood aside and waited for the nurses to come and run the code. In her words, "I don't know what else to do in a code."

If any of those residents were able to correctly read and interpret an EKG, I would have fallen out of my chair in surprise.

Finally, inpatient problems are NOT primary care problems. I don't think that primary care means what you think it means.

How much outpatient pediatrics do you get? That was one thing in your post that you don't mention.

You missed the point of lowbudget's post. Yes, you get more dedicated MSK in PMR....but his point is that Sports Medicine isn't just MSK.

Sad to hear all of PM&R is not created equal as I am sure not all FP or other primary care is.

Ar my program, We manage all of our medical issues on inpatient rehab hospital services and consult if needed (just like a primary medicine or family medicine service would).

Unfortunately, each specialty brings our biases to the table. At my current institution, Ortho and PM&R run the entire sports medicine department. We currently have no FP, IM, ER, staff doing sports medicine, and I am at one of the largest quaternary care centers in the world. So I just do not see FP docs caring for athletes, weekend warriors, or MSK injuries. In fact, most primary care docs in our system refer most MSK issues to PM&R, Ortho, sports (PM&R) or rheum.

However, I know FP does do the lions share of primary care sports med from my experiences in college football where we had only ortho and FP as team docs.

To answer another posters question PM&R do get outpatient pediatrics.

IMHO we see everything needed for complete care of the athlete including life threatening cardiac and pulmonary issues. We do CCU and ICU and PICU months in our intern and transitional years too, plus we get all the tbi, sci, and neuromsk stuff in our three additional years.

The nice thing is sports is multidisciplinary and I am learning that every specialty brings something great to the table
 
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Are you serious? You can't be this delusional...

I should qualify this to say we learn the similar stuff needed to be excellent primary care sports physicians. I would be delusional to think I could deliver a baby or take care of sick kids to the same degree as an FP trained doc... I do think most FP docs have an advantage in the training room given three years of primary care knowledge.

Perhaps my perception is skewed because I moonlight at UC and ER so I see lots of primary care issues, I just think my year of internal medicine and post acute care of our adult and pediatric rehab population has priestess me well to care for most everything or at least know who to call if I need assistance from other specialists. The same is true for most PM&R trained residents.

I also think because most of sports is nonoperative orthopedic/MSK care that PM&R will continue to have an increased presence in sports medicine. It is delusional for people in the primary care sports world to not recognize that.

Especially since most PMR residents want to work in pain MSK and sports practices these days. The ability to do sports fellowships and get great sports and MSK exposure in residency is a huge draw to PM&R.

For now Family Med continues to dominate primary care sports and rightly so...and I for one am thrilled to learn from great FP ED and IM docs in sports fellowship. It is definitely easier to get into sports from FP given the # of primary care sports fellowships that only take FP IM or ED Residents. I just would not have chosen those paths to sports for myself. I also am a huge advocate for PM&R which may be another bias.

I just believe the OP wanted to know which path to take in pursuit of sports medicine career, so perhaps some more FP IM ER or Peds sports docs could comment on theirs primary specialties perceptions and opinions.
 
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Start with the prevention of sudden cardiac death. That's the mother of them all. Why else do we do sports physicals?

I've reduced fingers and shoulders on the field and Colles in clinic before. I credit my MSK training for those skills.

I've coded a couple of athletes. Both pulseless. One I intubated when paramedics arrived. Both made it. I credit my FM training for those skills (and, of course, someone upstairs looking out for me).

Yes, on the sideline, I can suture a lac faster than a PM&R doc I've once watched fumble, and I can stick an IV faster than an ortho doc can during half-time. But that's nothing to brag about since any monkey can do that... then again, all you need is 1 monkey sideline instead of having to schedule 4 monkeys.

I manage fractures non-operatively. I do MSK ultrasounds to diagnose and I do guided and blind injections just like every other new generation of sports medicine family physicians. I'm all about the physical exam as much as I can be and yes I read my own MRI's, X rays as much as I can because I have the benefit of knowing what the physical exam was.

And yes, I can help you run faster and farther if I regulate your menstrual cycle. I can tell you why your those supplements you're taking to get big is causing your chest pain. I can help you figure out how to manage your insulin during exercise, even though you've had diabetes since you were 9 years old.

I'm a collegiate team physician and my athletes are on scholarship. Yes, I know which pimple medicines will cause you to sunburn. And, yes, I know which antibiotic to give you after you win the conference championship.

I know very well that your shoulder pain has nothing to do with your shoulder, but in fact is due to your GI system. I also know well and good that your cough and cold is going to hold you out from contact sports for 3 weeks. And that chest pain you're feeling now is related to the cough and cold you had 2 weeks ago, because I have the EKG to prove it and that's why you're done for the next 6 months.

I know that your shoulder hurts because I watched you throw every week and you throw like an idiot.

I also know that despite what you think, you don't have ADHD, so quit bugging me for Adderall. Why not let me help you with your dyslexia or anxiety, and maybe you can keep your scholarship?

The most rewarding part of my job is that all the athletes know that I care more about them than I do about their sport. Even for athletes, sports is one part of their lives. So if they can come to me with anything sports related, they can come to me with anything going on in their lives.

And, now that these kids are out of school and working for an accounting firm, I'm still their go-to guy. You want to know what's even more rewarding? Yes, it's taking that HTN and DM and making them athletes.

I don't think I'm really doing anything that's all that brilliant or hard or amazing, even though somedays people think that I do or I feel like I do.

The truth of the matter is that I'm a family doctor first. If any of that sounds worthwhile, you should go by way of FM.

As a Urology-resident who just tore his ACL, that makes me feel a little bit inadequate.
 
I don't think I'm really doing anything that's all that brilliant or hard or amazing

See, that's the problem. You are.

As I've said a gazillion times before, primary care is easy to do poorly, but difficult to do well.

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