How do I become a PM&R Doctor?

[Sage of Pale Bones]

Hello!

I am an incoming OMS-1 who is leaning heavily towards PM&R. I am starting med school soon and could use some wisdom as my biggest fear is going unmatched, so I am trying to get a head start on this. I am attending MSUCOM which has it's own AOA recognized PM&R program and a lot of research opportunities for a DO school so I suspect I have an advantage in that regard compared.

With that said, I had a few questions as well:

1. What do I need to know/ do early on to be successful?

2. How much will having a D.O. rather than a M.D. affect my match odds?

3. Is it better to focus on acing the COMLEX or try and manage STEP + COMLLEX at the same time?

4. How Useful is OMT/OMM in PM&R. I plan to give OMM the same amount of respect and effort as I would any other class, mostly for COMLEX, but It would be great to see it be applicable in practice as a doctor.

5. How is the job outlook for PM&R and would you pick it again if you were a med student today?

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[Chelsea FC]

1. THe best thing u can do early is acclimatizing yourself to med school, dont be failing anything because you looking too far ahead and not focusing on your classes now. Second to that is getting involved in the field, volunteering workshops, networking with faculty at your home institution and elsewhere etc.

2. It wont really affect your odds much overall but it will affect ur odds at certain places. LIke Harvard/Spaulding rarely interviews DO candidates and haven't accepted one in a while. But there are more places where that wont hurt u that much than they are places that discriminate. Overall rehab is a very DO-friendly field.

3. While rehab is one of those fields that focus more on the commitment to the field over grades I think focusing on one to get the best grade is more important than doing Step+comlex and doing okayish. (im not a DO so maybe someone else can shed some light on this)

4. Not much (again im not a DO) but I think we will all learn the important topics of rehab during residency and dont see a difference between the MD and DO residents,.

5. This is an answer no one can give you without a crystal ball. When i was a medical student starting out Anesthesia job outlook was said to be bad because of CRNA but now they making bank and the market is doing great so it's hard to tell. This gets even harder to predict when fellowship and specialization come into play. Maybe gen rehab goes up but pain reimbursements keep going down so hard to tell. The would you do it again question is a tough one for rehab docs. I think rehab and rads and alot of "lifestyle" fields are filled with people who find alot of joy outside of work than doing it. So I would choose rehab again if I had to do medicine but would prob go a different route overall if I had the choice.

 

[JBM16BYU]

1. Agree with Chelsea FC. The only thing I would add is to get involved right away with AOCPMR (American Osteopathic College of Physical Medicine and Rehabilitation) and stay involved throughout medical school.

2. Being a D.O. in PM&R should not be a detrimental thing (speaking as a D.O. in PM&R). I, as well as my classmates pursuing PM&R, all got plenty of interviews are institutions throughout the USA, both the "household name" residencies and the "university of [fill in the blank state]" places. It is a very DO-friendly field and there are PM&R DOs in private practice, hospital-employed, and academia, doing everything from general PM&R to pain medicine to inpatient rehabilitation heavy fields to sports medicine. It is really a "choose your own adventure."

3. Personally, I went through this in the past 10 years. I studied for USMLE Step 1 for 6 months (since studying for Step 1 will definitely prepare you for COMLEX Level 1), took Step 1 first, then took COMLEX level 1 a few days later after spending a few days knowing all of the OMM. With combining of residencies (ACGME/AOA merger) it was supposed to make both on even playing grounds, but, in my opinion, it is easier to compare apples-to-apples than apples-to-oranges, and I didn't want that to be a hindrance for me not getting any interview somewhere if I had only chosen to take COMLEX instead of both.

4. Depends on where you look and in what branch of PM&R. I know PM&R physicians who subsequently did OMM fellowships and primarily practice as an OMM physician now. I know of ones who did sports medicine after PM&R it use it a fair amount. I also know some who do not use it at all as they do not see it as applicable in their practice setting. I think it is one of those things that if you look for where to use it, you may find ways to, but if you are not super into using it, you will still gain plenty of other tools in PM&R residency to treat patients.

5. Job outlook, like Chelsea FC, is hard to tell. That being said, PM&R can be put into so many settings that the different aspects have always survived, from General, Pain, Sports, Brain Injury, Spinal Cord Injury, Pediatric, Cancer Rehab, Neuromuscular/EDX, etc. Would I choose again? Yes, I would.

I do think it is important to know that we often suffer from somewhat of an identity crisis. Unlike cardiology, where the focus is "the heart", not many individuals know what PM&R does unless they have been educated. PM&R doesn't have the sole claim to any organ / organ system, rather we are physicians that help individuals to function in their daily life and try to help eliminate barriers that get in the way of that, whether that be a traumatic injury, genetic condition, or simple sprained ankle. that being said, we are not "functional medicine doctors" which is something different. If you tried to limit us to an organ system, I would probably say we deal mostly with the musculoskeletal and nervous systems, but we are non-operative (unlike orthopedic surgeons/neurosurgeons) but with the potential to be highly interventional (spine injections, ultrasound guided joint injections, trigger point injections, botox injections for spasticity, electrodiagnostic testing, baclofen pump programming and refills, diagnostic ultrasound, etc.), or more cerebral.

 

[Sage of Pale Bones]

@JBM16BYU @Chelsea FC
Thank you both so much!

 

[DMBandFan86]

If you learn your OMT well then you can use it in practice. I believe Michigan state is about the only PMR program that will integrate OMT into the residency training.

I do OMT only occasionally. Mostly because I’m not the best at it anymore and I have found other things I like better. It also takes a lot of time and my patients already take all the time I have with them without doing OMT. PM&R patients send to be complex and lengthy. OMT training tends to be strongest in year 1 of medical school with a small decline in year 2. Year 3 and 4 OMT will be up to your institution and attending, but typically becomes minimal. Then most of us do an allopathic residency after. I had 1 DO attending in residency and I did OMT formally 1 time (other times were informally). Unfortunately, unless you keep up a strong personal interest in OMT, then you may hardly ever do it. I’d suggest getting as good as you can in your first 2 years, then try to incorporate with patients as much as possible after if you want a strong skill set to use in practice. Skills atrophy is a real thing if you don’t keep your skills up.

OMT also works best when patients are educated in it and also want the OMT. If patients are coming to your clinic for shoulder pain and expect X-rays and allopathic treatment then they may not want the OMT. Patients typically respond better to OMT when they are sold in on the treatment.

By the way, it is a great way to get patients for the long run if you are good at OMT. You can basically OMT anyone and everything and they will always have somatic dysfunction. So theoretically is good business.

OMT in PM&R is very useful. We see pain, MSK, brain injury, etc who all could use OMT.

 

[Sage of Pale Bones]

If you learn your OMT well then you can use it in practice. I believe Michigan state is about the only PMR program that will integrate OMT into the residency training.

I do OMT only occasionally. Mostly because I’m not the best at it anymore and I have found other things I like better. It also takes a lot of time and my patients already take all the time I have with them without doing OMT. PM&R patients send to be complex and lengthy. OMT training tends to be strongest in year 1 of medical school with a small decline in year 2. Year 3 and 4 OMT will be up to your institution and attending, but typically becomes minimal. Then most of us do an allopathic residency after. I had 1 DO attending in residency and I did OMT formally 1 time (other times were informally). Unfortunately, unless you keep up a strong personal interest in OMT, then you may hardly ever do it. I’d suggest getting as good as you can in your first 2 years, then try to incorporate with patients as much as possible after if you want a strong skill set to use in practice. Skills atrophy is a real thing if you don’t keep your skills up.

OMT also works best when patients are educated in it and also want the OMT. If patients are coming to your clinic for shoulder pain and expect X-rays and allopathic treatment then they may not want the OMT. Patients typically respond better to OMT when they are sold in on the treatment.

By the way, it is a great way to get patients for the long run if you are good at OMT. You can basically OMT anyone and everything and they will always have somatic dysfunction. So theoretically is good business.

OMT in PM&R is very useful. We see pain, MSK, brain injury, etc who all could use OMT.

Thank you for your feedback. One of my top choice GME program is actually MSU's PM&R program so hopefully I will be able to keep my skills sharp!

 

[JBM16BYU]

Thank you for your feedback. One of my top choice GME program is actually MSU's PM&R program so hopefully I will be able to keep my skills sharp!

There are several previous AOA-accredited PM&R residency programs throughout the country. These will be the ones more likely to incorporate OMT into your training. That being said, I do know that there are also programs that were never AOA that also have faculty that perform OMT. You just have to ask around to find that out if it is something important to you!