More basic info on PM&R please

[Shujo]

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Hi, I am a 3rd year medical student who is interested in PM&R.

1. I do not know what PM&R physicians actually do on a day to day basis and am having a hard time finding that out.

2. I am interested in doing a rotation in PM&R but can’t tell which programs are better than others. I have heard that the program in El Paso is good.

3. I also have questions about private practice. I am interested in opening a gym that rehabilitates neuro, cardiac, and physical injuries. Is this feasible?

4. I heard that physiatrists just manage physical therapists and do not do much with the patient themselves. This came from an upperclassman who did a rotation in PM&R and ultimately chose Orthopedics. Is this true? I have 10 years of massage therapy experience and would like some interaction with patients.

Sorry about the basic questions, just getting started with my inquiry into PM&R, Thanks.

 

[axm397]

Hi, I am a 3rd year medical student who is interested in PM&R.

1. I do not know what PM&R physicians actually do on a day to day basis and am having a hard time finding that out.

2. I am interested in doing a rotation in PM&R but can’t tell which programs are better than others. I have heard that the program in El Paso is good.

3. I also have questions about private practice. I am interested in opening a gym that rehabilitates neuro, cardiac, and physical injuries. Is this feasible?

4. I heard that physiatrists just manage physical therapists and do not do much with the patient themselves. This came from an upperclassman who did a rotation in PM&R and ultimately chose Orthopedics. Is this true? I have 10 years of massage therapy experience and would like some interaction with patients.

Sorry about the basic questions, just getting started with my inquiry into PM&R, Thanks.

Try checking out the FAQs first: http://forums.studentdoctor.net/showthread.php?t=400935

 

[MSKalltheway]

Hi, I am a 3rd year medical student who is interested in PM&R.

1. I do not know what PM&R physicians actually do on a day to day basis and am having a hard time finding that out.

This is likely found in the FAQ's. The absolute best way to find out would be to shadow (although since you are in your 3rd year I know that would be very difficult at this point) or to do a rotation.

2. I am interested in doing a rotation in PM&R but can’t tell which programs are better than others. I have heard that the program in El Paso is good.

This is extensively talked about in the FAQ's, you'll have no problem finding this.

3. I also have questions about private practice. I am interested in opening a gym that rehabilitates neuro, cardiac, and physical injuries. Is this feasible?

Our more experienced attendings who post here can speak to this better, but I think doing something like this would take a certain business sense. Don't see why it wouldnt be possible, I've heard of docs opening up things like day spas...

4. I heard that physiatrists just manage physical therapists and do not do much with the patient themselves. This came from an upperclassman who did a rotation in PM&R and ultimately chose Orthopedics. Is this true? I have 10 years of massage therapy experience and would like some interaction with patients.

This upperclassman likely was displeased with his/her rotation. I don't find it to be like this at all...it's easy to shortchange any specialty when you don't enjoy it, Orthopedics is no different. I wouldn't worry about interacting with patients, you get plenty of that in PM&R, often lasting contact too like FP or general IM. I think its very inaccurate to say physiatrists do little with the patient, other specialties don't do any more than PM&R does from what I've seen.

Sorry about the basic questions, just getting started with my inquiry into PM&R, Thanks.

Like axm said, its better to browse the FAQ's for most of your questions, but I know some of your specifics may or may not be addressed (I don't remember since its been a while I have cruised SDN for questions), so I can take up a few from my perspective. Look above where I quoted you to find my answers (in boldface). I hope this helps!

 

[Shujo]

Thank you both. I will read the FAQS.
If you have any info on specific programs I would be interested.
Thanks again.

 

[dc2md]

shujo,
your best bet for finding info on specific programs is to take a look at the Freida site from the AMA and to check out the "interview experiences" (or similarly named) threads from SDN.

basic advice: get a PM&R rotation set up at ANY PM&R program with exposure to both inpatient and outpatient. and better yet, get a rotation at one of the more prestigious programs b/c they'll have the opportunity to get letters of recommendation from the bigger names in PM&R that will carry the most weight. and MSKalltheway is right, the best way to learn what a physiatrist does is call one up, tell the receptionist you're a medical student interested in PM&R and would it be alright for you to come to the office one day and shadow Dr. Whatever...pick a physiatrist with an outpatient clinic similar to what you're wanting to set up. and if that doc leaves a bad taste in your mouth about PM&R, go and shadow another one.
good luck.
-chris

addition: check out the medical student section from the AAPM&R (our national academy)...here's the link

 

[Shujo]

Much appreciated. The link is very helpful.
Shujo

 

[dc2md]

I forgot to mention that the AAPM&R has volunteer mentors for medical students. You can search by program (RIC, mayo, lsu, etc.), state, region (north, south, etc), city, and country. Then, just email one of the mentors that has a listed PM&R interest (pain, msk, sports, tbi, etc.) similar to your own and off you go making connections, networking, and learning a ton about PM&R. I wish I had known about this a few years ago.
I'm sending in my application to be a mentor tomorrow so I'll be on there shortly.
Good luck.

 

[Llenroc]

Hi, I am a 3rd year medical student who is interested in PM&R.

1. I do not know what PM&R physicians actually do on a day to day basis and am having a hard time finding that out.

I'm doing my PM&R rotation right now. It's tough to describe in one sentence what exactly a Physiatrist does. And a lot of guides out there are pretty worthless in their description, as they talk in broad terms without discussing specifics.

Basically, there's inpatient rehabilitation and outpatient physical medicine.

When you do inpatient rehabilitation, you are essentially the primary care (Internal Medicine) doctor who rounds on the patient's each morning, and manages their chronic medical conditions and ship them back to the main hospital when they develop new, severe acute conditions. The afternoon is spent discharging and admitting new patients. You meet with physical therapists, occupational therapists, psychologists, social workers, etc. once a week at a treatment team meeting to provide feedback on the patient's medical issues. It is at these meetings that rehab. goals are discussed, and a discharge date is set. There are usually a few different services (which represent some of the main reasons someone would go in for acute rehab. hospitalization in the first place): stroke, traumatic brain injury, spinal cord injury, and general (which includes orthopedic and neurosurgery patients after their procedures, and others who are "deconditioned" from long stays in the hospital). However, they all operate pretty much the same way. Inpatient rehabilitation is very similar to an Internal Medicine or Neurology service (though not nearly as intense in overnight call/patient emergencies and turnover rate), which is why some people dislike it.

Outpatient physiatry will consist of different specialized clinics. A general clinic for example will see patient's previously hospitalized in rehabilitation hospitals and adjust various pain, depression, and neurological medications. A spasticity clinic will involve adjusting the baclofen dosage of patients with severe spasticity from stroke, cerebral palsy, etc. An EMG clinic will involve performing numerous NCV's and EMG's on patient's referred for peripheral nerve conditions like Carpal Tunnel syndrome. A wheelchair clinic will assess patient's problems with their wheelchairs. A TBI clinic will involve managing the neurological issues of patient's who have suffered traumatic brain injury in the past, and are now well past their stay in an acute rehab. hospital. Same with spinal cord injury clinic.

2. I am interested in doing a rotation in PM&R but can't tell which programs are better than others. I have heard that the program in El Paso is good.

I wasn't aware El Paso had a program. In Texas, Baylor is supposed to be good.

3. I also have questions about private practice. I am interested in opening a gym that rehabilitates neuro, cardiac, and physical injuries. Is this feasible?

My impression is that these rehabiliation hospitals are quite expensive and are owned by corporations, academic medical centers, or health care groups, who then employ Physiatrists. I'm not sure if outpatient rehabilitation places like you describe even need Physiatrists. Physiatrists do not oversee PT, OT, SLP, etc. The outpatient clinics however are owned by the Physiatrists themselves.

4. I heard that physiatrists just manage physical therapists and do not do much with the patient themselves. This came from an upperclassman who did a rotation in PM&R and ultimately chose Orthopedics. Is this true? I have 10 years of massage therapy experience and would like some interaction with patients.

Actually, from what I've seen, at least at the major rehabiliation hospitals the Physiatrists have very little power over the physical therapists, and do not involve themselves excessively in the day to day details of what they do. The PT's have as much, if not more say in how long a patient gets to stay. What is true however is that Physiatrists perform no actual physical therapy themselves. At my institution it would be totally bizarre to see a Physiatrist peform a massage on someone, let alone any kind of physical or occupational therapy. I have however seen Physiatrists assess things like strength and gait on rounds, during which they may hold a patient up themselves.

 

[Fin-Nor]

sounds a lot like how my current rotation is going. 🙂

I'm doing my PM&R rotation right now. It's tough to describe in one sentence what exactly a Physiatrist does. And a lot of guides out there are pretty worthless in their description, as they talk in broad terms without discussing specifics.

Basically, there's inpatient rehabilitation and outpatient physical medicine.

When you do inpatient rehabilitation, you are essentially the primary care (Internal Medicine) doctor who rounds on the patient's each morning, and manages their chronic medical conditions and ship them back to the main hospital when they develop new, severe acute conditions. The afternoon is spent discharging and admitting new patients. You meet with physical therapists, occupational therapists, psychologists, social workers, etc. once a week at a treatment team meeting to provide feedback on the patient's medical issues. It is at these meetings that rehab. goals are discussed, and a discharge date is set. There are usually a few different services (which represent some of the main reasons someone would go in for acute rehab. hospitalization in the first place): stroke, traumatic brain injury, spinal cord injury, and general (which includes orthopedic and neurosurgery patients after their procedures, and others who are "deconditioned" from long stays in the hospital). However, they all operate pretty much the same way. Inpatient rehabilitation is very similar to an Internal Medicine or Neurology service (though not nearly as intense in overnight call/patient emergencies and turnover rate), which is why some people dislike it.

Outpatient physiatry will consist of different specialized clinics. A general clinic for example will see patient's previously hospitalized in rehabilitation hospitals and adjust various pain, depression, and neurological medications. A spasticity clinic will involve adjusting the baclofen dosage of patients with severe spasticity from stroke, cerebral palsy, etc. An EMG clinic will involve performing numerous NCV's and EMG's on patient's referred for peripheral nerve conditions like Carpal Tunnel syndrome. A wheelchair clinic will assess patient's problems with their wheelchairs. A TBI clinic will involve managing the neurological issues of patient's who have suffered traumatic brain injury in the past, and are now well past their stay in an acute rehab. hospital. Same with spinal cord injury clinic.



I wasn't aware El Paso had a program. In Texas, Baylor is supposed to be good.



My impression is that these rehabiliation hospitals are quite expensive and are owned by corporations, academic medical centers, or health care groups, who then employ Physiatrists. I'm not sure if outpatient rehabilitation places like you describe even need Physiatrists. Physiatrists do not oversee PT, OT, SLP, etc. The outpatient clinics however are owned by the Physiatrists themselves.



Actually, from what I've seen, at least at the major rehabiliation hospitals the Physiatrists have very little power over the physical therapists, and do not involve themselves excessively in the day to day details of what they do. The PT's have as much, if not more say in how long a patient gets to stay. What is true however is that Physiatrists perform no actual physical therapy themselves. At my institution it would be totally bizarre to see a Physiatrist peform a massage on someone, let alone any kind of physical or occupational therapy. I have however seen Physiatrists assess things like strength and gait on rounds, during which they may hold a patient up themselves.