Pediatric Physiatry Scope of Practice?

[phd2b]

All,
Thanks to the regulars here (in advance) for indulging me (a long-time lurker). I have an interest in pediatrics pm&r, but wonder if the relatively narrow scope limits me to practice in a large university center (Colorado, Cinci, Richmond, etc). What are the advantages of the combined residency (and potential double board certification) in peds & pm&r vs. pm&r alone with some emphasis on peds?

What is the demand for such a dual concentration?

Why do I even ask? I love kids, love rehab, and like it that most pediatric rehab patients respond favorably compared with adult (esp geriatric) patients. I like seeing the big improvements over shorter periods of time, I guess.

Any comments?

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[gecko]

I actually did a year of peds for my prelim prior to switching to PMR, and was considering peds PMR because I also love kids. I asked around several Peds PMR attendings, and recently (the past 2 yrs), there have been changes in accreditation. Before then, you can get grandfathered into peds PMR without doing a fellowship, but now, you need to do a peds PMR fellowship after finishing your 4 yrs (prelim and 3 yrs PMR) residency. This fellowship is 3 yrs (you'll have to check that as things may have changed in the last two years). If you complete a peds residency before hand, I was told that you can save 1 year off of the fellowship (so it's just 2 years). I talked to attendings at RIC and Schwabb and most recommended being double boarded in peds and rehab before doing the fellowship...I know...it's a long road. But if you really like it, it's worth pursuing.

In terms of job outlook, you should have no problems in any major city as there is an EXTREME shortage of peds PMR attendings. I heard there were only 2 or 3 South of the Southern California area (take that info with a grain of salt, cause that's just word of mouth from a Peds PMR graduate that was looking for jobs in that area).

I think what is most enjoyable with Peds PMR is the inpatient side, but because there is this new "75-25%" rule (75% of patients admitted to an acute inpatient rehab facility need to fall under a short list of rehab diagnoses), I'm not sure how the inpatient setting of peds PMR will be affected.

While doing my PMR residency, I decided not to do peds PMR, because it is a ton of paperwork (more than general peds)...and I hate paperwork. Also, many of the peds PMR patients don't tend to improve all that much. Many of them have congenital disorders that don't really improve much after therapy. It can be quite depressing really. But do a rotation....that's the best way to figure out if you'd want to do it. Everyone has different likes and dislikes.

Good luck.

 

[phd2b]

I actually did a year of peds for my prelim prior to switching to PMR, and was considering peds PMR because I also love kids. I asked around several Peds PMR attendings, and recently (the past 2 yrs), there have been changes in accreditation. Before then, you can get grandfathered into peds PMR without doing a fellowship, but now, you need to do a peds PMR fellowship after finishing your 4 yrs (prelim and 3 yrs PMR) residency. This fellowship is 3 yrs (you'll have to check that as things may have changed in the last two years). If you complete a peds residency before hand, I was told that you can save 1 year off of the fellowship (so it's just 2 years). I talked to attendings at RIC and Schwabb and most recommended being double boarded in peds and rehab before doing the fellowship...I know...it's a long road. But if you really like it, it's worth pursuing.

In terms of job outlook, you should have no problems in any major city as there is an EXTREME shortage of peds PMR attendings. I heard there were only 2 or 3 South of the Southern California area (take that info with a grain of salt, cause that's just word of mouth from a Peds PMR graduate that was looking for jobs in that area).

I think what is most enjoyable with Peds PMR is the inpatient side, but because there is this new "75-25%" rule (75% of patients admitted to an acute inpatient rehab facility need to fall under a short list of rehab diagnoses), I'm not sure how the inpatient setting of peds PMR will be affected.

While doing my PMR residency, I decided not to do peds PMR, because it is a ton of paperwork (more than general peds)...and I hate paperwork. Also, many of the peds PMR patients don't tend to improve all that much. Many of them have congenital disorders that don't really improve much after therapy. It can be quite depressing really. But do a rotation....that's the best way to figure out if you'd want to do it. Everyone has different likes and dislikes.

Good luck.

Thanks for the reply. I guess I can't understand why you'd want to do an additional 3 year fellowship if you did one of the five combined programs. http://www.ama-assn.org/vapp/freida/pgmrslt/1,1239,,00.html

With all of that training, what is their compensation like?

Thanks again.

 

[Stinky Tofu]

While it might be ideal to do a combined program and then a fellowship, the reality is that no one will do it. Even when they were grandfathering people, they couldn't find enough people interested in Peds PM&R. In the history of our program, no one has ever applied for a Peds PM&R fellowship. I think it's a great field, but not many people are interested in the fellowships and hence the shortage.

Another option you might want to consider is doing a PM&R residency followed by a one-year fellowship in Pediatric Pain Management. I think if you have the skills sets of a Physiatrist (without a Pedi fellowship) combined with the tools from a Pediatric Pain fellowship, you'd be just as (if not more) desirable than someone who has done training longer than some Neurosurgery residencies.

 

[rehabmd]

The reason it is important to be double boarded is because most rehab departments wont invest in pediatric rehab bc it is not lucrative, and most pediatiricans refer their neuromuscular pts directly to pedaitric orthopedists, neurologists and physical therapists. If you want someone to hire you as a pediatric physiatrist, you are more likely to get a job though the pedaitirics department than rehab dept, but the peds depts trusts people in their own specialty. THe AAPediatrics just started their own one year equivalent to a pedaitric rehab fellowship called a neurodevelomental disability fellowhip open to peds, neuro and psych, not physiatrists.

 

[pedspm&R]

I am a double board trained peds rehab doctor. Just to clarify: the two current pathways are a four year PM&R residency + a 2 year peds PM&R fellowship or a 5-year combined peds/PM&R program + a one year peds PM&R fellowship (both being a 6 year duration). After completing the 6 years, one can sit for the Pediatric Rehabilitation Medicine certificate (if already boarded by the ABPMR). The benefit of the PRM certificate, as recently discussed at the AAPM&R convention last week, is that one will need to recertify only in PRM and not in the ABPMR recertification exams. That is a huge benefit to those of us who practice peds rehab, as we see a more generalized patient population of TBI's, SCI's, myelo, CP, congenital deficits, but rarely have exposure to the musculoskeletal/chronic pain/EMG/procedural part of PM&R that is covered heavily on the adult board certifications. This in itself would be incentive to do the fellowship after residency if you plan to practice peds rehab.
I think both programs likely have their benefits. A large part of my practice is inpatient and consulting, so the general peds training helps me out a lot with haveing a better comfort level with sick kids, I think. In addition, I would agree with the above poster in that there are likely better working environments/comraderie if pediatric certified and working in a Children's Hospital. In addition, many third party payors are insisting on a board certified peds trained physician with privileges on a peds rehab unit. SO recruitment is probably more for the double boarded physicians in some institutions.

 

[phd2b]

I am a double board trained peds rehab doctor. Just to clarify: the two current pathways are a four year PM&R residency + a 2 year peds PM&R fellowship or a 5-year combined peds/PM&R program + a one year peds PM&R fellowship (both being a 6 year duration). After completing the 6 years, one can sit for the Pediatric Rehabilitation Medicine certificate (if already boarded by the ABPMR). The benefit of the PRM certificate, as recently discussed at the AAPM&R convention last week, is that one will need to recertify only in PRM and not in the ABPMR recertification exams. That is a huge benefit to those of us who practice peds rehab, as we see a more generalized patient population of TBI's, SCI's, myelo, CP, congenital deficits, but rarely have exposure to the musculoskeletal/chronic pain/EMG/procedural part of PM&R that is covered heavily on the adult board certifications. This in itself would be incentive to do the fellowship after residency if you plan to practice peds rehab.
I think both programs likely have their benefits. A large part of my practice is inpatient and consulting, so the general peds training helps me out a lot with haveing a better comfort level with sick kids, I think. In addition, I would agree with the above poster in that there are likely better working environments/comraderie if pediatric certified and working in a Children's Hospital. In addition, many third party payors are insisting on a board certified peds trained physician with privileges on a peds rehab unit. SO recruitment is probably more for the double boarded physicians in some institutions.

To revisit this a little. I believe that I now understand the political side of doing a fellowship if one wants to associate with a children's hospital. Can anyone address any possible differences in compensation associated with the different options address in the previous posts? As someone suggested, 6 years is the equivalent of some neurosurgery residencies, and most folks would want some additional compensation to account for the extra years of training.

Please advise and thanks in advance...