Pediatric Rehab

[DCHawk10]

I am a medical student interested in Pediatric Rehab. I notice on FREIDA that there are only 4 programs in the whole country, so I assume it's pretty competitive. Does anyone know if there is any plan to create more programs? Also, just how necessary is it to get a fellowship since you can already treat all ages with General PMR? What are the advantages/disadvantages? I've thought of doing combined Peds/PMR as well, but the number of programs (5) is just as scarce. Any thoughts? Any info about Pediatric Rehab in general would be welcome.

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[rehab_sports_dr]

Most people I've talked to seem to prefer the regular PM&R residency with 2 years peds PM+R fellowship

Peds physiatry is really a distinct beast, and those I know who do it don't do very much general pediatrics- thus, the extra training in Pediatrics residency wasn't that helpful.

Spending more time in fellowship allows them to develop the more core skills that a peds physiatrist needs- especially technical skills like Botox injections and alcholol blocks, but also knowledge bases like gait deviations.

It's similar to why not very many people do combined medicine and PM+R programs- it's extra training that doesn't really reflect your scope of practice.

The other thing to keep in mind is that by considering all PM+R programs instead of just the one's that have a combined PM+R/Peds residency, it gives you more choice of programs, so you should be able to get a better fit for your needs.

I would just look for a program that has a very good Peds rehab experience. UC-Davis is famous for their peds, but many of the other programs have very good experiences too.

For what it is worth, I know the residents at our program (Kessler) think that Peds is one of the major strengths.

 

[Disciple]

I am a medical student interested in Pediatric Rehab. I notice on FREIDA that there are only 4 programs in the whole country, so I assume it's pretty competitive. Does anyone know if there is any plan to create more programs? Also, just how necessary is it to get a fellowship since you can already treat all ages with General PMR? What are the advantages/disadvantages? I've thought of doing combined Peds/PMR as well, but the number of programs (5) is just as scarce. Any thoughts? Any info about Pediatric Rehab in general would be welcome.

I think there are more like, 11 programs.

Peds rehab is quite complex, and most programs only include 1-3 months in their curriculum. Additionally, you must do the fellowship for subspecialty certification even if you're in a combined program. So yes, I would say the fellowship is necessary.

As far as getting a spot, I don't think it will be a problem as long as you have some exposure and a good LOR from your peds rehab attending. We had a resident get a spot for peds fellowship next year and supposedly the applicant pool was 7. The year before it was 2 or 0.

 

[DCHawk10]

It's my understanding that you can either do a combined peds/pmr residency and then do 1 year of peds pmr fellowship, or you can do a regular pmr residency and then do 2 years of peds fellowship. My question is, if your preliminary year for pmr is in pediatrics, are you thus eligible for the 1 year peds pmr fellowship?

 

[melancholy]

It's my understanding that you can either do a combined peds/pmr residency and then do 1 year of peds pmr fellowship, or you can do a regular pmr residency and then do 2 years of peds fellowship. My question is, if your preliminary year for pmr is in pediatrics, are you thus eligible for the 1 year peds pmr fellowship?

I have a friend who matched to Cinn. for their combined peds/PM&R program. From what she said, after you've completed the residency you can sit for both of the boards. From what I remember, there were only three programs, each with one spot (Colorado, Cinn, DuPont) unless I am mistaken for this particular combination specialty.

She was less interested in adult rehab and more interested in pediatrics, so she felt this was a better route for her than doing a general PM&R residency, then a peds fellowship. That being said, she did state that because there were not many programs, the flexibility in their rotation schedules switching between peds and PM&R was quite lessened.

If i recall correctly, going this route also decreases your total residency time by one year versus a general PM&R residency followed by a 2 year peds rehab fellowship.

Anyone else, please correct me if my information is wrong. Thanks!

 

[MM9]

If i recall correctly, going this route also decreases your total residency time by one year versus a general PM&R residency followed by a 2 year peds rehab fellowship.

Anyone else, please correct me if my information is wrong. Thanks!

First of all, Peds Rehab is a great field. The OP's early interest in it is wonderful. Might I ask how you came to learn about it? I've always wanted to be a doctor, but didn't learn about rehab, let alone peds rehab, until med school.

The combined program is 5 years. The 'regular' route is 1+3+2, or 6 years. However, from what I glean from this website, http://www.abpmr.org/certification/subspecialty.html, starting in 2008 the only way to sit for the Peds Rehab boards (PRM) is to complete either the combined program PLUS the one year fellowship (5+1) OR the 'regular' route. Up until 2007, you can sit for the boards if you can verify that you have worked in PRM for 3 years after completing training in PM&R. So basically for anyone considering the field or in residency now, the only way to become board certified is to do one of the fellowships.

The combined program allows you to board in Pediatrics and PM&R, but not PRM. I'm pretty sure you'd always be able to find work after 'just' completing the 5 years of the combined program, but to actually be board certified in both PM&R and Peds Rehab Medicine, it seems like you'd have to do an extra year.

 

[DCHawk10]

First of all, Peds Rehab is a great field. The OP's early interest in it is wonderful. Might I ask how you came to learn about it? I've always wanted to be a doctor, but didn't learn about rehab, let alone peds rehab, until med school.

I actually first learned about PMR after reading "Ultimate guide to choosing a medical specialty" by Brian Freeman (highly recommend it to anyone), and the chapters on PMR and Peds really just stood out as specialties I could see myself doing and enjoying. Since then, I've just been looking for more info about PMR through SDN and other sites.

Thanks, MM9, and everyone else for providing info.

Would anyone happen to know the current (and/or projected) demand for pediatric physiatrists?

 

[axm397]

I just PM-ed you.

 

[MM9]

I just PM-ed you.

Axm, is there any wisdome in your PM you'd like to share with the rest of us?

 

[axm397]

Sure - I gave him names of residents that came up on the AAPMR mentor database when I searched under pediatrics. there is also a PGY4 at RIC who will soon be double boarded in peds and PM&R and is going for his ped fellowship at Colorado. Since he wasn't listed in the database, I told DCHawk10 I can see if the guy is willing to give his email address to him.

 

[MM9]

Sure - I gave him names of residents that came up on the AAPMR mentor database when I searched under pediatrics. there is also a PGY4 at RIC who will soon be double boarded in peds and PM&R and is going for his ped fellowship at Colorado. Since he wasn't listed in the database, I told DCHawk10 I can see if the guy is willing to give his email address to him.

Thanks. I didn't mean to pry. I really just wondered if you'd commented on any of the above.

 

[hyper_74]

Does anyone know if most of the people that match into a peds rehab fellowship also did their residency at that same institution?

Just wondering if you are completely set on peds rehab, if you should try to be getting your residency at a spot that also has a fellowship.

 

[Hemisphere]

what is the outlook for peds rehab as a field? considering the population is "aging" and such is there a good market for PM&R/peds fellowship trained docs?

Does anyone know if most of the people that match into a peds rehab fellowship also did their residency at that same institution?

Just wondering if you are completely set on peds rehab, if you should try to be getting your residency at a spot that also has a fellowship.

 

[PMRKIDZDOC]

Thanks. I didn't mean to pry. I really just wondered if you'd commented on any of the above.

Boy this is embarassing after reading the message board...I wsa forwarded this site by a colleage of mine to answer your questions...

I am currently boarded in pediatrics and finishing my PMR residency and I elected to do a Peds-PMR fellowship next year.

To answer your first question--YES there are a lot of pediatics PMR jobs out there..

But i guess the major question is if I you are intrested in pediatric rehab what and should you do??? Combined program vs. PMR and fellowship vs. peds PMR.

First of all if you do plan on doing a PMR residencey with just the pediatric fellowship I would highly reccomend doing your "transition" year in pediatrics. I can tell you for a fact that all the pediatric fellowships in my opinion do not give adequate general pediatric knowledge...Here is the rationale ---or my reasoning why I think being Pediatric-board elligible (regardless of your method) is the way to go.....

In order to PMR you must do a transition year so that you have an understanding of medicine...but they do not account for that to do a peds fellowship...so if you are going to run an inpatient unit you need to KNOW pediatric medicine. Many of the jobs out there require inpatient experience (especially if you want a directorship) Many of the peds-rehab units have to employ hospitalists because they aren't able to manage their own units...There are also other potential jobs who only want double boarded attendings....The other difficulty is that peditricians only trust other pediatricians...it is much harder to get into a field and get pediatricans (or even other pediatrics subspecialists to refer to you) by not being a pediatrican

The other thing to consider is how you visualize yourself...are you a physiatrist who likes kids or are you a pediatrician who wants to help children with special needs/ sports medicine and spinal cord injuries. I love my pedaitric experiences in PMR..I HATE ADULTS....3 years of general PMR was extremely painful...I have thought about quitting a thousand times..the point is you ahve to decide what your dedication level is....if you do not want to do the long haul and something comes up in your life what would you rather be when you grow up a general pediatrician or an adult PMR doc...

Before I make this too long---becuase I can go on and on---let me know if you have any specific questions, something you want me to elaborate on ...I will be more than happy to respond

 

[DocWiz]

Does anyone have any info regarding where and what kind of setting does most Ped Physiatrists work in? I suspect it is mostly academia. Is there any private practice oppurtunities? Also, anyone has any idea regarding salary range for Ped Physiatrist?

 

[rehabmd]

As of this month, due to a change in the bylaws of the AAP(Am Acad of Pediatrics) board certified pediatric physiatrists(who are not pediatricians) can apply for membership in the American Academy of Pediatrics as a Specialty Fellow in the Council of Children with Disability, which means they can use the FAAP(Fellow of the American Academy of Pediatrics) title which non-pediatrician peds ortho and peds neuro and peds psych are allowed to use. More importantly,it gives pediatric physiatrists a community to belong to with a very strong leadership in caring for children with disability, sports medicine and exercise. It also enables Physiatry FAAP to apply for membership in other AAP councils such as the council for Sports Medicine and Exercise, which is comprised mostly of pediatricians with sports fellowships by the ACSM. The annual AAP(Am Acad of Pediatrics) conference has some of the best sports medicine lectures and workshops I have ever been to. (Most athletes are young)
In response to your question, currently most private practice jobs in pediatric rehab are in the area of pediatric sports medicine, when a pediatric physiatrist is affiliated with a hospital based or private pediatric orthopedic or family practice practice, which is not very common. It is uncommon to sustain a private practice caring just for children with special needs (eg CP, DMD), but the AAP is working on a Medical Home Initiative to improve coordination of care.

Does anyone have any info regarding where and what kind of setting does most Ped Physiatrists work in? I suspect it is mostly academia. Is there any private practice oppurtunities? Also, anyone has any idea regarding salary range for Ped Physiatrist?

 

[drlena]

hello all..i am in med school b/c i want to do peds rehab...but feel kind of confused about which route to take (i guess everyone feels like that)...is it necessary to be PPMR board certified..or would it suffice to be peds certified and pmr board certified??? also, if i want a combined program, does anyone have suggestions about how to go about actually getting that program...i am shadowing docs there, doing rotations there, etc...idoes anyone have any suggestions about anything else i should do??? i know the programs are competitive but it seems like the interest is lacking...and if i dont match with the dual programs, what are some of the pmr programs with good peds expereince??

any advice is great...

 

[rehabmd]

As a non pedaitrician pediatric physiatrist, I highly recommend doing a double board program, since most physiatry depts play a marginal role in caring for pediatric patients with disabilities or sports injuries. Pediatricians and FP's will see these kids and refer them to ortho to be evaluated for primarily non surgical orthopedic issues like flat feet and osgood schlatter; neuromuscular issues will go to pediatric neurologists. Infants and toddlers with dev disability who need PT/OT or ST will be referred by most pedaitricians nationwide to Early Intervention Specialists, who are primarily PT's/OTs ST and Special educators. I work as an early intervention specialist in order to get referrals into my office for children with disability. Most adult physiatrists who will train rehab residents dont have a clear understanding of normal and abnormal child neuromuscular development, which you can learn by doing electives as a peds resident in pediatric neurology/orthopedics or developemntal peds.You will receive mentorship and more financial support from your pediatric and orthopedic chairman. They see you as a fellow physiaian and recognize the huge need for outpatient pediatric physaitrists bc they are accountable and care about patients. I know when I attend conferences attended by pedaitricians, orthoepds and FPs caring for children wih musculoskeletal problems, I feel like there is leadership there that is lacking in our specialty. 3/4 NYC 's largest hospitals have no pediatric physiatrists on staff. Rusk is the only one that does and she runs an inpt peds rehab unit. When a pedaitric chair or orthpedic chairman sees that you have an interest and skills in caring for children with musculoskeletal problems, they will invest in you, while your rehab dept will only pay you to work on their in patient unit, and waste a large portion of your residency time doing intern level or PA level scutwork. Pediatricians and orthopedics surgeons and pediatric neurologists collaborate alot, and your pedaitric chairman can help you collaborate with ortho and neuro, but most rehab depts have strange issues with orthopedics depts, resulting in limited exposure and training of rehab residents in musculoskeltal eval and treatment, ie the rehab chair of Col/Cornell wont even allow the ortho chair to hire and pay for a ped physiatrist, even though CC has the largest children's hospital in NYC. I believe this has a lot to do with direct access issues for therapists and the rehab depts that depend on them. Such issues dont exist in the mind of pediatricians and orthopedics surgeons, who will see you as a fellow physician, who cares for patients(regardless of them being inpatients or outpatients). Email or call Dr Jacob Neufeld, who is a double boarded pediatric physiatrist who runs the fellowship in Virginia (?MCW)-he had provided me invaluable mentorship and career direction via phone and email a few years ago, even though he barely knew me.

hello all..i am in med school b/c i want to do peds rehab...but feel kind of confused about which route to take (i guess everyone feels like that)...is it necessary to be PPMR board certified..or would it suffice to be peds certified and pmr board certified??? also, if i want a combined program, does anyone have suggestions about how to go about actually getting that program...i am shadowing docs there, doing rotations there, etc...idoes anyone have any suggestions about anything else i should do??? i know the programs are competitive but it seems like the interest is lacking...and if i dont match with the dual programs, what are some of the pmr programs with good peds expereince??

any advice is great...