PM&R with Interest in Spina Bifida + Traumatic Brain Injury

[sardonicmedicine]

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Hi everyone, I was recently (and luckily) accepted to med school (MD) and am very interested in PM&R as a specialty. In particular my interests lie in spina bifida and traumatic brain injury. I value (1) developing long-term relationships with disabled patients and their families and (2) working in a team environment with other physicians and healthcare providers.

Here are a few questions I have that I don't believe are covered in any of the sticky threads:

1) Are there any other specialties I should be considering given my current interests and values? Pediatrics, neurology, neurosurgery, and orthopedic surgery seem like obvious alternatives (and perhaps even psychiatry). I'm hesitant about going into internal medicine (though the SDN quiz says my personality would be a good match for it).

2) After residency, can I do multiple fellowships (pediatric rehabilitation + brain injury)?

3) Is it better to do a prelim year in internal medicine or pediatrics given my interest in pediatric rehabilitation? What are the advantages and disadvantages of doing a prelim year in internal medicine? What are the advantages and disadvantages of doing a prelim year in pediatrics? Should I do a transitional year instead if I somehow get into one? What are the advantages and disadvantages of doing a transitional year relative to a prelim year? I've read in previous threads that a prelim year in general surgery is normally not a good idea (and I have very little interest in surgery, though of course it is too early to say for sure). What exactly are the advantages and disadvantages of doing a prelim year in general surgery?

4) What residency programs are best at (or known for) preparing their residents well in pediatric rehabilitation? I am open to any locations and do not really care about prestige (i.e. Doximity rankings). I have a preference for NYC, but it is not at all a deal breaker.

5) What residency programs are best at (or known for) preparing their residents well in traumatic brain injury? I am open to any locations and do not really care about prestige (i.e. Doximity rankings). I have a preference for NYC, but it is not at all a deal breaker.

6) What are the advantages and disadvantages of doing a combined residency in pediatrics and PM&R relative to doing a residency in just PM&R and then doing a fellowship in pediatric rehabilitation?

7) Are there any books worth reading about the history and future of PM&R? I was a non-science major in undergrad (not history, but sort of similar) and love these sorts of books.

8) What are the current research trends in spina bifida and traumatic brain injury? I don't have much experience doing research in either of these two topics, but would love to learn what seminal articles or books I should read to get a sense of where to start. I have grad school experience in cost-effectiveness research (i.e. modeling, data analysis, etc.). Is there a current need for this in researching spina bifida or traumatic brain injury?

9) For a spinal cord injury fellowship, do you come into contact with spina bifida patients? From what I've read, it's not clear.

10) Can a PM&R physician be a team doctor for a sports team? Do they have to have a fellowship in sports medicine? Despite my primary interest in treating disabled patients, I also have career interests in working for a sports team (but not exclusively).

Thank you in advance for anyone who answers any of these questions! I've been reading (and searching through) this subforum for the last week since my acceptance and have learned a lot.

 

[RangerBob]

I copied your post and put my answers in blue (I know everyone else uses red, but I never liked red--red is for corrections...) so you can differentiate them from your questions:

Hi everyone, I was recently (and luckily) accepted to med school (MD) and am very interested in PM&R as a specialty. In particular my interests lie in spina bifida and traumatic brain injury. I value (1) developing long-term relationships with disabled patients and their families and (2) working in a team environment with other physicians and healthcare providers.

Congratulations on your acceptance! And that's great you're already interested in PM&R--I didn't learn about it until late in my 3rd year of medical school.

Here are a few questions I have that I don't believe are covered in any of the sticky threads:

1) Are there any other specialties I should be considering given my current interests and values? Pediatrics, neurology, neurosurgery, and orthopedic surgery seem like obvious alternatives (and perhaps even psychiatry). I'm hesitant about going into internal medicine (though the SDN quiz says my personality would be a good match for it).

Your interests are pretty specific, and peds PM&R and general PM&R are really the best two specialties that match those interests. But I would encourage you to go into medical school with an open mind and try to gain as much as you can on your rotations. You may find that you fall in love with urology or geriatrics. I was convinced I was going to do psych when I entered medical school, and up until most of the way through 3rd year that was how I felt. It's great that you know what you want to do, so do what you can to advance you interest in the field, but just keep the door open to others in case you find something else that's a better fit or something you love more.

2) After residency, can I do multiple fellowships (pediatric rehabilitation + brain injury)?

You can, but I'm not sure why you'd want to. Peds rehab is a 2yr fellowship and brain injury is a HUGE part of that fellowship. Half the consults I got on my peds rotation were brain injuries, so I really don't think a BI fellowship would help, unless you want adult BI experience.

3) Is it better to do a prelim year in internal medicine or pediatrics given my interest in pediatric rehabilitation? What are the advantages and disadvantages of doing a prelim year in internal medicine? What are the advantages and disadvantages of doing a prelim year in pediatrics? Should I do a transitional year instead if I somehow get into one? What are the advantages and disadvantages of doing a transitional year relative to a prelim year? I've read in previous threads that a prelim year in general surgery is normally not a good idea (and I have very little interest in surgery, though of course it is too early to say for sure). What exactly are the advantages and disadvantages of doing a prelim year in general surgery?

I would go with peds if peds rehab is what you really want to do. An IM year will help you out more during residency because you're working with adults, but you'll find your peds rotation a lot harder if you don't have any peds experience. A TY is great because you could do mostly peds related rotations and add in, say, two medicine months. TY years tend to be more relaxed as well, but not always. But the main advantage to them is the flexibility--I did one and I could've done rotations in IM, peds, surgery, FM, psych, PM&R, etc. etc. But you want to make sure the quality of those rotations is strong--some TY programs are way too "cush" and you really don't do or learn as much. I don't really know any advantages to a prelim-surgery year other than it counts as a prelim year. I think you just spend the whole year managing floor patients, repleting electrolytes and r/o PE's, as well as being yelled at by your senior residents...

4) What residency programs are best at (or known for) preparing their residents well in pediatric rehabilitation? I am open to any locations and do not really care about prestige (i.e. Doximity rankings). I have a preference for NYC, but it is not at all a deal breaker.

Probably programs with a peds fellowship (Davis, Cincinnati, Columbus, Colorado, RIC, Mayo, Minnesota, Kansas, Kessler) or combined Peds/PM&R programs (Colorado, Thomas Jefferson/duPont, Cincinnati). I got the fellowships off the AAP website--I don't know how many of those are current. At our program we do 4 months of peds, and one of our grads used most of her elective months (4 months) to do more peds and now she practices peds rehab. It's actually really hard for hospitals to fill peds-PM&R positions with board-certified peds physiatrists because they're just not that common (so if you are boarded, you have a huge leg up)

5) What residency programs are best at (or known for) preparing their residents well in traumatic brain injury? I am open to any locations and do not really care about prestige (i.e. Doximity rankings). I have a preference for NYC, but it is not at all a deal breaker.

I think there's be too many to list. But generally any program with a brain injury fellowship belongs on the list. Plus any program with a dedicated brain injury rotation should prepare you well, as that suggests their volume is high enough if they can create a whole rotation (in some programs everything is just lumped together and you get a mismatch of different areas--you may get a lot of BI's, or maybe more SCI's, or maybe they're all polytrauma and amputee.) Basically bigger hospital and trauma center = more BI experience.

6) What are the advantages and disadvantages of doing a combined residency in pediatrics and PM&R relative to doing a residency in just PM&R and then doing a fellowship in pediatric rehabilitation?

Advantages: Less time (5 years instead of 6). More integrated program (you do peds prelim your first year and after that you do a mix of peds and PM&R, so things aren't separated the way they are if you did a peds pre-lim, then 3 years of PM&R, then 2 years of peds rehab.
Disadvantages: I'm not sure there are any (assuming peds rehab is what you want to do), other than you're committing to a longer program up front.

7) Are there any books worth reading about the history and future of PM&R? I was a non-science major in undergrad (not history, but sort of similar) and love these sorts of books.

This is the one I have, which seems pretty good--I've only read part of it. Unfortunately it's pretty specific (just history of amputations) and expensive (fortunately I got it for free when our library needed to get rid of a lot of books...)
Amazon product ASIN 1846284430

8) What are the current research trends in spina bifida and traumatic brain injury? I don't have much experience doing research in either of these two topics, but would love to learn what seminal articles or books I should read to get a sense of where to start. I have grad school experience in cost-effectiveness research (i.e. modeling, data analysis, etc.). Is there a current need for this in researching spina bifida or traumatic brain injury?

I don't know about spina bifida, but certainly with TBI there's a lot of research due to IEDs and now more research about re-integration into society, psychosocial adjustment and concerns, etc. I couldn't really point you in the right direction for research though, and if you want to do research I'd recommend finding a research mentor and going from there.

9) For a spinal cord injury fellowship, do you come into contact with spina bifida patients? From what I've read, it's not clear.

Yes, but not as much as if you're in peds PM&R. I think I've only seen a handful of spina bifida patients in SCI clinic or on the rehab unit.

10) Can a PM&R physician be a team doctor for a sports team? Do they have to have a fellowship in sports medicine? Despite my primary interest in treating disabled patients, I also have career interests in working for a sports team (but not exclusively).

Usually the team doctor for a sports team is FM, since they're the "team doctor" and managing the team's overall health. But I think plenty of PM&R physicians work as the sports physicians for a sports team, though sports really isn't my interest so I don't know as much of the details. If you just want to be a sports doc for a high school team you wouldn't need a fellowship, but if you're interested in working with professional athletes you'll probably need a fellowship (or a really strong background and great connections...)

Thank you in advance for anyone who answers any of these questions! I've been reading (and searching through) this subforum for the last week since my acceptance and have learned a lot.

 

[sardonicmedicine]

Thank you so much @RangerBob! Here are two follow-up questions:

1) If I do become sub-specialized in peds rehab, does that mean as a practicing physician that I can only treat peds rehab patients? Or is it just harder to get referrals for adult rehab patients? My worry is that, once my patients turn 18, I won't be able to help them with their rehab (perhaps that might be a good thing if I'm not well trained for adult rehab).

2) Is there an additional/hidden cost to doing a second fellowship? I know for a second residency, you're sometimes not funded as well as other residents (and there's the lost salary though money/debt isn't too important for me). I'm thinking that I'll probably want to do both a peds rehab fellowship and sports fellowship (if I don't end up matching into one of the three dual peds/PM&R program).

 

[RangerBob]

Thank you so much @RangerBob! Here are two follow-up questions:

1) If I do become sub-specialized in peds rehab, does that mean as a practicing physician that I can only treat peds rehab patients? Or is it just harder to get referrals for adult rehab patients? My worry is that, once my patients turn 18, I won't be able to help them with their rehab (perhaps that might be a good thing if I'm not well trained for adult rehab).

2) Is there an additional/hidden cost to doing a second fellowship? I know for a second residency, you're sometimes not funded as well as other residents (and there's the lost salary though money/debt isn't too important for me). I'm thinking that I'll probably want to do both a peds rehab fellowship and sports fellowship (if I don't end up matching into one of the three dual peds/PM&R program).

If you do subspecialize in peds rehab you can generally still treat adults--especially if you go the route of doing a fellowship, then most of your experience would actually still be with treating adults. Most jobs will have you focus solely on peds though. However, it's also fairly common for peds physiatrists to see their patients past age 18--it seems like they follow in clinic until their early 20's, though I still don't have a ton of peds experience (just two months).

As you mention, the main hidden cost of a second fellowship is missed opportunity income and lost time. I also don't know how helpful you'd find doing a sports fellowship after peds--you could very likely get a ton of peds sports exposure in a fellowship. Most likely you couldn't in the combined fellowship, since you'd be a lot more limited as there is usually no elective time.

I haven't personally heard of any physiatrists that are double-boarded at the subspecialty level unless one of them was electrodiagnostics. But it's certainly possible--I'm just not sure how helpful it would actually be. However, you're still a long ways out, so I wouldn't plan things too specifically at this point--just know that those options are all open, but whether or not doing multiple fellowships is a good idea is something that you'll likely explore more while you're in residency.

For now focus on getting good PM&R exposure early in medical school and find a good mentor. Study hard, do well on Step 1, do well in your clinical rotations, and keep an open eye on the off-chance that something else seems to fit better (hopefully it'll be peds PM&R--we really need more peds physiatrists!).

 

[j4pac]

Everyone wants to be a Pediatric vascular neurosurgeon entering med school...then people get into med school and realize. "Damn, I'm tired, not sleeping, studying 90% of the time, and am broke." The internship hits and you realize, "Wow, I'm even more tired now."

There aren't many Van Wilders of medical education...and that is because it is an absolute grind and people eventually want to be an adult...they want to be established, get a pet, perhaps a family, and want to eat something more than Ramen.

 

[sardonicmedicine]

I fully recognize I'm getting ahead of myself here, but I just wanted to get a sense of the possible career paths (and let's be honest, I'm bored out of my mind right now while on break). Another question I thought up today:

1) Is it possible to convince NHSC that PM&R qualifies as "primary care"? I feel like the specialty belongs in the sense that physiatrists can provide day-to-day care for patients. In the case that I can't convince NHSC that PM&R is primary care, would I still potentially qualify if I did a combined peds/PM&R residency? I ask only because I was considering maybe applying for a NHSC scholarship in case I wanted to attend a private out-of-state school instead of an in-state school.

 

[Jitter Bug]

I started medical school absolutely sure I would do Infectious diseases. Then ER. Then anesthesia, radiology, and eventually PM&R. I like your enthusiasm, just don't shut the door on other fields before you even get into medical school.

No reason to do >1 fellowships. A good residency will teach you what you need, and if you really really love one area or want to go academic, one fellowship should do it. And as posted above, being poor gets old. Those loans keep capitalizing each year you train.

No, PM&R is not primary care, so you won't be able to use a NHSC scholarship.

Good luck, enjoy medical school!