>In looking at the Articles Sticky, I notice there are multiple areas in which physiatrists work - stroke rehab, spianl cord rehab, traumatic injury in children, etc. I was wondering:
1) do most people specialize in one, or just a few related areas?
2) which of these areas absolutely needs a fellowship?
To answer 1, most people specialize in one or a few related areas. It would be very difficult, e.g., to to both interventional spine and SCI medicine, since they are very different populations, and both have large literatures to keep on top of. It is not uncommon, though, for people to have areas of overlappign practice- e.g., acute trauma consults + inpatient TBI and SCI + botox injections, or occupational medicine + sports medicine + EMG + interventional spine
To answer question 2, the areas that require specialization:
a. Interventional spine- it is rare that any residency gives suffecient volume to be truly safe independently post-residency. And those that do may not give suffecient training in the general physiatric principles that should accompany the training so that you don't just become a "needle-jockey"
b. SCI- one of the few ACGME accredited fellowships, SCI can be very complex because of all the cormobidities, and the fact that a physiatrist is often acting as a de facto primary care doctor
c. Pediatric rehab- same issues as SCI, a 2 year ACGME fellowship
d. EMG- if you want to be truly comprehensive, it would help to have a fellowship, since many residencies have insuffecient trainign in the the neurology type EMGs, like myopathies and neuromuscular disorders. A reasonable alternative path would be self study and sitting for the AANEM board, which is not ACGME accredited, but is valued by some as a useful proof of skills as an electrodiagnostician
