info on pm&r?

[squeek]

Hi, all--

I just finished two weeks of gyn, and I think I've decided I definitely do NOT want to be a surgeon (previously high on the list). I actually found myself bored in the OR. So, I'm looking at other options, and pm&r has come to mind. I have a few questions for anyone more knowledgeable than myself...

1) What are job prospects like these days? FRIEDA says almost 25% of 1998 graduates had difficulty finding a good position...anyone have updated stats or anecdotal advice?

2) How competetive is residency application? Are there certain things I'd need to do for my CV?

3) What personality types are drawn to this sort of field?

4) I've heard that hours are pretty good...is this true? And what is the residency like?

Thanks for any feedback you may have!

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[Stinky T]

1. In my opinion, the future of PM&R is excellent. There are a few reasons that I see. First, I think that PM&R is a growing field and other physicians as well as patients are starting to learn about the services a Physiatrist can provide. For instance, at Harvard, the growth has been really phenomenal. Our program has plans to build another wing to our 300 bed hospital and now has an Interventional Pain Management Department with flourosopy suites. We also received ACGME recogition for our fellowship in Interventional Pain Management. Secondly, their is a rapidly growing geriatric population. This translates to both a greater need for inpatient rehabilitation services as well as outpatient physical medicine (neuromusculoskeletal complaints is one of the top complaints in the geriatric population). I think the job opportunities are excellent, especially in the field of outpatient physical medicine. The salaries that I've heard for those who do this exclusively (especially Interventional Pain) range from 200K-400K+). Those that do inpatient rehab generally make about $150K-200K. Talk to some Physiatrists at your medical school or in the area. Here's one link to salaries for different fields (including inpatient rehab and medical orthopedics):

http://www.cejka.com/content.asp?intPageID=264&intBrowserRes=1024

2. Residencies in general are not very competitive. However, the top programs are competitive because these are the ones that most people want to go to. The top programs from my limited experience are (in no particular order):

a. Northwestern
b. Harvard
c. Mayo
d. Kessler
e. Columbia/Cornell
f. University of Washington (still a great program, but has become less popular due to the tough residency and heavy focus on inpatient rehab)
g. UTHSCSA (great program, but location turns away a lot of good applicants)


3. & 4. PM&R is a very cushy residency; there are programs where you don't even have overnight call (UCLA comes to mind). The Harvard program is considered one of the more rigorous programs and we have roughly Q7 call at SRH and Q4 call at MGH. PGY-3 is roughly Q14 with no call on rotations at MGH. The entire PGY-4 consists of no calls at SRH/BWH/MGH and electives 10/12 months of the year. Oh, we also have a elective in Hawaii and the condo is paid for. The lifestyle after residency is also pretty nice. The ones who do Physical Medicine (Medical Orthopedics, Sports, Interventional Pain Management, EMGs, etc.) have no call. Those who do inpatient rehab will have a call schedule dependent on the setting they are practicing in. So, given the great lifestlye, PM&R does attract applicants who have a lot of interests outside of medicine. Also, many former athletes or those into fitness are drawn to the field as well. I've also met people who were interested in Orthopedics, but either failed to match in Ortho Surg or didn't want to be in the OR. The field is very broad and attracts a number of different people (many of whom I didn't cover). However, these are the types of applicants/residents who I've come into contact with the most recently.

I hope this answered some of your questions and feel free to post more questions or send me a private message. Good luck.

 

[Ligament]

Originally posted by squeek
Hi, all--

1) What are job prospects like these days? FRIEDA says almost 25% of 1998 graduates had difficulty finding a good position...anyone have updated stats or anecdotal advice?

I cannot offer stats right now, but there is a serious demand for physical medicine services, especially in musculoskeletal/sports/spine/pain. Every outpatient physical medicine doc I have talked to has a very busy practice.

2) How competetive is residency application? Are there certain things I'd need to do for my CV?

It is not very competetive until you arrive at the percieved "top tier" programs. Even then, your personality will play a very large role in your ranking. Physiatrists are a personable group and your interviewers will ask you questions that will help illustrate whether you are well-rounded. I was never asked anything technical on my interviews. In fact, one of the most popular topics was related to the radio shows I have produced. My other outside interests were a big topic too. Contrast this to Derm where one of my friends was subjected to WRITTEN exams during her interviews!

The "top tier" programs are not set in stone, but some of the top programs follow: RIC, U. Wash, Kessler, University of Michigan, Spaulding, UC Davis, Baylor, Mayo, Columbia-Cornell, U. Virginia, Ohio. Some programs have a clinical focus. U. Wash has a greater inpatient focus; U. Mich, Spaulding, UC Davis, Mayo, have an outpatient focus. Some are 50/50 such as RIC (in my opinion). These programs also have a higher percentage of fellowships compared to the others.

However there are plenty of other excellent programs out there. Take the above programs reputations with a grain of salt.

3) What personality types are drawn to this sort of field?

Usually laid back and inquisitive people. I personally like mechanical work (cars, electronics, etc). I was having a discussion with an ER doc about the roles of the Pelvis and I mentioned that it was an energy storage device (storing gait energy in the ligaments). He looked completely lost on this comment. I obviously like to think of the more subtle functional characteristics of the human body while he likes to think about gross abnormalities of the body, such as when the pelvis is fractured.

I have never met a Physiatrist I did not like. PM&R docs are also a humble group, as PM&R has been historically misunderstood and under-appreciated.

4) I've heard that hours are pretty good...is this true? And what is the residency like?

The residency is usually really laid back, with a few exceptions. Most programs have home-call. For example, at my residency, I have roughly 6 weeks home call my pgy2 year, then 3 weeks pgy3, then zero call pgy4. This is VERY nice! RIC and Spaulding have in house call but it is not too bad...

Thanks for any feedback you may have!

 

[drusso]

Job prosects in PM&R are pretty good (at least better than average) because the field is so diverse. You can be a generalist physiatrist focusing on medical inpatient rehab, an outpatient musculoskeletal specialist, or subspecialize in any number of other areas and/or types of injuries: Trauma rehab, pain medicine, occupational medicine, sports medicine, brain injury and neurological rehab, spinal cord injury, etc. I found a new PM&R job board that may help give you sense of the opportunities in the field. Scroll down and check out some of the jobs under the PM&R section.

http://www.practicesight.com/

As other posters have mentioned, PM&R rises to the top of the list of the "lifestyle specialties." When was the last time you saw an order "stat rehab." In part, this is what attracted me to the field. I want to be in control of my career, not have my career control me. Rehab patients are usually complex. While physiatrists typically see these patients after they have been medically stabilized in an acute care facility, dealing with the sequelae of injuries and debilitating diseases interests and challenges me. Okay, Mr. Jones so you're paralyzed, now what?

That said, rehab is not for everyone. If you're a "johnny on the spot" kind of person who always has to be doing something invasive to patients, then you'll probably find the pace of rehab medicine excruciatingly slow. While there are indeed opportunities for procedures on the more interventional end of the specialty, physiatrists are typically not considered proceduralists. About as invasive as most physiatrists get is a needle EMG or maybe some very simple joint injections.

I'm happy more medical students are learning about the field as I believe it has a lot to offer. If you enjoyed your neurology, ortho, and anesthesia rotations--you might consider doing a PM&R rotation as it combines certain elements of all these specialties.

 

[squeek]

Wow--thank you all so much. Much more information that I had expected. And to think that my school (Cornell) has one of the top national programs, and I didn't even know of it! I will definitely have to contact people here and see what I can discover.

Thank you, too, for the personality info...part of what attracts me about PM&R is the non-invasive nature. I can barely abide drawing blood from patients, much less doing invasive surgery. I am also your "well-rounded" type...I love to paint and draw (especially the human body), I play several instruments, and I want to write professionally in the future, so I really want a career in medicine that will give me time to pursue these other aspects of my life.

Also, I really enjoy working with the elderly and those with neurological diseases, and improving "functional status" is high on my list of "would really like-to-do" in my career. I loved neuro and I did some research in geriatric orthopedics (radiculopathy and myelopathy and spine surgery), so it sounds like these things may be helpful if I decide to do physiatry.

Thanks again for all of the helpful information!

 

[PTjay]

I'm currently a physical therapy student working on my MSPT. I am currently also finishing orgo 2 and taking the MCAT next weekend so that I can apply to medical schools when I finish my master's degree.

I was wondering if anyone could post info on PM&R or where I could find some solid information. A DO PM&R position seems right up my alley so I'd like to find out more about it.

Thanks

 

[Stinky T]

This definition is take from the American Academy of Physical Medicine and Rehabilitation.

What Is a Physiatrist?
A physiatrist (fizz ee at' trist) is a physician specializing in physical medicine and rehabilitation. Physiatrists treat a wide range of problems from sore shoulders to spinal cord injuries. They see patients in all age groups and treat problems that touch upon all the major systems in the body. These specialists focus on restoring function to people.

To become a physiatrist, individuals must successfully complete four years of graduate medical education and four additional years of postdoctoral residency training. Residency training includes one year spent developing fundamental clinical skills and three additional years of training in the full scope of the specialty.

There are 80 accredited residency programs in physical medicine and rehabilitation in the United States. Many physiatrists choose to pursue additional advanced degrees (M.S., Ph.D.) or complete fellowship training in a specific area of the specialty. Fellowships are available for specialized study in such areas as musculoskeletal rehabilitation, pediatrics, traumatic brain injury, spinal cord injury, and sports medicine.

To become board-certified in physical medicine and rehabilitation, physiatrists are required to pass both a written and oral examination administered by the American Board of Physical Medicine and Rehabilitation (ABPM&R). The ABPM&R also has agreements with each of the boards of pediatrics, internal medicine, and neurology to allow special training programs leading to certification in both specialties.

Physiatrists treat acute and chronic pain and musculoskeletal disorders. They may see a person who lifts a heavy object at work and experiences back pain, a basketball player who sprains an ankle and needs rehabilitation to play again, or a knitter who has carpal tunnel syndrome. Physiatrists' patients include people with arthritis, tendonitis, any kind of back pain, and work- or sports-related injuries.

Physiatrists also treat serious disorders of the musculoskeletal system that result in severe functional limitations. They would treat a baby with a birth defect, someone in a bad car accident, or an elderly person with a broken hip. Physiatrists coordinate the long-term rehabilitation process for patients with spinal cord injuries, cancer, stroke or other neurological disorders, brain injuries, amputations, and multiple sclerosis.

Physiatrists practice in rehabilitation centers, hospitals, and in private offices. They often have broad practices, but some concentrate on one area such as pediatrics, sports medicine, geriatric medicine, brain injury, or many other special interests.

This website also lists some of the common procedures done by a PM&R Doc:

http://www.med.virginia.edu/medicine/clinical/phys-med-rehab/pmrspine.html

 

[PTjay]

I didn't realize there was a PM&R section here on the network. Thanks again for the info.

Also, I will be applying to both MD and DO programs, is it any more difficult to get a PM&R residency as a DO? Seems like the DO philosophy might fit me better but if I can get into my state school I'll go there (much cheaper).

 

[DigableCat]

To be honest, it doesn't matter. PM&R is one of the most DO friendly allopathic specialties out there. It wont necessarily give you an advantage to be a DO, but it won't go against you either. Most PM&R programs consider MDs and DOs on level playing ground.