many questions

[scm]

hello everyone, I've been lurking for awhile + have enjoyed all the posts, they've been helpful.

I'm a 2nd year who is very interested in PM&R, I've had quite a lot of personal exposure to the field, met a handful of really inspirational docs, and given it all much thought. After exploring some other fields I was interested in, but had little exposure to, I'm as certain as one can be going into 3rd yr that PM&R is on top of my list, it really has many things that appeal to me that I don't think other fields can offer. Noone at my school has gone into PM&R in a few years, noone I know is consideirng it, I have many questions...here come a few


1.I've been exposed primarily to outpatient rehab. This involved figuring things out/making a diagnosis via palpation +anatomical knowledge(cool!), diagnostic tests(i.e. EMG), treatment w/continuity(i.e. pt), intervation(i.e. injections), and so on. I feel very passionate, and inspired by many of these things + other aspects of PM&R, but I won't go into details here. I've had very little exposure to inpatient rehab. In fact, I often have a problem replying when people who I tell I am interested in rehab ask "What do they actually _do_? Don't pts and ots do everything anyway?"....

Granted, I realize there are many different types of inpatient rehab(pain, spinal, traumatic brain injury/stroke etc), but, well, what do Physiatrists actually _do_ in many of these cases where they don't need to figure out the initial problem per se and there isn't much intervention (procedures) to be done? A specific example: a patient is recovering from a heart attack in the hospital, his muscles have atrophied, he needs help getting mobile, would a Physiatrist essentially be evaluating range of motion, strength, etc, and telling a PT what to do? Couldn't a PT kinda just do this on their own?(sure these are all naive assumptions, but I have no idea)


2.Ok, I apologize, trite, but "what does it take to get into a top residency program in PM&R"(i.e. UWash, Spaulding, RIC etc)? More about myself : I'm at a "top 20" school according to the BS USNews ratings thingie if that matters, however, I don't think many/if any people from here have gone into rehab recently, would this put me at a disadvantage for these programs? I've been involved in all sorts of activities and groups, created/implemented a study that will be published etc, but most of these things had more to do with acess to healthcare, not PM&R, would this, again, put me at a disadvantage? I've been sort of exploring other things since I always knew I was interested in PM&R and had already had some exposure to it...I'm sure I'll do ok on the boards, and I've started talking to the residency director of PM&R at my school, but I'm not sure what else I could be doing...(I'm not at all interested in doing PM&R here).


3.are there any other good programs besides UWash on the west coast? in Portland? out west anywhere? seems like the most commonly mentioned programs are UWash(although, not many people seem to like it lately), Spaulding, RIC, I'm not sure I remember what the other good ones were..(sure I read a bunch about the programs in NYC, + Kessler, but there's no way I'm living in NYC or NJ, long story)...

4.Something I just started thinking about: Does the training in PM&R during residency in some way cover rehabilitation of individuals who have lost a limb + use a prosthetic device? is there a fellowship for that? What type of docs typically design/do research in this field? Or, if I'm more interested in helping people use their prosthesis rather than designing it, would a normal PM&R residency be sufficient?


thanks so much everyone for your time and insight. im sure your replies will not only help myself, but all those like me who are are lurking and haven't posted yet...

take care
scm

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[drusso]

Congrats on discovering PM&R---I think that it's a great field with lots of diversity and interesting patient care issues. To me, PM&R is a field at the inteface of a variety of medical disciplines (neurology, internal medicine, rheumatology, and orthopedics), social sciences (psychology, cognitive science, and social work), and health policy (care and advocacy for the disabled).

The short answer to your question regarding inpatient rehab is that physiatrists are responsible for both directing the multidisciplinary rehabilitation team and managing any medical issues that occur as a part of a patients rehab. In other words, physiatrists steer the ship. Medical complications on inpatient rehab units are very common and physiatrists must apply a breadth of knowlege from internal medicine, neurology, psychiatry, orthopedics, pulmonology, and surgery. Patients not uncommonly crump on rehab units and it's important to be able to manage them acutely until they get transferred to the ICU or the floor. Physiatrists almost daily work-up fevers of unknown origins, chest pain, SOB, abnormal lab values, coagulopathies, anemias, wound healing and ulcers, mental status changes, new CVA's and TIA's---all the general internal medicine stuff you see on the wards. Therapists (like nurses who do the bulk of the daily hands-on care) lack the medical knowlege to spot important medical issues that can delay a patient's rehabilitation or permanently diminish their final level of maximum functional capacity. An appropriate analogy is the difference between a pulmonologist and a respiratory therapist: Yes, most RT's are better vent jockeys than the majority of general internists (or even some critical care docs), but they lack the medical knowledge to understand the underlying pathophysiology of disease. Thus, just like in rehab, patients ultimately benefit the most from both a good pulmonologist (or ICU intensivist) and a conscientious respiratory therapist.

Physiatrists get extensive training in orthotics/prosthetics/gait analysis and work closely with prosthetists and orthotists in prescribing the appropriate medical equipment and assistive technology. Most "stump clinics" are staffed with physiatrists, orthopods (or vascular surgeons), and prosthetists. If you're interested in artificial limb technology, PM&R is probably far and away *THE* field to be in...You should definitely look into Seattle and RIC in Chicago---their artificial limb programs are incredible!

Another cool area is trauma rehab. Leading trauma centers (Harborview in Seattle, for example) incorporate physiatry from the moment a trauma patient hits the door and early rehab (like starting in the ICU) for a variety of trauma injuries is becoming standard of care. Again, in this setting, physiastrists are responsible for overseeing and orchestrating a variety of rehab services (PT, OT, ST, Cognitive Rehab, etc) and keeping a watchful eye for medical complications that can delay a patient's return to maximum function. Since traumatic brain injuries and spinal cord injuries are the bread and butter of rehab and trauma, this is a great area for inpatient-oriented physiatrists.

Rehab is getting more competitive again (it goes in cycles), but generally speaking it is not a tough match. Passable board scores, no "black-eyes" on your academic record, experience in rehab and dedication to the field, good LOR from leaders in the field, and rehab related research experience are looked upon very favorably.

Good luck! There are several PM&R residents on this board (myself at Mayo, StinkyTofu at Harvard, Ligament at University of Michigan, and others) who I'm sure will be happy to share experiences with you.

--Dave

 

[scm]

cool, much thanks for your insight! (sintky tofu PMed me as well)..if anyone else has any input concerning any of the above, would be appreciated...
take care
scm

 

[Stinky T]

Dave did a great job of anwering most of your questions. The only thing I have to add is about the different programs on the West Coast and about matching. I think the best programs would be UWash, UC Davis, and Stanford. Those are the only programs that I'd consider for myself.

Making yourself competitive for PM&R is not unlike any other specialty. As a second year, I would try to do well on the USMLE and continue to make contacts in the field. Not doing research in PM&R will certainly not preclude you from matching at a good program. However, it will certainly be viewed favorably. Most of the residents in my program did research in PM&R, Neurology, or Neurosurgery as a medical student. Places like Stanford will likely not interview you if they don't know you (last year they took two Stanford grads for their three spots). So, I would consider doing an externship at your top choice. Good luck.

 

[scm]

thanks again Stinky. heh. this is just a general comment.....ostensibly 3rd yr is when people figure out what they love/hate, want to go into etc, in fact i would be somewhat dubious of anyone who claimed they were _sure_ they knew what they wanted to go into during their 1st yr, as would, I assume, most people(?). however, for some reason, for each specialty, to get into top programs most students are expected to have published some research in that particular field, which obviously would be quite impossible for anyone who is unsure what they want to do prior to third year, and difficult to do after making the decision during 3rd yr..

this being said, it might be safe to assume that the top programs are essentially accepting people who made their decsion, of some sort, early on? i guess they know what they are doing, but doesn't seem like it's always the wise way to go, granted, students should show interest in something, and that they are hardworking and such, but i think i would tend think someone who has fully explored their options and come to a decision about what they love would be a better candidate than someone who decided 1st yr that they were going into Ortho, for instance, and essentially ignored everything else... i dunno..i find this whole situation very annoying and contradictory at my school, every interest group tells you "what you should be doing" during 1st and 2nd yr to get into a "good residency" in that field, w/c invariably involves research, and in constrast there is much emphasis on the exposure/decision being made during 3rd yr.