Ortho/PMR

[jointman]

Hey guys,

I'm a second yr med stu with a long standing interest in ortho, particularly arthritis treatment in areas like ankylosing spond. or other back problems. Not very competetive for ortho, had anxiety problems, top 90 percent of class and trying to make it up in boards, not many extracurrics first two years except therapy (does that count? )

My questions are...
1. For those of you who got above a 240 and are not naturally good memorizers, how did you study for boards. my current plan: focus on first aid and questions for anatomy, pharm and micro and for rest go with kaplan except use BRS for patho and FOCUS on q bank. I have a hard time reading text and getting the big picture...i'm guessing questions may help my integration...any advise?

2. Any orthos or residents out there who faced anxiety/depression...in particular a specific social phobia....and how does the ortho community sympathize with docs with these problems.
3. What are career options for a person interested in spine surgery, pain management and physical therapy....what is the lifestyle like for a spine surgeon compared to a PMR spine specialist...and how do their jobs differ. I like working with hands, carpentry etc so think that aspect of surgery is fun....do PMR's do any invasive procedures? Do spine surgeons only do surgery or do they help with pain and rehab as well. Does anyone know what the overlap is between PMR spine, PMR pain and Ortho spine?

4. I would like to set up my own practice....if i go into pmr, does it necessarily mean i will most likely need to work for an ortho surgeon, i want to work for myself.

5. can u do an ortho residency in canada/australia and come here for fellowship and practice ortho in the u.s.? Do I have any kind of shot at ortho in the u.s.?

thanks for u're time and advise.

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[Stinky Tofu]

You definitely do not need to work for a Spine Surgeon. However, at least at the institutions I've worked at, Physiatrists and Surgeons work well together. Our services are highly valued by the surgeons and we refer lots of patients to each other. We can do the workup (MRI, CT, EMGs, X-rays, diagnostic SNRBs, discography, etc.) and try conservative treatment (PT, medications, TPIs, ESIs, MBBs, joint injections, IDET, etc.) first. If these measures don't work, we refer them to the surgeon and they are happy to get these patients because they can schedule surgery for them fairly quickly. Most surgeons will want to confirm the source of the pain generator and make sure that it isn't amenable to conservative treatment before performing surgery. Additionally, we see lots of patient after surgery to prescribe an appropriate rehabilitation program, monitor progress, or because they have FBSS and they aren't surgical candidates. With additional training such as the ones described here, we can also offer minimally invasive surgeries such as spinal cord stimulators, peripheral nerve stimulators, intrathecal pumps, etc.

I pulled a few job listings to show how Physiatrists might fit into an Orthopaedic practice.

1. CT - Seeking a fellowship trained physiatrist to join our comprehensive musculoskeletal center Located one hour from New York City and two and one half hours from Vermont ski country with a reputation for excellence in patient care, our group covers professional Athletes including Division 1 college athletes as well as many local high schools. The primary emphasis of this position would be spinal intervention, pain management and electrodiagnosis. Experience in intraoperative spinal cord monitoring would confer advantage. Comprehensive salary and benefit package including profit sharing and 401K.

2. NY - Excellent opportunity for a Board Certified/Board Qualified physiatrist to join a progressive five member private practice orthopaedic group with sub-specialty interest in spine, sports medicine, adult reconstructive, total joint arthroplasty, and metabolic bone disease. Experience in muscle testing, electrodiagnostic testing, and injection treatments (epidural blocks, etc.) required. The position is primarily outpatient with in-patient acute rehabilitation available.

3. **** Healthcare is seeking a Physiatrist or Anesthesiologist with a pain fellowship to develop a comprehensive outpatient spine and pain management program. The provider will work primarily with the neurosurgeons and orthopedic surgeons to establish a non-operative spine, sports and postoperative program. Candidates will practice a full spectrum of physiatry including clinical diagnosis, invasive procedures and epidural pain management. **** Healthcare is a teaching hospital, affiliated with Columbia University, serving an 8-county region in Upstate New York, with active neurosurgical and orthopedic programs as well as practices in 22 regional health centers.

4. **** Orthopaedics & Sports Medicine, five respected and innovative surgeons with spine program serving population base of 350,000 offer excellent practice opportunity. Candidates must be board eligible. Community has excellent hospitals, including an in-patient rehabilitation hospital. We offer generous salary, outstanding benefits and partnership opportunity.

5. **** Health Care is seeking 1 BC/BQ musculoskeletal physiatrist to join 2 other physiatrists in a thriving multi-specialty group. The primary focus is outpatient musculoskeletal physical medicine. Patient mix includes shoulders, knees, spine, sports, arthritis & EMGs. Flouroscopy available for epidurals and other procedures. Referral sources are primary care and orthopedics. Department includes 2 orthopedic surgeons, 1 podiatrist and 2 physiatrists, and it is adjacent to a full service radiology department.

Physiatrists who do a Pain/Spine/MSK/Sports Medicine fellowship will also have additional skills that may open up even more options in terms of practice settings. Most graduating residents I know sought out practices with other Physiatrists or in a job in a multidiscplinary Pain/Spine/Sports clinic.
If you do a Pain or Spine Fellowship, I think this gives you more tools for a successful solo practice.