Physical Medicine and Rehabilitation
Physicians who specialize in Physical Medicine and Rehabilitation are called physiatrists. A physiatrist treats patients with physical impairments or disabilities that limit daily functioning and impair quality of life. Physiatrists provide a spectrum of care, from diagnosis to treatment and rehabilitation in patients of all ages with a focus on the following:
- Rehabilitation of patients with severe physical impairments primarily in inpatient rehab hospitals, with some follow-up in the outpatient setting. The physiatrist leads a team of rehabilitation professionals that includes physical therapists, occupational therapists, recreational therapists, rehabilitation nurses, psychologists, social workers, speech language pathologists, and others. The types of conditions that are commonly treated by physiatrists and the rehabilitation team include: spinal cord injuries, traumatic brain injuries, amputations, multiple trauma, stroke, back problems, cancer, burns, post-orthopedic surgery, and other conditions.
- Diagnosis and treatment of musculoskeletal conditions (both acute and chronic conditions). These run the gamut from industrial, sports, and performing arts injuries to degenerative conditions as common as arthritis or low back pain, and more complex pain syndromes. In the setting of musculoskeletal medicine, physiatrists are experts in non-surgical, conservative solutions to musculoskeletal/orthopedic conditions. This type of practice is typically outpatient/clinic based with numerous types of injection techniques, often under fluoroscopic or ultrasound guidance.
Future Prospects and Beyond…
- Nationally, there is a deficiency of rehabilitation specialists. There is an excellent job market now, and with the population aging, it is projected that the demand for physiatrists will continue. The outpatient-based musculoskeletal job openings are most popular right now.
- Approximately half of PM&R residents choose to pursue a career in general rehabilitation and the other half pursue 1-2 year fellowships. The most popular fellowships include Interventional Pain Management, Sports Medicine, Interventional Spine, Traumatic Brain Injury, Spinal Cord Injury, Pediatrics, and more recently Cancer Rehabilitation.
- Right now what is “hot” is Pain Management and Interventional Physiatry. Many residency graduates are pursuing Fellowships in Pain (either PM&R based or anesthesiology based programs) or Sports & Spine. Becoming board-certified in Pain requires a one-year fellowship. The interest and growth of this subspecialty is driven by impressive financial reimbursements and a desire to have a procedure-oriented practice.
- Salaries in private practice range from $120-200K, but in an Interventional/Pain-based practice, the upper limit can be much higher. One of the overall benefits of PM&R is that there is very little Call or Weekends.
- The University of Maryland is now jointly affiliated with the residency program at Sinai Hospital of Baltimore, and the program director there is Melanie Brown, M.D. She is very helpful as an advisor, and if you rotate at Sinai, it would be a good idea to impress her and get a letter of recommendation. The field is small, and the residency program directors know one another well.
- Also, Dr. Henry York, a physiatrist at the University of Maryland Rehabilitation & Orthopaedic Institute (UMROI, formerly Kernan Orthopedics and Rehabilitation) is a tremendous resource and has offered to mentor students interested in PM&R.
- Dr. Samuel Mayer, the Program Director of the Johns Hopkins PM&R Department is a great mentor and welcomes students to shadow as well as apply for elective rotations at their program. Inquiries can be sent to Residency Coordinator, Nicole Prioleau.
Clinical Schedule and Letters
- Do a rehabilitation elective rotation late in the third year or early in senior year to confirm your interest in the field and to make a good impression on those who you will ask to write letters. At least one letter from a physiatrist is required; two letters, however, is ideal. There is an in-house rotation at UMROI, where you will work closely with three physiatrists that can write good letters on your behalf.
- An away rotation is strongly recommended, especially since University of Maryland does not have a home residency program. A good option is at Sinai (see above). Another advantage of an away rotation is that the in-house UMROI rotation is heavily inpatient, and rotating at a more outpatient focused institution may provide a fuller view of the non-inpatient aspects of PM&R.
- Other away electives can be attained through VSAS. Still other programs may require a specific application that can be found at the program’s website. If there is a program that you are strongly interested in, try to do a rotation there if possible.
- Many PM&R applicants do away rotations at top-tier programs. This is not necessary, but it can be helpful. Again, PM&R is a small field and growing more and more competitive. A letter from a big name or a faculty at your top choice can go a long way.
- The other recommendation letters often come from faculty in internal medicine (since you will need one for your preliminary year applications anyway) and those in closely related fields, such as neurology. If you have significant research experiences, a letter from your research advisor can help.
- Research is not crucial for a successful match, and many successful applicants have little to no research experience (or interest). With that said, PM&R, as a field, is investing heavily into developing a more robust research community and infrastructure. To this end, many academic programs are looking for research minded applicants, which can be a big plus. Dr. Macko, a neurologist at the VA, does a lot of neuro-rehabilitation research. Dr. Braun at UMROI is an MD, PhD that is also well connected and is starting her research program in stroke rehabilitation. There are a number of additional research projects at UMROI that you can get involved in.
- The Association of Academic Physiatrists offers a summer research program (Rehabilitation Research for Medical Students or RREMS) where students work with a research mentor on a project that will be presented at the AAP national conference: Association of Academic Physiatrists
- PM&R residency begins after an internship year (PGY1: either Transitional or Prelim. Medicine or Prelim. Surgery), and the residency is three years in length.
- A handful of programs offer a four-year categorical option. The internship year is very similar to a preliminary. medicine year, and sometimes offers one month of PM&R in that year. The advantages to these programs are that you don’t have to move twice, you will gain familiarity to the system, many of the built-in electives are geared towards PM&R, and you get to know many of the consultants whom you may have to call once you’re a PM&R resident.
- Residency is usually 50% inpatient and 50% outpatient. The ACGME requires 12 months of inpatient and 12 months of outpatient. With the job market trend towards outpatient physiatry, many programs have increased the outpatient focus (50-70%) and are emphasizing or increasing musculoskeletal medicine training.
- Call is very light compared to other specialties. For example, some programs have this type of call schedule: q-7 in PGY2, q-14 in PGY3 and no call in PGY4. Programs may either have in-house vs. home call. While many residents enjoy the convenience of home call, in-house call usually gives residents a post-call day.
Difficulty of Getting a Residency Position
- Several of the top programs are competitive. The remaining institutions accept a wide range of applicants. Just like in other specialties, the higher your class rank and the more honors you have, the more attention you’re likely to receive initially. However, in this field, personality plays an important role. As noted above, the team concept is very important to PM&R. Programs will probably learn the most about your ability to be a team leader and a team player from your letters of recommendation. Lastly, programs want to see that you have a real interest in and enthusiasm for this field.
- Interest in this field has swelled in recent years. But many of the applicants for this field are still foreign grads or DOs; there is an advantage coming from a US allopathic medical school.
- Attend the American Association of PM&R (AAPMR)national conference in the fall if you can! During the conference there is a residency fair where medical students can talk to PM&R residents and Program Directors. In 2018 it will be in Orlando, FL in October. The Association of Academic Physiatrists national conference is smaller than the AAPMR conference and will be held in Puerto Rico in February 2019.
Transitional Year vs. Preliminary Year
- The preliminary year in internal medicine is an excellent preparation for inpatient rehabilitation rotations. Most inpatients on the rehab. service will have general medical issues that physiatrists must be able to address and manage (Inpatient rehab involves quite a bit of internal medicine). The transitional year, on the other hand, usually offers more elective time.
- Many top residency programs are based at “stand-alone” rehab hospitals. In these situations, the physiatry resident is the only in-house physician on call, so a rigorous medicine internship is valuable.
Programs and Interviews
- The number of programs to which you apply should be determined by the competitiveness of your application. If you are a solid student with good letters, obtaining interviews is a given at the not top-tier places. It is probably overkill to interview at more than 10-12 PM&R programs, although the field is progressively becoming more competitive.
- American Academy of PM&R: http://www.aapmr.org/ Excellent website. Explore!
- Association of Academic Physiatrist: http://www.physiatry.org/
- Directory of Physical Medicine and Rehabilitation Residency Training Programs can be found via the Association of American Physiatrists : http://www.physiatry.org/?page=program_directors
For additional information please contact:
Last Revision - March 9, 2018