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Medical Education
Medical Student Education

Career Information: Physical Medicine and Rehabilitation

Specialty: Physical Medicine and Rehabilitation

Completed by: Lisa Pascual and Mitul Kapadia

Date completed/updated: April 2014

  1. What can students do in the 1st and 2nd years to explore and/or prepare for this career?
    Briefly, PM&R specialists (aka Physiatrists) provide comprehensive care for patients with medical conditions resulting in loss of function or ability to perform self-care or day-to-day tasks (both vocational and avocational). Physiatrists provide patients with a medical rehabilitation plan of care with the goals of improving patient function and preventing complications or deterioration secondary to disabling conditions.

    1st and 2nd year students should consider contacting any of the UCSF PM&R faculty in either the Department of Orthopaedic Surgery or Pediatrics to learn more about the specialty. 

    Additional information can be found on the American Academy of PM&R website specifically for medical students: http://www.aapmr.org/career/students/Pages/default.aspx. In recent years, the Academy has offered a Medical Student Program during their annual assembly designed to provide information about pursuing a career in PM&R.  These courses have been free of charge.

    If students are very interested in the field, they may rotate as 3rd or 4th year students on the Physical Medicine and Rehabilitation Clinical Clerkship 140.08.
     
  2. What common variations exist in the length/content of residency programs for this career?
    There are approximately 77 ACGME accredited PM&R programs across 28 states. The majority of PM&R training programs are 3 years in length after completion of an intern year. Approximately 28 programs offer a four-year program that includes the intern year.

    The PGY-1 year should provide training in fundamental clinical skills. This can either be in an accredited transitional year program (most common choice) or at least six months accredited training in family medicine, pediatrics, surgery or a combination of these patient care experiences. The remaining six months may include accredited training in a combination of specialties or subspecialties.

    All training programs include inpatient and outpatient experiences in PM&R. Training includes, but is not limited to, care of patients with: musculoskeletal disorders, acute and chronic pain, neuropathies, neuromuscular disease, central nervous system disorders, cardiovascular disease, traumatic brain injury, spinal cord injury, amputations, polytrauma, arthroplasties, sports injuries, rheumatologic disorders, medical deconditioning, burns and wounds.  All programs include training in electrodiagnostics (electromyography and nerve conduction studies). 

    There are also options for combined Pediatrics/PM&R programs that are five years in length total. Interested students can contact the UCSF pediatric physiatry faculty about these paths if they have a particular interest in pediatric rehabilitation.
     
  3. What common variations exist in this career after training?
    Many residents pursue fellowship training after completion of residencies. Many fellowships are ACGME accredited. Fellowship opportunities include, but are not limited to: Pediatric Rehabilitation, Brain Injury Medicine, Spinal Cord Injury Medicine, Neuromuscular Medicine, Sports Medicine, Pain Medicine and Sports/Spine Medicine.

    Many residents proceed straight into clinical practice following residency. Whether an individual goes into practice after residency or completes a fellowship, there are a variety of clinical settings where PM&R can be practiced. The scope of PM&R training affords individuals with a high degree of flexibility when choosing a practice setting.  A physiatrist may practice in a purely inpatient (e.g. inpatient rehabilitation center) or purely outpatient setting or a combination of both. Other individuals may pursue careers in academic settings. Further, physiatrists may choose to specialize in the treatment of specific type of patients (e.g. patients with sports and spine disorders or patients who have sustained trauma). Given the trends in health care, many physiatrists join group practices (as opposed to a solo practitioner setting). Often, these groups are multi-specialty practices, consisting of orthopaedic and/or neurosurgical specialists.
     
  4. What is a typical work day for someone in this field?
    The typical work day of a physiatrist varies widely, depending on the type of practice setting (see #3). Outpatient practices may consist of seeing scheduled patients throughout the day. Those who practice interventional spine and joint injections may have days (or part of days) designated solely to procedures. Inpatient physiatrist schedules are less predictable. However, team conferences are a unique aspect of inpatient rehabilitation care and include a comprehensive team including the physiatrist, rehab nurses, physical therapists, occupational therapists, speech therapists, psychologists, social workers, and case manager. They are a staple for inpatient physiatrists as these times are designated to coordinate care for, often, complex patients. 
     
  5. What is the culture of this career?
    The practice of PM&R is truly a team sport. Physiatrists have been “brought up” in a culture of learning to lead and work effectively in interdisciplinary teams with focus on patient-centered care, long before this model of care was universally adopted. As such, the specialty attracts individuals who work and communicate well with their peers, colleagues, patients, and caregiver/families. Physiatrists develop a unique bond with patients and their families, often helping them through some of their most difficult days and often following them long-term. In addition to the medical aspects of care, physiatrists are focused on function and developing an individualized plan for patients to return to their regular lives.
     
  6. How compatible is this career with raising a family? How is this different for men and women?
    PM&R as a career is very compatible with raising a family. Call schedules vary, depending on the practice setting. In general, as there are few “rehabilitation emergencies,” being on call may not be as demanding as other specialties. There is no significant difference for men and women in terms of raising a family.
     
  7. What are the most important qualities or character traits for a person in this field?
    As noted in #5, physiatrists need to be able to work well with their colleagues and to demonstrate excellent communication skills. Physiatrists need to be able to both attend to the details of a patient’s care and look comprehensively about a patient’s functional status as it relates not only to self-care, but also to overall functioning within the community. Physiatrists must be able to motivate patients to take an active role in their health care. In addition, physiatrists need to be excellent educators, not only for the patient and their caregivers, but also for the medical team caring for the patient. As with any other specialty, physiatrists must possess the drive for continual learning and honing of their skills to continue to evolve into a better clinician.
     
  8. How competitive are the residency programs in this field?
    As there are so few residency positions available, matching in the top programs can be competitive. Recently, there has been an increase in the number of PGY1 positions available in the match. In general, on average, nearly 100% of the positions offered in the match are filled.
     
  9. How competitive is the job market after residency?
    As with many other specialties, the job market can be competitive for those seeking to live in certain areas of the country that are thought to be desirable.  However, there are excellent job opportunities throughout the country for both inpatient and outpatient (and a combination of both!) physiatrists. As noted in #3, one of the unique aspects of this field is the wide spectrum of practice opportunities – inpatient/outpatient, academic/non-academic, solo/group.
     
  10. What programs have been popular among UCSF applicants, or how should applicants go about considering programs?
    There are many excellent PM&R residency programs. Information for most programs can be found on their respective websites. Recently, the American Academy of PM&R has been offering a Residency Fare during its Annual Assembly. Many residency programs are represented at the Fare by their residency directors and residents. Additional information can be found at the Academy’s website: http://www.aapmr.org/members/residents/Pages/default.aspx.

    UCSF students have traditionally sought programs on the west coast. Of note, there are only five PM&R programs in the state of California – UC-Davis, Stanford, UCLA, UC Irvine, and Loma Linda. Recent program matches have included: Stanford, UCLA, and the University of Washington. East coast matches have been to the Spaulding Rehabilitation Hospital associated with Harvard University. UCSF faculty members can help put students in touch with attendings or residents of a variety of programs to help with program choices. It is highly recommended that students rotate to the program of their choice for a sub-internship, especially if the program is highly competitive.
     
  11. What resources (e.g., websites, books, professional groups) would you recommend for students interested in learning abou this field?
    Please see the links noted in #1 and #10.
     
  12. How important are each of the following for admission to a competitive program?
     Very ImportantSomewhat ImportantNot ImportantComments
    Extracurricular/
    volunteer work
    x   
    Research/publications x Certainly helpful
    Honors in third yearx   
    AOA x  
    Subinternshipx   
    Externshipx  Particuarly for competitive PM&R programs

 

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