The Medical Student's Guide to PM&R
Most PM&R residencies are three-year programs and offer positions starting at the PGY2 level, which means that the medical student must seek a transitional/preliminary year in addition to an advanced residency spot. Some residencies offer a four-year program which integrates the first year of basic clinical training into their curriculum.
A minimum of four years of graduate medical education from an allopathic or osteopathic medical school are required. Residency in physical medicine and rehabilitation consists of one year of general clinical training (internship / PGY1) followed by three years of physical medicine and rehabilitation training (PGY2-4). Most residents complete a preliminary medicine, transitional, or surgical internship to fulfill this requirement. Other acceptable internships can be done in family medicine, pediatrics, or a traditional osteopathic internship.
Some PM&R residency programs offer an internship along with three years of PM&R training (PGY 1-4), which are known as categorical positions. However, a majority of PM&R residencies offer advanced positions which include only PGY2-4. Program requirements for a three-year program are 12 months of inpatient rotations and 12 months of outpatient rotations; the remaining 12 months are a variable inpatient/outpatient mix depending on the program. You may wish to investigate this variability when choosing a program that fits your interests.
Severe deconditioning and general debility
Neurologic disorders: multiple sclerosis, ALS, Guillain-Barré syndrome, and myasthenia gravis
Complicated amputations, arthritides, fractures
Brain injury: traumatic, neoplastic, ischemic
Spinal cord injury
Pediatrics: including cerebral palsy, spina bifida, muscular dystrophy and trauma
The remainder of the residency is filled with outpatient rotations which may include the following:
- burn rehabilitation
- cancer rehabilitation
- cardiopulmonary rehabilitation
- chronic pain management
- general consults
- hand clinic
- impairment evaluation
- industrial rehabilitation
- injection clinic
- musculoskeletal clinic
- pediatric clinic
- prosthetics and orthotics
- spine center
- sports medicine
- work hardening
- wound care center
Research is required or encouraged at most institutions. A maximum of six months within a four-year residency program is permitted for research, although each program has its own restrictions. A few programs offer positions in a Clinical Investigator Pathway in PM&R residency training, which is a five-year track, allowing an extra 12 months for research.
ACGME-accredited fellowships are available in pediatric rehabilitation, spinal cord injury, neuromuscular medicine, sports medicine, hospice and palliative care medicine, and interventional pain medicine. Non-accredited fellowships are available in cancer rehabilitation, neurorehabilitation, multiple sclerosis, spine, musculoskeletal, and research. These are typically one year in length with some exceptions.
Lifestyle, Salary and Benefits
For the most part, the lifestyle of a PM&R resident is quite reasonable and predictable. As a general rule, inpatient services tend to be more time-intensive than outpatient rotations. Call schedules vary across different residency programs. Depending on the residency program, call can be taken from home or in-house. This can range from in-house call every fourth night to at-home call every 11th week.
Salaries for PM&R residents in their PGY2 year range from $40,000 to $72,000 per year, consistent with other specialty residencies. The annual salary does vary with region of the country and the local cost of living. There is typically a $1,000 to $3,000 raise in salary with each advancing year of residency. Moonlighting is the opportunity to work outside of your residency program—for example, in a private clinic or emergency room—to supplement your income. Moonlighting privileges are typically program dependent.