The Residency

The Medical Student's Guide to Physical Medicine and Rehabilitation

• Description
• Basic Requirements
• Lifestyle, Salary and Benefits
• Education

Description

Most PM&R residencies are three-year programs and offer positions at the    PGY-2 level, which means that the medical student must seek a transitional/preliminary year in addition to an internship. Some residencies offer a four-year program which integrates the first year of basic clinical training into their curriculum.

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Basic Requirements

A minimum of four years of graduate medical education: one year for the development of fundamental clinical skills, i.e., internship (transitional or preliminary year). This includes rotations in medicine, pediatrics, general surgery, or a combination of the above. Additional months in a primary care field or more specialized field may also be included. Some recommendations that will prove to be particularly useful in PM&R include those listed in Table 2.

PM&R residents are required to spend a minimum of one year and no more than two years caring for hospitalized patients. This may include a combination of the following:

• General Rehabilitation

• severe deconditioning and general debility

• neurologic disorders such as multiple sclerosis, ALS, Guillain-Barré syndrome, and Myasthenia Gravis

• complicated amputations, arthritides, fractures

• post-arthroplasty

• Stroke

• Brain Injury

• traumatic, neoplastic, ischemic

• Spinal Cord Injury

• traumatic, neoplastic, ischemic

• Pediatrics

• including cerebral palsy, spina bifida, muscular dystrophy and trauma

Residency programs vary in the number of months allotted to inpatient services. You need to bear this in mind when choosing a program, particularly if you have an idea of the type of patient population you wish to treat in your practice. The remainder of the residency is filled outpatient rotations which may include the following:

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.

Fellowships are available in pediatric rehabilitation, spinal cord injury, head injury, stroke, sports medicine, musculoskeletal rehabilitation, pain medicine, EMG, and research. These are typically one to two years in length.

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Lifestyle, Salary and Benefits

For the most part, the lifestyle of a PM&R resident is quite reasonable and predictable. You can pursue a life outside of the hospital in many cases. As a general rule, inpatient services tend to be more strenuous than outpatient ones. The PM&R resident may or may not manage a large portion of the patient's acute medical problems, depending on the particular institution's threshold for admitting acute rehabilitation patients. This is something to keep in mind when looking for a residency program, particularly if you feel strongly about the amount of "internal medicine" you wish to practice.

Call varies a great deal in terms of frequency and whether it is from home verses in hospital. This can range from in-house call every fourth night to at-home call every 11th week. Typically, most programs schedule call five to six nights per month with one weekend call each month.

Salaries for PM&R residents in their PGY-2 year range from $33,000 to $39,000 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 earn extra money. Moonlighting is permitted at many programs within certain guidelines, provided it does not interfere with your ability to fulfill your duties as a resident.

Benefits vary tremendously among residency programs. Any of the following may or may not be provided:

• paid insurance (health, life, disability)

• expenses for meetings, review courses

• professional dues

• licensure fees

• parking, uniforms, meals

• textbooks

• audiovisual services and equipment including photocopying, slides

• computer literature searches and library support services

• counseling

Most programs allow three to four weeks of paid vacation per year. Some also permit additional time for academic trips (e.g., research presentations, board review).

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Education

The amount of teaching you will receive depends on the faculty-to-resident ratio and the emphasis on didactics and clinical tutorship in any particular program. Further, if you are interested in teaching medical students or junior residents during your training, inquire if such opportunities exist.

As a medical student, you may wish to consider rotating through a clerkship in PM&R or a complimentary specialty. This provides you with more insight into the specialty and gives the program a chance to get to know you. See Table 2 for suggested clerkships.

In order to be Board certified, physiatrists are required to take both a written and an oral examination. Part I is typically scheduled for August after completion of your 4th year and Part II is taken in the spring of the following year. Review courses are offered by a number of institutions.

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