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PM&R Resident E-Newsletter

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June 2016

From Your Resident Physician Council (RPC)

Wound Care? What Are You Talking About?
Joseph L. Connor Jr., MD
PGY-3, Physical Medicine and Rehabilitation, MedStar Georgetown University Hospital/National Rehabilitation Network, Washington, DC
Joseph.Connor@gunet.georgetown.edu

Wound care is a specialty of medicine that focuses on the treatment of chronic, non-healing wounds. The majority of diagnoses seen are venous stasis ulcers, diabetic ulcers, pressure ulcers, and arterial ulcers. This specialty does not require fellowship training or board certification. In fact, many employers will provide a new employee with on-the-job training in wound care and hyperbaric oxygen therapy, which is a well-accepted adjunct treatment in the management of many chronic wounds.

As a wound specialist, one will likely practice in an outpatient setting with some or no inpatient consult responsibilities, no call, and no weekends. Wound centers can be stand alone, private, semi-private or in hospital and academic centers. The physician works with a team of wound nurses, nurse practitioners, and physician assistants, who assist with follow up visits and permit the physician more time with complicated patients or non-clinical duties. Also, there is frequent collaboration with specialists in plastic surgery, vascular surgery, orthopedic surgery, and podiatry, who recognize the importance of non-operative treatments the wound specialist will provide. 

The wound care physician utilizes various treatment approaches to treat the underlying cause of the wound. This is where the physiatrist comes in. All patients with pressure ulcers require the proper pressure relieving techniques and equipment we see in the rehab setting. Diabetic ulcers require offloading orthotics that may be foreign to other subspecialists. Furthermore, some patients are not able to salvage their limb after a complicated ulcer and have it amputated. A physiatrist is best for their long-term prosthetic care. Additionally, the wound specialist is hands-on when applying compression wrappings, or performing in-office sharp debridements and epidermal skin grafting on a regular basis. Some wound specialists choose to practice wound care a few days per week, while seeing patients in their background discipline, such as PM&R.

Many patients have difficulty finding a physician who specializes in wound care and they end up receiving multiple referrals by the time they make it to a wound specialist. They arrive exhausted and dissatisfied with their quality of life. Fortunately, many wound centers boast a healing rate above 90%. In my experience at an outpatient academic wound center, the patient satisfaction was palpable the first day in clinic. The patients raved about the ability to wear shorts in warm weather and the fact that they could now attend social events without worrying about the odor an untreated wound may produce. Happy patients result in happy doctors.

The demand for wound care is expected to greatly increase over the next 20 years due to the diabetes epidemic being faced nationwide. This is an attractive career path for those who desire hands-on care with tangible results, while enjoying good quality of life in and out of the workplace. Furthermore, there are numerous opportunities for wound specialists to perform research, or collaborate with pharmaceutical and medical device companies to advance the field.

Fellowship Highlight: Pediatric Rehabilitation
Elizabeth Martin, MD, MPH, MHS
PGY-4, Stanford University
AAPM&R RPC Past President




Kelly Pham, MD
Pediatric Rehabilitation Medicine Fellow, Seattle Children’s Hospital


Physiatrists that specialize in pediatric rehabilitation focus on “the prevention, diagnosis, treatment, and management of congenital and childhood-onset physical impairments,” according to the National Resident Matching Program’s website. This seemingly simple definition covers a very broad spectrum of conditions, including but not limited to, brain injury and spinal cord injury, congenital conditions such as cerebral palsy, spina bifida or muscular dystrophy, rare metabolic or genetic conditions, as well as areas such as pediatric sports or pediatric musculoskeletal medicine. Those interested in pursuing a career in pediatric rehabilitation medicine (PRM) have a couple of routes to choose from. As of 2011, applicants must complete either a 5-year combined pediatric and PM&R residency, or complete a PM&R residency followed by a 2-year PRM fellowship in order to be eligible for board certification in PRM. Residents completing a combined residency are no longer required to complete an additional year of fellowship to qualify for PRM board certification. At the time of this article, there are 3 programs offering the combined residency.

Currently, PRM fellowship programs participate in the ERAS application cycle and NRMP match. There are currently 19 programs, with the number of participating programs and slots available fluctuating from year to year. Due to the interest in this field and demand for physiatrists specializing in pediatric rehabilitation medicine across the country, programs have made an effort to increase the number of available fellowship positions in past years. More information is available at the AAMC ERAS website and NRMP website.

I connected with Dr. Kelly Pham, who is currently completing her second year of pediatric rehabilitation fellowship at Seattle Children’s Hospital, to discuss her experiences pursuing PRM as a career and during fellowship.

Dr. Martin: What is one important reason you chose to pursue a pediatric rehabilitation fellowship?
Dr. Pham: I chose to pursue a pediatric rehabilitation medicine fellowship because PRM is what I want to do as a career, and I love working with children with disabilities. They are so robust and resilient in the face of disease and disability. They make me laugh, they make me smile. More than anything I found that I was very happy doing pediatric rehab and if there is one thing that is important to me in my career, it’s happiness. Another great thing about PRM is that it includes a lot of neurorehabilitation, which is another part of rehab that I find interesting. PRM is such a vast field because it includes everything in adult rehab plus child-specific diagnoses such as cerebral palsy.

Dr. Martin: If you could go back to the year you were a resident applying to fellowship, what piece of advice would you have liked to receive during that process?
Dr. Pham: Choose what is best for you and your family, if you have one. This was something that guided my decision and a piece of advice that I would give anyone. You both/all need to be happy and fulfilled in your careers and life.

Dr. Martin: What has been your favorite part of your fellowship? What about your career as a pediatric physiatrist so far?
Dr. Pham: My favorite part of fellowship is being able to learn from such an amazing group of mentors who are so truly invested in my education. I had not experienced that in my medical education until I came here and I am so grateful for it. I appreciate the collegiality across different specialties and the colleagues that I have met and provided care for patients with. As far as my career, I look forward to being able to provide care to children with CP and brain injuries, as those are my 2 biggest areas of interest.

Dr. Martin: What do you think your career will look like moving forward?
Dr. Pham: I picture myself providing mainly outpatient-based care of children with CP and brain injury, as well as acute management of brain injury in children in the hospital as a consultant. Though I don’t see myself as a primary inpatient provider, I certainly understand the importance of staying involved in that. I would like to find a researcher with similar interests who I can join forces with to be the clinical counterpart in collective research projects. I also look forward to providing the fine education that I was afforded in fellowship to residents, fellows, and medical students who come through our system. I’m excited to see where my career takes me!

Academy News

Coming Soon: 2016-2017 Dues Renewal for Members In-Training and Recent Graduates

Dues renewal for in-training members will open in early July. You are eligible for renewal if you meet 1 of the following criteria:

  • You are a resident.
  • You are in a fellowship (fellowship application must be submitted to AAPM&R).
  • You graduated from your residency program in 2015 or 2016.
  • You are a medical student with a PM&R Journal subscription.

Academy membership is just $75 for residents and recent graduates! Residents and medical students receive all AAPM&R membership benefits, as well as special benefits just for you—review them here. Stay tuned to www.aapmr.org for renewal information. 

Thank you in advance for your support in helping move the specialty forward!

How Would You Describe Physiatry?

The Resident Physician Council (RPC) Board invites all residents and medical students to raise awareness for PM&R by answering the question, “What is PM&R?” This is your chance to show everyone what PM&R is really all about! AAPM&R is currently accepting YOUR video submissions to showcase the specialty and show everyone how awesome PM&R is! The winning video will be used to promote physiatry on the AAPM&R website, social media, and at the 2016 Annual Assembly in New Orleans. Creators of the video will also win free tickets to the President's Reception. We can't wait to see your video submissions! Learn more here and hurry—the deadline is July 31!
Seeking Nominations for the 2016-2017 RPC Board
The Resident Physician Council’s (RPC) Call for Nominations is now open for a number of Executive Committee officers and committee/liaison appointments. Any interested, current AAPM&R resident members (PGY1-3) may apply. This is your opportunity to gain valuable leadership experience, insight into the specialty of PM&R, and serve on behalf of the Academy’s resident membership. Don’t miss your chance to get involved!

View the position descriptions and submit your nomination today.

Annual Assembly

“Move Physiatry Forward” with Your Peers in New Orleans!

You’re invited to Move Physiatry Forward with your peers in New Orleans for AAPM&R’s 2016 Annual Assembly, the largest annual gathering of PM&R residents in the country! Join us in the “Big Easy” to network with more than 500 residents, attend educational sessions designed exclusively for you, and distribute your CV to potential employers during the Job Fair. Learn more about the Resident Program here.

Register by August 24 to take advantage of member discounts, early-bird registration rates, and to reserve a seat in our popular limited-attendance workshops. 

P.S. Your Academy has reserved a number of discounted hotel rooms near the Ernest N. Morial Convention Center. Book your room by September 15!

Learn about the Latest Coding and Billing Issues with Our Preconference Course

Join us on Wednesday, October 19, for our preconference course, Coding & Reimbursement: Avoiding Audits and Denials. Led by Course Director Scott Horn, DO, this full-day course will give you an introduction to ICD-10’s impact on PM&R with specific tactics for implementation, how to effectively incorporate 2016 CPT® coding guidelines into practice, and much more. Learn more and register now!

Run for a Great Cause: PM&R Research

Join your peers for an early morning run on Friday, October 21 to raise money for PM&R research. Registration is just $25/$15 for residents. Sign up when you register for the Annual Assembly or onsite at the Foundation booth in the PM&R Pavilion. All funds raised through registration fees and donations will be used for physiatric research.

Education

Prepare for ABPMR’s Part I Exam by Utilizing AAPM&R Resources

AAPM&R has the resources to help you prepare for the American Board of Physical Medicine and Rehabilitation’s (ABPMR) Part I Examination on August 9, 2016. Get a head start on studying with these must-have resources, including:

Find all of the above and other great study resources on me.aapmr.org.

Abridged 2016 SAE-R Now Available
The 2016 Self-Assessment Examination for Residents (SAE-R) Abridged Version is now available on mē® and FREE for residents! The abridged version includes 85 questions covering the 12 content areas of the SAE-R, and serves as a great study tool for future SAE-R and/or board exams. Commentary and references are provided for each question. Learn more.

Physiatry News

Young Investigators: Apply for USBJI Grant Mentoring Program by July 15
The United States Bone and Joint Initiative (USBJI) and Bone and Joint Canada are dedicated to increasing research of musculoskeletal diseases and has developed a grant mentoring program to provide early-career investigators an opportunity to work with experienced researchers to assist them in securing funding and other survival skills required for pursuing an academic career.

The fall workshop will be held November 4-6, 2016 in Toronto, Ontario. The deadline to apply is July 15, 2016. Learn more and apply for this program.

Health Policy/Advocacy


Busy with patient care on the wards? Take a minute for this quick update. American health care is changing at lightning speed. Health care’s move toward value-based payment systems is driving much of the changes. Your Academy and the Resident Physician Council are working hard to guide our membership and to protect and promote the future of physiatry.

Please take a few moments from your busy day to get up to speed on the latest developments and news below. The strength of our Academy comes from a strong and well-informed membership.
                - P. Bobby Katta, DO, JD, LLM and Charles Odonkor, MD, MA



AAPM&R Releases MACRA & MIPS Video Primers

To help educate members on the most extensive changes to physician payment policies in the past 2 decades, the Academy has created 2 short videos—one highlighting MACRA, the other detailing MIPS.

The systematic changes occurring in health care are impacting how you practice and how you are reimbursed. Depend on your Academy to lead you through the transitions occurring in the business of health care to ensure you, and ultimately the specialty, are successful. Spend just 10 minutes viewing the videos to gain a better understanding of these important new health care initiatives. Learn more.

P.S. We’re 8 days away from the MACRA proposed rule comment deadline—learn more and submit a formal comment by June 27.

AAPM&R Co-Signs Letter in Response to Proposed Official Disability Guideline (ODG) Recommendations
On May 27, your Academy co-signed a letter sponsored by the North American Neuromodulation Society commenting on Official Disability Guidelines (ODG) proposed policy that would prevent coverage for intrathecal drug delivery systems (IDDS) for all workers’ compensation injuries, including new and current low dose therapies. The letter is in opposition to the ODG proposed policy in effort to preserve patient access to this care. Read more.
Rehabilitation Research & Innovations Highlighted at NIH Conference—A New NIH Rehabilitation Research Plan in Final Stages of Development
Several AAPM&R members attended the National Institutes of Health first ever National Rehabilitation Research Conference in Bethesda, MD on the main NIH campus. The main focus of the conference was round table discussions and a town hall meeting that focused on a draft national rehabilitation research plan. Your Academy submitted comments on the draft priorities and will continue to actively engage in the process until a new plan is finalized. Read more.
Academy Member Michael Hatzakis, MD, Attends Registry Conferences
On May 4, Michael Hatzakis, MD, along with your Academy, attended the Qualified Clinical Data Registries Conference hosted by the American Medical Association. Dr. Hatzakis and your Academy also attended the National Quality Registry Network (NQRN®) Registries Conference on May 5 in cooperation with the Council of Medical Specialty Societies (CMSS).
House Energy & Commerce Oversight & Investigations Subcommittee Discuss Concussions and Head Trauma
On May 13, the House Energy & Commerce Oversight & Investigations Subcommittee held a hearing, following an initial roundtable discussion in March, to examine concussions and head trauma in youth sports. Read more.
AAPM&R Signs On to OHA Decision to Eliminate Coverage of Epidural Steroid Injections
In May, your Academy, as part of the Multi-Society Pain Work Group, signed on to a letter commenting on Oregon Health Authority’s (OHA) decision to eliminate coverage of epidural steroid injections (ESI), effective July 1. Read more.
AAPM&R Participates in S.800 Congressional Meetings
AAPM&R recently participated in a series of congressional meetings in support of S. 800— Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act. Read more.

Resources for You

What’s Coming Next
Look for the next issue of the PM&R Resident in your email inbox in August.

Want more resident-specific content before then? to get additional articles written by your peers right in your news feed.

Missed the last issue? Check it out on the Academy’s website.