Roadmap to a Fellowship

Disclaimer: AAPM&R does not hold itself responsible for statements made by any contributor. Statements or opinions expressed within this document reflect the views of the authors and not the official policy of AAPM&R.

The field of physical medicine and rehabilitation (PM&R) offers a wide array of areas in which physicians can build their interests and practices. The diversity in the field affords residents many options – and investigating these areas during residency can be overwhelming.

AAPM&R’s Resident Physician Council created this “roadmap” for residents wishing to pursue fellowships. This roadmap serves as a guide to assist in choosing their career path - whether directly entering into practice or obtaining fellowship training. The goal is to provide a guideline that emphasizes important aspects of this often confusing process.

During the PGY-2 year, most residency programs are designed to expose residents to many different aspects of PM&R; residents should seek out as many different practice settings as possible. They should decide what aspects of the field are of interest and ask attending physicians regarding their practices - what they like, what types of patients do they see, what types of treatments they prescribe, etc. As residents transition from PGY-2 to PGY-3 years, they should use their interests to formulate ideas regarding their future practice. However, the diversity of the field allows many physicians to combine two or more areas of interest; residents should not feel confined to one setting and should recognize this potential during their job search (fig. 1, PDF download).

A PGY-3 should research the types of fellowship or job opportunities available in their field of interest, consult with senior residents and attendings, and use Internet resources to guide their search. A PM&R physician should be comfortable with the fundamentals of musculoskeletal and inpatient rehabilitation – many use fellowships as a means to further enhance their residency training.

Fellowship Timeline

PGY-2 Year

• Obtain broad exposure to all aspects of PM&R

• Build on experiences and consider what type of practice:

  • Inpatient vs. outpatient

  • Research component

  • Teaching responsibilities

• Think about the practice setting:

  • University-based, veteran affairs, community, or private practice

• Seek advice from attendings and other residents regarding interests. Finding a mentor can be helpful at this stage

• Consider the location – including housing, schools, recreation

  • Urban vs. rural

• Attend conferences on topics of interest – begin networking

• Join national organizations, which can provide valuable information for fellowships and jobs. These organizations may provide discounted membership and conference rates for residents

Examples include:

• American Academy of Physical Medicine and Rehabilitation (AAPM&R)

• Physiatric Association of Sports, Spine and Occupational Rehabilitation (PASSOR)

• American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM)

• American College of Sports Medicine (ACSM)

• American Academy of Pain Medicine (AAPM)

• American Paraplegia Society (APS)

• International Spine Intervention Society (ISIS)

• North American Spine Society (NASS)

PGY-3 Year (Early)

• Attend conferences on topics of interest – begin networkingg

• Choose elective rotations in areas of interest

• Present at journal clubs and resident lectures on topics of interest – this is a great opportunity to formulate research ideas

• Consider a fellowship and begin preliminary research – use the Internet, and discuss with attendings, current fellows, and senior residents

PGY-3 Year (Mid)

• Choose elective rotations in areas of interest

• Develop research on a topic of interest – submit poster presentations to conferences, publish

• Shadow attendings who have practices in geographical areas that are a potential future practice location

• Decide on type of fellowship to pursue

• Collect information on fellowship programs. Use AAPM&R’s fellowship database, as well as other national organizations’ resources. Contact programs and collect the necessary application materials

• Ask attendings for letters of recommendation, and ask them early

PGY-3 Year (Late)

• Choose elective rotations in areas of interest

• Apply early – be diligent in noting application deadlines, as they may vary significantly

  • Composing personal statements can be arduous, so prepare in advance

  • Obtain official documents such as board score reports before the application process so they are accessible when needed

  • An updated CV is a must

PGY-4 Year

• Arrange interviews early, as the adage goes – the early bird catches the worm

• Hit the interview trail. As with residency interviews, this process may be expensive, so plan ahead

• Await offers and be prepared to make decisions quickly as they arrive

Fellowships

Currently the subspecialties of spinal cord injury (SCI), pain medicine, and pediatrics require ACGME-accredited residency training (PGY-5) in order to sit for board certification. Traumatic brain injury (TBI) does not require further board certification to practice; however fellowship training is encouraged and may be required in some academic settings. Neurorehabilitation fellowships may combine TBI and stroke elements in one program, while other may not; residents should become familiar with each program’s design. Other fellowships include research that often is funded via research grants. The Association for Academic Physiatrists and the National Institutes of Health Web sites include links available for programs such as the K-12 grant for those interested in a research-based fellowship or an academic position.

Pediatrics and Spinal Cord Injury

Beginning in 2006, all fellowship positions in pediatric rehabilitation require ACGME accreditation. If a resident pursues a pediatrics fellowship after completing PM&R residency training, a two-year fellowship is required; if a resident completes both PM&R and pediatric residency training, a one-year fellowship is available. SCI fellowships are accredited by ACGME and require subspecialty training for one year in order to sit for the certification examination. A list of ACGME-approved fellowships in pediatrics and in SCI, in addition to certification requirements for each, can be found on the American Board of Physical Medicine and Rehabilitation’s (ABPMR) Web site at www.abpmr.org/certification/subspecialty.html.

Musculoskeletal and Sports Medicine

When considering a practice in musculoskeletal or sports medicine, residents should keep in mind that many specialties (including internal medicine, family practice, emergency medicine, and pediatrics) offer fellowship training and board certification in sports medicine. These programs generally do not offer positions to PM&R residents, and physiatrists are currently ineligible to sit for the American Board of Medical Specialties’ sports medicine board certification. Within PM&R, musculoskeletal and sports medicine fellowships are available. These fellowships usually are based in the outpatient setting, and with various programs providing training in epidural spinal injections, peripheral joint injections, and ultrasound diagnostics. These programs are designed to supplement the musculoskeletal exposure residents receive during their fellowship, build expertise in the area of biomechanics and sports management of the injured athlete, and provide research opportunities for those who wish to pursue an academic career.

Pain Medicine

Pain medicine fellowships are numerous and diverse, and are becoming increasingly more competitive. These fellowships are offered through PM&R, anesthesia, and a few neurology departments (fig 2 PDF download). Many anesthesia programs, as well as a handful of PM&R programs, are ACGME accredited. Beginning in 2005, physiatrists must complete an ACGME-accredited pain medicine residency program to sit for the ABPMR board certification exam in pain medicine.

Residents interested in pain medicine fellowships should become familiar with the types of interventions and the types of practices. This information serves as a necessary guide for residents as they choose fellowship programs. Anesthesia programs may, for example, focus heavily on pharmacology or general pain management and may also train fellows in procedures such as stellate ganglion blocks, nerve stimulators, etc.; PM&R programs may be largely based in lumbar spine interventions. PM&R programs may also offer musculoskeletal and sports training as available in the sports fellowships discussed above. The types of training will differ between individual programs, so it is necessary to research them. For anesthesia and neurology programs, ask what programs have offered positions to PM&R residents in the past and if any physiatrists practice in their departments – these factors may be important when distinguishing between programs.

As fellowships become increasingly competitive, it is recommended that residents become familiar with the application process and with the multitude of programs available. AAPM&R and PASSOR’s Web sites provide excellent resources for such information.

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