Post-graduate years 3 and 4 are exciting times for PM&R residents as the completion of their residency training approaches. This can be a daunting time as well with new stressors compared to intern and PGY2 years.
It is the time to begin looking closely at the next step in your career. The key to this success and reducing stress at this stage is early preparation. Whether you plan on joining a private practice, working in a hospital, pursuing fellowship training, becoming an educator, becoming a hospital administrator or pursuing a non-traditional route, it is vital to be prepared.
Regardless of your future plans, a strong curriculum vitae and cover letter are critical. Update your curriculum vitae to include your accomplishments during residency and ask a colleague to review it prior to distribution. Residents at academic institutions may contact their university career development center to make this document more concise and professional. Equally important is drafting a cover letter, which describes your strengths and career aspirations. See "Polishing your CV" for more details.
Deciding What You Want to Do
Choosing from a variety of career paths that you can take after residency training takes some soul searching. It is a great idea to make a list and weigh the pros and cons for each choice including personal and professional preferences. Your attendings, mentors and recent graduates may be able to provide a unique perspective on the type of work environment that would be most suitable for you. They have seen many residents graduate from the program and can be very helpful with the complex decision making process. You should review your experiences and decide if there are any additional rotations that can help you make this decision or bolster your application prior to graduation.
Traditional vs. Non-Traditional Routes
Regarding traditional routes, residents first consider if they desire to pursue further training through fellowship positions. It is important to begin your research early as there are many fellowship and research opportunities available to PM&R graduates. You should evaluate the differences between ACGME and non-ACGME recognized programs. Often, faculty at your residency program can be helpful in explaining the pros and cons of each type of program. You can find a list of fellowships available to PM&R graduates on the AAPM&R Fellowship page.
Those residents intending on practicing general physiatry should consider many factors, such as the scope of the practice, patient demographics and allotted time for electrodiagnostics and procedures. It is also important to think about whether you see yourself in an academic, government hospital or private practice setting. Other important considerations include payer mix, size of the practice, contractual benefits and call coverage.
Do you intend on setting up a private practice? There are some great resources to look into including the U.S. Small Business Administration (sba.gov) as well as practice resources which can be found on the Academy's website.
Personal factors are equally important. This may be something to discuss with your significant other or family. What community would you like to work in? What are housing costs in the area? What are the taxes? What is the anticipated income for that community? What is the type/diversity of leisure activities?
Residents who are pursuing non-traditional routes should begin research into that niche. For instance, is an MBA required or recommended for hospital administration? What experiences would prepare you for a career in medical informatics, consulting (medical-legal, pharmaceuticals) or independent medical examinations?
Often residency programs offer education of contract negotiation which can be helpful as well to prepare for eventual job offers. Make sure to take advantage of these opportunities!
Do you want to be board certified? If so, it is important to look into the American Board of Physical Medicine and Rehabilitation (www.abpmr.org). An important consideration is timing. A computerized board examination is administered by ABPMR at Pearson Professional Testing centers in August following graduation. Passing the written exam allows the candidate to sit for the oral board examination. The oral boards are held in Rochester, MN, in May of the subsequent year. These exams are expensive, specifically $1395 (Part 1) and $1910 (Part 2) and may require logistical planning and cost—late fees are $500 per exam. Expect to spend a similar sum on travel, lodging and food. Some residents study independently while others opt for national board review courses, which are usually a week long. It is important to research the differences between these options and develop a schedule.
With the exception of working at a Veterans Association Hospital, you will need a state-specific license to practice in any state in the United States. The Federation of State Medical Boards provides a credentialing service which can help with storing and forwarding paperwork to state medical boards for a cost (~$300+). This is especially helpful with multiple state licensure applications. Information can be found for state specific requirements at fsmb.org.
Most states require:
- A self query (www.npdb.hrsa.gov)
- A Drug Enforcement Agency Certification
- Official copies of diplomas from undergraduate, medical school, internship and residency
- USMLE® and/or COMLEX Board Scores
Please note that obtaining some of these documents may take time and money so allow ample time for acquisition.
If you plan to accept Medicare and Medicaid patients you will have to complete provider applications which can take approximately three months. Applications are available at medicare.gov and at state specific sites for Medicaid.
Employers commonly request the following documents:
- Passport photos
- A copy of your driver's license
- Immunization records including titers
- A letter with your anticipated board certification dates
- A program director stating that you have completed the program and they have no claims against you
We understand this may be an overwhelming time your career, but with the right support and preparation you are sure to be successful!
Your Academy wishes you the best of luck as you complete your training and prepare for the next phase in your professional career.
For more career information, feel free to contact the AAPM&R Physiatrist in Training (PHiT) Council at any time.
The 2013 Resident Physician Council Board
Updated 2021 by Kristina Barber, MD