Sara Raiser, MD
PGY4, University of Virginia
Lindsay Ramey, MD
Sports Fellow, Shirley Ryan AbilityLab (formerly the Rehabilitation Institute of Chicago)
The Primary Care Sports Medicine (PCSM) fellowship is a competitive program that matched 81.1% of applicants in 2017. PCSM is a 1-year fellowship that can be completed by residents from 5 different specialties (physical medicine and rehabilitation (PM&R), emergency medicine, family medicine, internal medicine, and pediatrics). Most PM&R residents will apply to both PM&R and non-PM&R affiliated programs.
I spoke with Lindsay Ramey, MD, a sports fellow at the Shirley Ryan AbilityLab (formerly the Rehabilitation Institute of Chicago), regarding her PCSM fellowship experience. Dr. Ramey attended the University of Virginia for her medical education and completed her PM&R residency at Spaulding Rehabilitation Hospital/Harvard Medical School.
Dr. Raiser: What initially developed your interest in sports?
Dr. Ramey: I’ve always been interested in anatomy and body movement. I grew up dancing, and I think that’s probably where it started. Even in high school and college, I took some anatomy courses, and I thought it was really interesting how one small change in your anatomy or alignment can cause such big downstream effects. And, the more I started spending time with sports medicine physicians and patients, the more I fell in love with it. I think the patients are very motivated for the most part, and they want to learn and take an active role in their treatment, which was really important to me. I also had some really great mentors throughout my training and if you’re working with someone who comes to work every day and is happy with what they do, you can see yourself being happy doing that, too. So I think it’s a combination of interests, liking the patient population, and then having some really great mentors.
Dr. Raiser: Why did you choose a fellowship?
Dr. Ramey: My major was in education; so, I actually thought I was going to be a teacher, but then I fell in love with medicine. As soon as I realized I could still focus on teaching in medicine, I was 100% committed. Once I found sports medicine, I knew I wanted to go into sports medicine academics. I set my goals on becoming a part of a fellowship training program for sports medicine. I chose to pursue fellowship because I needed more training to improve my clinical knowledge and procedural skills to be the doctor and the mentor that I want to be. With my academic interests, I also want to be board-certified in sports. So, I wanted to go to an ACGME-accredited sports fellowship program for that reason too.
Dr. Raiser: Do you have any recommendations regarding how to choose between PM&R and non-PM&R affiliated programs?
Dr. Ramey: I really don’t think there is a right or a wrong answer to this. The advice that I would give to anyone who is planning to apply to sports fellowship is… sit down and literally write out your career goals and try to prioritize them. There are so many options of what you can do. Do you want to be a professional or a collegiate-level team physician? Procedurally, do you want to do spinal procedures? Do you want to do ultrasound-guided procedures? Do you want to do EMG? Do you want to do regenerative medicine, and if so, to what extent? Do you want to do PRP or stem cells? There are just so many possibilities there. Do you want to do primary research? Or do you want to focus more on, maybe, a clinician educator track? So, I think when you can sit down and say where you fall on the spectrum of all of these things, a fellowship program will kind of pick you. Once you have your priorities, you can read about programs online, and talk to colleagues and mentors at various programs to see if the goals of a program are in line with your personal career goals. For example, I am very interested in women’s health and bone health. And, I wanted to find a program that would allow me to focus on these areas. So, tailoring what I want to do in my career path and defining that before I even stepped into the interview allowed me to find a program that fits my needs.
So, that is a very broad comment that I would make to anyone. But once you can define those things, there are some generalizations about PM&R vs. primary care that might help. I think that PM&R fellowships probably offer a little bit more robust training in spinal procedures, ultrasound, and regenerative medicine. I know there are some primary care programs that offer that, but it is not quite as common in that setting. Primary care programs, on the other hand, offer incredibly broad team coverage opportunities and broader exposure to some of the medical issues, the dermatologic conditions, the cardiovascular issues, et cetera, that you want to know if you plan on being a team physician one day. I think that both categories have their strengths, so once you define what you want to get out of a program, that might help you pick between PM&R and primary care. I would just caveat that there are definitely exceptions to those rules. I know some primary care places that do spine a half day each week and their trainees come out feeling really confident in it. If there is a particular program that you’re looking into, I would send them an email, and see if there is a physiatrist on staff that you could talk to.
Dr. Raiser: Have there been any surprises along your path of fellowship applications to where you are now, midway through your fellowship year?
Dr. Ramey: Every day is a surprise… my co-fellow probably said it best, “The first week of fellowship is like trying to drink from a fire hydrant.” You learn so much, so quickly. It’s such a steep learning curve at the beginning. I kept thinking that the learning curve was going to flatten out. But I am constantly surprised at how much I continue to learn every single day, even after 8 months. And then the more that I learn, the more questions I have. It’s like the world of sports medicine just keeps getting bigger and bigger to me, which isn’t necessarily a bad thing. But I’ve been surprised at how much growth can happen every single day.
Dr. Raiser: What has been the most challenging aspect of your sports fellowship?
Dr. Ramey: I’m the type of person that likes to be involved in everything. So, I would say for me, trying to stay focused on a few key areas throughout the year has probably been the hardest thing. You’ll get so many opportunities throughout the year. You’ll have opportunities to cover 10 different sports. You’ll have opportunities to do adaptive sports, research, QI projects, book chapters, and case reports. You’re in an academic program that offers you support, and you want to do it all but you can’t. It’s 1 year, and there’s literally not enough time or coffee in the world to do everything that you might want to do. I found that I go back to that career list that I talked about earlier. I think, “What am I going to do tonight? Am I going to cover the wrestling match? Am I going to go to training room? Am I going to work on my research project? Or, am I going to spend time with my fiancé?” I look at my professional and personal goals, and I think, “which will get me there?” That’s helpful. Granted, a lot of times, events are mandatory, but when you have the option, that can be helpful. But I think that the more you can weed out extras that are not mandatory or useful to you or your program, the happier you will be during your fellowship year, and probably the better you will come out for it, because you will come out with a few key areas that you will feel well-versed in.
Dr. Raiser: How has your fellowship been helpful in developing your career goals and finding your first job?
Dr. Ramey: I came in with “these are my career goals” and “this is what I want to achieve.” I think it’s helpful to come in with your own career goals. But it has been helpful to talk to fellowship staff with more experience about how to prioritize my goals, realistic timelines, and practical ways to achieve them. I came in with a list of about 4-5 things that I wanted to achieve, and I showed my program that. And, I’m lucky to be in a program where they allow me to build my schedule around my goals. Based on a list that I gave them, I was able to notch out dedicated time to do ultrasound, spend time with bone health specialists in both orthopedics and endocrinology, and teach residents. My program was really helpful once I defined my goals and helped me achieve them.
Dr. Raiser: What additional advice would you give to a resident who is considering applying for a sports fellowship?
Dr. Ramey: I remember mid-way through the fellowship application process how frustrated and tired, and frankly, broke I was. And I remember, thinking to myself, “I wonder if this is worth it.” Granted, I went to the extreme. I interviewed at 14 different programs and I really don’t think anyone needs to do that. But knowing my career goals, I really wanted to get into an ACGME-accredited PM&R fellowship. I wanted to keep every option on the board and really explore my opportunities. That being said, having gone through it now, it was 100% worth it. I know it can be competitive, and it can be frustrating when you’re trying to build your CV. But, you will learn more than you think possible during a year of fellowship training. While I can only speak for my program, a lot of friends in other programs all say the same thing. You are just amazed at how much you learn in such a short period. I would tell people that we know it’s frustrating, hard, and expensive, but if you are passionate about sports, and you know that you want to do a sports fellowship, don’t give up just because it’s hard or competitive or you might not think you’re the best applicant. Try to stick it out because it’s totally worth it.
Thank you, Dr. Ramey!