A Guide to Physical Medicine and Rehabilitation Residency Program

8 min read
Olivia Kelly, MD
Updated April 22, 2021
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A Guide to Physical Medicine and Rehabilitation Residency Program

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Commonly referred to as physiatry, the physical medicine and rehabilitation residency program is a specialization offered in many universities that deals with the diagnosis, evaluation, and provision of intervention for patients with mechanical difficulties resulting from an underlying disease, injury, or inborn impairment. Despite the stereotypical definition that the program is mainly focused on the physical rehabilitation of the patient’s body, the scope of their actual practice is more extensive than one might think. PM&R programs are aimed at the holistic development and rehabilitation of the patient, with their goals emphasized at providing patients with independent mobility and improved quality of life. Apart from this, their work also extends up to the prevention of complications arising from such disabilities and alleviation of pain associated with any type of impairment.

Misconceptions in the Field of Physiatry

The practice of physiatry is not necessarily limited to special sessions as they may take on general hospital shifts, in-patient monitoring, and out-patient consultations as well. Contrary to what one might think, physiatrists are different from physical therapists. Although both areas focus on the holistic rehabilitation of the human body, physiatrists are more focused on the provision of diagnosis and prescribing of appropriate interventions that will then be performed by the physical therapist. This is because physical therapists are the ones who are trained in the examination of various musculoskeletal features and their management – making them the more appropriate choice to deliver the regimen suggested by the physiatrist. Nevertheless, both professions always work hand in hand to provide the best intervention for the specific condition of a patient.

The residency programs for this specialization range from 3 to 4-year courses, varying depending on the university of choice. 4-year programs are usually the ones that integrated the 1 year of training (internship/PGY1) required before proceeding to the 3 years allocated for the PM&R program proper. Other individuals opt to accomplish the initial requirement in other fields such as preliminary medicine, and surgical internship. It is possible for as long as the 1-year training in general medicine is accomplished in any way.

Considering the lengthy procedure necessary to complete this specialization, it is important to know the various aspects associated with this course and prevent any instances of indecision when it’s far too late to back out.

Basic Overview

As mentioned previously, PM&R programs usually last from 3 to 4 years, depending on the integration of the 1-year preparatory training that is required in many universities. Apart from preliminary medicine and surgical internship, interested students may also opt to take their internships in family medicine, pediatrics, and even in traditional osteopathic internship programs. This variation will solely depend on the preference of the student and the availability of these programs as a substitute for the general medicine training requirement. Consultation with the program director is necessary to clarify these points, but it will more or less follow such a format.

In addition to that, some programs offer advanced variations that simultaneously implement the 1-year internship along with the 3-year program proper of your PM&R residency. These are known as “categorical positions,” and if ever you’d like to take up a faster but more challenging format, this is probably the most efficient option for you. PGY 1-4 is tackled within these 3 years, and you’ll essentially be juggling your internship with your residency training – making it incredibly taxing and difficult at every level. Most programs separate these two aspects and focus on PGY 2-4 during those 3 years, with the rotations alternating between outpatient and inpatient consultations. This option is not necessarily easier per se, but it sure does remove the simultaneous aspect which is probably too much for some individuals. It is important to assess your capabilities first before jumping to any conclusion as this might effectively make or break your overall performance in your program.

Scope of the Program

PM&R programs, as per its description, is mainly focused on the holistic rehabilitation of the human body. As such, it covers not only the physical aspect of rehabilitation but its emotional, mental, and social implications as well. For your general rehabilitation training, it is usually comprised of rotations in certain areas tackling the different aspects of general debility and deconditioning, neurologic disorders, complicated amputations, post-arthroplasty, brain injury, stroke, spinal cord injury, a touch of pediatrics, and cancer. In addition to that, you will also be required to perform outpatient consultations that will handle a wide array of conditions ranging from amputees and arthritis, to wound care centers and geriatrics.

Similar to other disciplines, research is also highly encouraged in such a program and a certain amount of time is also provided for students. Although PM&R programs vary depending on the institution, they usually offer a maximum of 6 months within a 4-year program that could be utilized by the student to perform research regarding various aspects associated with physical and rehabilitative medicine. You could also opt to take up a position in the Clinical Investigator Pathway to be able to utilize an additional 12 months of research which will then extend the duration of your residency program to 5 years. While this might seem counterintuitive, especially for those who are looking for a quick and efficient way to obtain their certification, focus in research is not as simple as you might think and a career in this field is just as fulfilling as with other areas. Appreciation for research is steadily rising and it is slowly becoming a stable area to focus on, even when you’re taking up medicine. Despite that, you should still assess your options and determine if an extension will be beneficial for you in the physical, mental, emotional, and financial sense. Proper gauging of your conditions will provide you with the answers that you need to pinpoint the optimal program that is most suitable for your conditions and capabilities.

Shifting and Rotation Scheduling

Shifts for PM&R programs are pretty much similar to other disciplines wherein it alternates between inpatient, outpatient, and on-call conditions. Inpatient services require more focus due to the possible influx of patients, on top of their timely rounds and intensive consultations with admitted individuals. It is essentially time-intensive and demanding of your attention, but this will then effectively condition yourself for your professional practice upon finishing the course. Time restraints are common in actual practice, and being exposed to such a situation even in your residency program is essential in building up the experience and instinct necessary to operate smoothly and efficiently as a physician. On the other hand, outpatient consultations are less rigorous and are more focused on mild conditions that need a routine examination. Of course, this is not always the case, but it will essentially be similar, one way or another, most of the time. On-call schedules are heavily dependent on the scheduling of the institution, and it is often separated into in-house and at-home calls. An example of this would be an in-house call every third night or an at-home call every 10th week, but this is variable depending on the conditions, patient traffic, need for continuous monitoring, and other factors that might require a specialist to be present.

Compensation and Benefits

The salary for physiatrists and individuals taking up the PM&R residency program varies depending on the location and area of practice. Residents at the PGY 2 level may earn an annual salary ranging from $40,000 to $72,000, depending on the offer provided by the hospital. This salary, although variable based on the institution you’re taking your program in, is always assumed to increase for each year of residency that you finish. Expected increments of $1000 to $3000 are usually observed in many institutions, but this will still depend on the conditions of the area and the average expenses incurred in such a context.

To give you a further idea of the average compensation provided for certified individuals in the PM&R discipline, physiatrists focusing on research and academics earn an annual rate of around $226,000. On the other hand, the salary for those working in clinics and hospitals averages around $252,000. While this might not seem like the highest-paying job out of all the medical specialties, it is still decent enough to cover your expenses while still living a moderately-luxurious lifestyle.

The Finish Line

The field of physiatry is a commonly misunderstood area that is likewise a fulfilling and effective study to focus on for many people. It offers a wide variety of options from a solo practice to academic affiliations and referral work. It is provided with similar possibilities that are sought after in other areas, and it is essentially a noble work that is the reason for the betterment of many people’s quality of life. It will be difficult in the beginning as physiatrists will initially be faced with mainly outpatient consultations while they’re still building their referral network.

However, these conditions will not matter for those who are convinced that their calling lies somewhere in the vast area of rehabilitative medicine. Your compatibility would always take precedence over everything else, and knowing how to target the ones that are best fit for you is the key to finding the right balance between your professional and personal life. Gauging every possible factor is necessary, but knowing if you’re going to cherish your time in that program is even more important. Careers are built out of passion, and finding the right lamp to hold your flame is step one in your journey towards the unknown.

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