Guide
to the
PM&R Clinical Elective
Department of Physical Medicine and Rehabilitation
University of Pittsburgh School of Medicine
Brad E. Dicianno, MD
Director of Medical Student Research and Education
Drafted May 2006
Revised Oct 7, 2009
Introduction to PM&R at the University of Pittsburgh
The field of Physical Medicine and Rehabilitation, known as physiatry, was officially
established in the United States in 1947 though its principles of healing have been used for
centuries. The word physiatry, pronounced fizz ee at’ tree, is derived from the Greek words
“physikos” (physical) and “iatreia” (the art of healing). Practitioners of physiatry are known as
physiatrists. Physiatrists take care of patients of all ages, specializing in the treatment of
patients with musculoskeletal injuries, neuromuscular disorders, pain syndromes, and
disabilities such as those resulting from traumatic injury or stroke.
At the University of Pittsburgh, the residency program in Physical Medicine and Rehabilitation
was established in 1983, as a division in the department of Orthopedic Surgery. In 2000, the
Department of Physical Medicine and Rehabilitation was established, and since that time the
department has seen much growth. Today, we are comprised of more than 25 clinical faculty
members with a wide array of interests, including musculoskeletal medicine, traumatic brain
injury, spinal cord injury, spasticity management, amputee and prosthetic management,
electrodiagnostic medicine, and wheelchair development and design.
The Institute for Rehabilitation and Research at the University of Pittsburgh is becoming
recognized as a national leader in the field of rehabilitation research, developing cutting edge
technology and clinical treatment options. With funding from the National Institutes of Health,
Department of Education, U.S. Department of Health and Human Services, Pennsylvania
Department of Health, National Institute of Disability and Rehabilitation, Centers for Disease
Control, among others.
For more information about the department, please refer to our website at
www.rehabmedicine.pitt.edu.
Educational Goals
During this rotation, you should begin to:
1. Understand the basic sciences underlying the normal and altered structure and
function of the neuromusculoskeletal and closely related systems.
2. Understand the epidemiology, pathophysiology, clinical features, diagnostic
criteria, and natural history of selected specific neurological and
musculoskeletal diseases.
3. Become aware of different therapeutic options available for patients with
selected disorders of the neuromusculoskeletal system, including the mode of
action, indications, contraindications, complications, and special considerations.
By the end of this rotation, you should be able to:
1. Discuss functional implications of illnesses and injuries
2. Discuss the international classification of Functioning, Disability, and Health
3. Describe the impact of chronic illness and pain on the individual, family, and
community, including social, economic, and cultural implications.
4. Be able to perform a physiatric history, with emphasis on functional abilities
and limitations and psychosocial factors.
5. Acquire skills in physical examination of the neurological and musculoskeletal
systems, with clear understanding of manual muscle testing and range of motion
testing.
6. Discuss therapeutic options available to patients with disorders of the
musculoskeletal and nervous systems.
7. Describe the advantages of a rehabilitation team, member disciplines, and
special abilities of each team member.
8. Describe the different facilities and levels of care appropriate for the different
stages in the rehabilitative and recovery course.
Methods:
Inpatient:
1. On the inpatient service, you will be part of the rehabilitation team consisting of
1 attending physician and residents. You will be required to attend daily
rounds, staffing meetings, etc. as they occur.
2. You will be assigned no less than two cases per week.
Outpatient:
1. A schedule will be given at the beginning of the rotation
General:
1. You will be required to attend Journal Club, Grand Rounds, and Resident
Didactics during the rotation.
Facilities
Inpatient Services:

Montefiore University Hospital
o General Rehabilitation Service





Attendings: Dr. Michael Munin, Dr. Tiffany Calloway, Dr. Louis Penrod, Dr.
Brad Dicianno
Resident Coverage: 1 Senior Resident, 2 Junior Residents
Beds: 20 total
Location: MUH 11 East West
Institute for Rehabilitation and Research at Mercy Hospital, 7th floor
o Spinal Cord Injury Service


Attendings: Dr. John Horton, Dr. Amanda Harrington
Resident Coverage: 1 Junior Resident
o Traumatic Brain Injury and Stroke Services


Attendings: Dr. Cara Camiolo, Dr. Jennifer Shen; Dr. Gary Galang, Dr. Louis
Penrod
Resident Coverage: 1 Junior Resident
o General Orthopedic Service


Attending: Dr. Jaspaal Singh
Resident Coverage: None
Facilities
Outpatient Services:

Kaufman Clinic – 11th floor
o Concussion Clinic

Attendings: Dr. Camiolo
o Spine and/or Pain

Attendings: Dr. Chu, Dr. Cortazzo, Dr. Sowa, Dr. Chimes
o General/Musculoskeletal Rehabilitation

Attendings: Dr. Helkowski, Dr. Liu, Dr. DeLuca
o Amputee

Attending: Dr. Munin
o Spasticity

Attending: Dr. Munin
o Traumatic Brain Injury/Concussion
Attendings: Dr. Camiolo, Dr. Shen

Mercy Hospital
o Spina Bifida Clinic

Attending: Dr. Dicianno
o Spinal Cord Injury/Baclofen Pump

Attendings: Dr. Brenes and Dr. Horton
o Traumatic Brain Injury/Concussion
Attendings: Dr. Camiolo; Dr. Shen

South Side Outpatient Clinic – 23rd and Jane Streets
o General/Musculoskeletal Rehabilitation, Spasticity, and Pain


Center for Assistive Technology – Forbes Tower
o CAT/Wheelchair Clinic


Attendings: Dr. Liu (acupuncture), Dr. Martini; Dr. Chimes; Dr. Chu
Attendings: Dr. Liu, Dr. Boninger, and Dr. Dicianno
Outpatient EMG Lab – MUH 6th floor/Presby 8th floor
o MUH 6th Floor

Attendings: Dr. Helkowski, Dr. Martini, Dr. Munin, Dr. Calloway
th
o PUH 8 Floor


Attending: Dr. Chu
Consults
o MUH and PUH

Attendings: Dr. Shen, Martini, De Luca, Calloway
o Shadyside and St. Margaret

Attending: Dr. Cabacungan and Dr. Singh
Participation Passport
During your 4 week PM&R elective, these activities should be completed and signed-off
on by an attending, resident, or therapist. The goal is to ensure exposure to the diverse
aspects of the field. Please note: Though a particular activity or clinic is listed only once,
or may be required to attend more than once during your rotation schedule. Your schedule
may also contain required activities/clinics not listed on this passport.
 Attend Gait Rounds on MUH Unit
(thur 830am)
 Attend Amputee Clinic with Dr. Munin
Attending:_____________________
 Attend CAT Clinic
Attending:_____________________




Attending:_____________________
Follow a patient from intake to
prescription with a therapist, including
a thorough mat evaluation
Review a letter of medical necessity
Review the difference between tilt-in-space
and recline features
Test drive a variety of equipment
 Observe acupuncture with Dr. Liu
Attending:_____________________
 Observe Inpatient Team Conference
Attending:_____________________
 Observe one day’s complete therapy
schedule for one patient selected by
resident/attending, should include PT,
OT, SLP (swallowing assessment)
Attending:_____________________
 Perform 1-2 inpatient consults, review
criteria for inpatient rehabilitation
admission with attending
Attending:_____________________
 Observe one complete H&P performed
by resident or attending
Attending/Resident:_____________
 Perform one complete H&P with
musculoskeletal and neurological physical
exam, observed by resident or attending
Attending/Resident:_____________
 Observe Modified Barium Swallow/FEES
Attending/Therapist:_____________
 Observe Urodynamic Study
Attending:_____________________
 Read 2 recent articles and present 5 minute Attending/Resident:_____________
summary of those articles to inpatient team
Clinical Clerkship Evaluation Form
Use the following scale to answer these brief questions regarding your PM&R elective.
Strongly
Disagree
1
Disagree
2
Neutral
3
Agree
4
Strongly
Agree
5
N/A
1. The educational goals of the rotation were clearly outlined at the beginning of the rotation.
1
2
3
4
5
N/A
2. Attending physicians provided bedside and didactic teaching.
1
2
3
4
5
N/A
3. Attending physicians and residents suggested further reading through journal articles.
1
2
3
4
5
N/A
4. I had valuable contact with residents.
1
2
3
4
5
5. On inpatient services, I was a valuable member of the rehabilitative team.
1
2
3
4
5
N/A
N/A
6. Upon completion of a patient H&P, my findings were discussed and feedback was given.
1
2
3
4
5
N/A
7. I was given an evaluation at the end of my rotation.
1
2
3
4
5
N/A
8. I feel more comfortable with performing the musculoskeletal and neurological physical exams.
1
2
3
4
5
N/A
9. I feel more comfortable obtaining a functional history from patients.
1
2
3
4
5
N/A
10. I understand the role of developing a treatment care plan with functional goals.
1
2
3
4
5
N/A
11. I feel as though I was able to achieve the goals of this rotation.
1
2
3
4
5
Please use the space below and on the back to discuss further comments:
N/A
Recommended Reading List
Textbooks
Braddom RL. Physical Medicine and Rehabilitation. 2nd ed. Philadelphia: WB
Saunders; 2000.
DeLisa JA. Rehabilitation Medicine: Principles and Practice. 3rd ed. Philadelphia:
JB Lippincott; 2004.
Review Books
Cuccurullo, S. Physical Medicine and Rehabilitation Board Review. 1st ed.
New York: Demos Medical Publishing; 2004.
O’Young, B. Physical Medicine and Rehabilitation Secrets. 2nd ed. New York:
Hanley and Belfus; 2002.
Journals
Archives of Physical Medicine and Rehabilitation (Red Journal)
—now the PM&R Journal (Purple Journal)
American Journal of Physical Medicine and Rehabilitation (Blue Journal)
Helpful Resources on the Net
American Academy of Physical Medicine and Rehabilitation – www.aapmr.org
To discover more about PM&R, click on the Medical Students web page on
AAPM&R’s website to find a list of mentors (current PM&R residents and
practicing physiatrists) eager to assist you further as you explore the field of
PM&R.
Association of Academic Physiatrists – www.physiatry.org
AAP Guide to Residency Application in PM&R (click on Directory of PM&R
Residency Training Programs, then go to Appendix 4):
www.physiatry.org/education/index.html
Policies
--Please read and adhere to the UPMC Dress code policy on the Student Website. We expect
and require professional dress/attire, attitude, and grooming as this reflects our Department
professionalism, safety, and patient care. Excessive jewelry, facial or oral jewelry, casual or
inappropriate clothing or footwear are not permitted. Restrictions also apply to certain tattoos.
Please see the policy for more details.
Specific Readings Suggested
Lin JL. Armour D. Selected medical management of the older rehabilitative patient (Review)
Archives of Physical Medicine and Rehabilitation, 85 (7Suppl 3): S76-82, 2004 Jul.
Klingbeil H. Baer HR. Wilson PE. Aging with disability (Review) Archives of Physical
Medicine and Rehabilitation. 85 (7Suppl 3): S68-73, 2004 July
Phillips EM. Schneider JC. Mercer GR. Motivating elders to initiate and maintain exercise
(Review) Archives of Physical Medicine and Rehabilitation. 85 (7Suppl 3): S52-7, 2004 Jul
Burris JE. Pharmacologic approaches to geriatric pain management (Review) Archives of
Physical Medicine and Rehabilitation. 85 (7Suppl 3): S45-9, 2004 Jul
Bean JF. Vora A. Frontera WR. Benefits of exercise for community dwelling older adults
(Review) Archives of Physical Medicine and Rehabilitation. 85 (7Suppl 3): S 31-42, 2004 July
Phillips EM. Bodenheimer CF. Roig RL. Cifu DX. Geriatric rehabilitation 4. Physical
medicine and rehabilitation interventions for common age-related disorders and geriatric
syndromes (Review) Archives of Physical Medicine and Rehabilitation. 85 (7 Suppl 3): S1822, July 2004
Stewart DG. Phillips EM. Bodenheimer CF. Cifu DX. Geriatric rehabilation 2. Physiatric
approach to the older adult. (Review) Archives of Physical Medicine and Rehabilitation. 85 (7
Suppl 3): S7-11, July 2004
Physiatric History and Physical Examination
What makes a physiatric history and physical examination different from a general medicine
physical exam? The physiatric exam includes a comprehensive functional assessment.
Remember, the goal of rehabilitation is to restore the patient to the highest level of physical,
psychosocial, vocational and avocational function possible. Therefore, the interview and exam
should focus on preview and current aspects of function, as well as eliciting patient’s personal
goals and needs. Here’s a basic outline of the complete note for a general rehabilitation history
and physical examination, with emphasis shown on the detailed functional history.
History
 Chief Complaint/History of Present Illness
 Past Medical History/ Past Surgical History
 Medications/Allergies
 Family History
 Social History – ie tobacco, alcohol use, recreational drugs
 Functional History (Remember “THREADS”)
o T = Transfers
 Bed mobility, on/off toilet, in/out shower, sit to stand
o H = Hygiene
 Grooming, bathing, toileting, shaving/makeup, brushing teeth
o R = Resources, Responsibilities, Recreations
 Resources: House (# stories, # steps, toilet location); whom do they live
with? Will this person be able to help out? Health of helpers? What
plans have they made? Married/Single/Divorced/Widowed?
Siblings/Children/Friends – how many and where do they live?
 Responsibilities: Employment? Driving? Housework? Responsibility in
the care of others?
 Recreating: What do you do for enjoyment?
o E = Eating
 Can you physically eat the foot? Cut it yourself? Any dysphagia or
choking? Does food get stuck (liquids/solids)? Do you cook your own
food? Buy your own food? How do you get to store? Can you carry the
shopping bags?
o A = Ambulation/Mobility
 Can you walk? Do you use a wheelchair? Assist devices used? Walking
distance: why not further? Falls? Unsteady but no falls yet? Steps? Drive
or public transportation?
o D = Dressing
 Any difficulty donning/doffing shoes/socks? Laundry?
o S = Stability
 Double check stability to ask about falls history on everyone
 Current Functional Status – for inpatients, get updated functional status by referring to
PT/OT/SLP notes if possible. Be familiar with these terms:
 Independent, with or without a device: no help required/safe
 Supervision: coaching/reminding needed, no physical contact
 Minimal assist: patient performs 75% of activity
 Moderate assist: patient performs 50% of activity
 Maximal assist: patient performs 25% of activity
 Total assist/Dependent: patient is unable to perform activity
Review of Systems
Neurologic Physical Examination
 Mental status examination
 Language, memory, judgment, perception
 Cranial nerves
 Musculoskeletal inspection – posture, scoliosis, range of motion, special tests
 Muscle strength testing
 Muscle tone
 Sensation – pain, temperature, proprioception
 Coordination
 Gait
 Reflexes
Laboratory results and radiographic review
 Most recent labs
 Dopplers
 Most recent Xrays, MRIs, CT Scans, etc
Assessment
 Predict patient’s highest level of function based on functional history and physical
examination
 Identify functional limiters (i.e. weight bearing restrictions, cardiopulmonary
restrictions/exercise parameters, prior injury or musculoskeletal limiters)
 Identify specifically where goals can be achieved and prescribe therapy
 Recommend devices which may be necessary to improve function
 Remember to include patient’s own personal goals and needs when delineating
functional goals
AAPM&R’s Medical Student Guide to PM&R
Updated and Edited by Cara Camiolo, MD and Nandita Keole, MD
RPC Liaisons, 2004 AAPM&R Physicians-in-Training Awareness Subcommittee
Definition
A physiatrist, pronounced fizz ee at' trist, is a physician specializing in physical medicine and
rehabilitation (PM&R). PM&R or physiatry is the branch of medicine emphasizing the prevention,
diagnosis, treatment, and rehabilitation of disorders, particularly those of the neuromusculoskeletal,
cardiovascular, and pulmonary systems, that may produce temporary or permanent impairment.
Physiatry is unique among medical fields in that its area of expertise is the functioning of the whole
patient, as compared with a focus on an organ system or systems.
A physiatrist treats disorders such as:
 Back Pain
 Sports Injuries
 Stroke Rehabilitation
 Spinal Cord Injury
 Chronic Pain
 Traumatic Brain Injury
 Arthritis
 Carpal Tunnel Syndrome
In addition to management used in general medical practice, physiatrists use therapeutic exercise, heat,
light, water, electricity, bracing, prosthetic and adaptive devices to treat patients of all ages. Physiatrists
also attend specifically to physiologic adaptation to disability and to preventing complications or
deterioration secondary to disabling conditions. The goal of the physiatrist is to provide medical care to
patients with pain, weakness, numbness, and loss of function so that they can maximize their physical,
psychological, social, and vocational potential.
As people survive conditions that once would have been fatal, the field of physiatry is moving to the
forefront of medicine. The specialty serves all age groups and treats problems that touch upon all the
major systems of the body.
Historical Perspective
The roots of PM&R date back to the use of physical agents such as the sun's heat and hot springs for
medicinal purposes in early recorded history. The field began in the 1930s to address musculoskeletal
and neurological problems, but broadened its scope considerably after World War II. As thousands of
veterans returned to the United States with serious disabilities, the task of helping to restore them to
productive lives became a new direction for the field. The Advisory Board of Medical Specialties
granted PM&R its approval as a specialty of medicine in 1947.
Dr. Howard A. Rusk, one of the specialty's pioneers, described three phases of medical care-preventive
medicine, curative medicine and surgery, and rehabilitation. He stated that the third phase was not to be
one of passive convalescence, but of active training to regain and maximize functional abilities to
achieve greater independence and quality of life. Hence, the raison d'être of this specialty. Since Dr.
Rusk's early observations, the application of rehabilitation principles has expanded to where they are
often included in the preventive and curative phases of medical care.
Restoring Maximum Function
Physiatrists treat conditions of the bones, muscles, joints, brain, and nervous system, which can affect
other systems of the body and limit a person's ability to function. Here are examples of how
physiatrists restore maximum function.
A life-long runner who complains of new onset foot pain.
A carpenter with pain in his lower back and down his leg with heavy lifting.
A woman with a spinal cord injury and paralysis below the waist after a diving accident.
A baby born with cerebral palsy.
The Physiatrist's Role
Diagnostics
The PM&R physician is very skilled in performing musculoskeletal and neurological examinations.
Aside from the history and physical that are the foundation of any patient evaluation, the physiatrist is
also trained to utilize laboratory investigations and imaging studies, particularly of the musculoskeletal
and central nervous systems.
EMG, NCS, and EP
There are only two specialties that include specific training in electrodiagnostics as a substantial part of
their curriculum-neurology and PM&R. Only PM&R allows enough training during residency to allow
for board certification in the procedure. Electromyography (EMG) consists of inserting fine needle
electrodes in muscles and observing the recorded motor unit potentials when the muscles are activated.
Nerve conduction studies (NCS) use electrodes to record motor and sensory responses that are
propagated by electrical stimuli. Evoked potentials (EP) are typically used to measure sensory
responses more proximally in the spinal cord, brainstem, and brain. These serve adjunctive roles in the
diagnosis of various neuromuscular disorders including compression neuropathies, radiculopathies,
peripheral neuropathies, motor neuron diseases, neuromuscular junction pathologies, and myopathies.
Spine Intervention
In recent years, the field of physiatry has grown to incorporate the use of interventional spinal
therapeutics to treat the growing number of patients with chronic debilitating back pain. Specialized
training in image-guided spinal diagnostics and injections includes the use of epidural, transforaminal,
and selective nerve root blocks. These techniques are being used as a nonsurgical pain-relieving
intervention for our patient population.
Treatments
The physiatrist is specially trained in management of musculoskeletal disorders and various other
entities including pharmacologic control of spasticity, chronic pain, bowel and bladder management,
and behavioral training in head-injured patients. Invasive techniques such as injections are options for
arthritis, bursitis, tenosynovitis, overuse, and myofascial pain syndromes.
Physical medicine refers to the use of physical principles and dynamic intervention to decrease pain,
improve range of motion, and maximize musculoskeletal function.
Examples of these agents are listed in Table 1.
Table 1
Type
superficial cold
superficial heat
deep heat
electricity
hydrotherapy
manual
other
Specific Modality
ice massage, ice baths
hot packs, heat lamp, paraffin baths, fluidotherapy
ultrasound, short wave, microwave
transcutaneous nerve stimulation (TENS), high voltage galvanic
stimulation
(HVGS), interferential current, iontophoresis, functional electrical
stimulation (FES)
whirlpool, contrast baths
massage, manipulation
traction, biofeedback, positive pressure pumping, phonophoresis,
laser,
ultraviolet light, microwave diathermy
The physiatrist is also trained in writing specific exercise programs tailored to the patient's needs. The
emphasis is on maintaining and increasing range of motion, muscular strengthening, improving
proprioception (awareness of joint position in space) muscle relaxation, and aerobic fitness, all in the
context of improving function. Examples might include strengthening and enhancing proprioception in
a runner's sprained ankle, improving range of motion and preventing contracture in a spastic spinalcord-injured patient, or providing optimal cardiopulmonary fitness in someone who has recently
suffered a myocardial infarction.
Also available to the physiatrist is a host of assistive and adaptive equipment including gait and
mobility aids, environmental control devices, communication aids, and various other tools to allow
greater independence, optimal safety, and decreased energy expenditure in activities of daily living
(ADLs).
One area of expertise is the selection and fitting of wheelchairs and appropriate seating. The PM&R
physician is also specially trained to prescribe proper orthoses (e.g., upper and lower limbs, and back
bracing) and to recommend prostheses to amputee patients.
Approach to Treatment
Much of the practice of PM&R is built on the "team approach," a unique interdisciplinary perspective
on patient care. The patient's physical, functional, emotional, and psychosocial well-being are all
considered in treatment. The typical members of a rehabilitation team, in addition to the physiatrist,
might include representatives from:
physical therapy
recreational therapy
social services
internal medicine
occupational therapy
rehabilitation nursing
speech therapy
neuropsychology
If patient contact is high on your list of priorities, this field offers the opportunity to work closely with
individuals who have long-term disabilities and could continue to have changing needs with advancing
age. This provides the satisfaction of observing the response to therapeutic intervention over a longer
period of time. In a sense, the physiatrist may serve the role of the "primary caregiver" for individuals
with disabilities.
The Residency
Description
Most PM&R residencies are three-year programs and offer positions at the PGY-2 level, which means
that the medical student must seek a transitional/preliminary year in addition to an internship. Some
residencies offer a four-year program which integrates the first year of basic clinical training into their
curriculum.
Basic Requirements
A minimum of four years of graduate medical education: one year for the development of fundamental
clinical skills, i.e., internship (transitional or preliminary year). This includes rotations in medicine,
pediatrics, general surgery, or a combination of the above. Additional months in a primary care field or
more specialized field may also be included. Some recommendations that will prove to be particularly
useful in PM&R include those listed in Table 2.
PM&R residents are required to spend a minimum of one year and no more than two years caring for
hospitalized patients. This may include a combination of the following:








General Rehabilitation
o severe deconditioning and general debility
o neurologic disorders such as multiple sclerosis, ALS, Guillain-Barré syndrome, and
Myasthenia Gravis
o complicated amputations, arthritides, fractures
o post-arthroplasty
Stroke
Brain Injury
traumatic, neoplastic, ischemic
Spinal Cord Injury
traumatic, neoplastic, ischemic
Pediatrics
including cerebral palsy, spina bifida, muscular dystrophy and trauma
Residency programs vary in the number of months allotted to inpatient services. You need to bear this
in mind when choosing a program, particularly if you have an idea of the type of patient population you
wish to treat in your practice. The remainder of the residency is filled outpatient rotations which may
include the following:
amputee
impairment evaluation
arthritis
industrial rehabilitation
burn rehabilitation
injection clinic
cancer rehabilitation
musculoskeletal clinic
cardiopulmonary rehabilitation
pediatric clinic
chronic pain management
prosthetics and orthotics
electives
spine center
EMG
sports medicine
general consults
work hardening
geriatrics
wound care center
hand clinic
Research is required or encouraged at most institutions. A maximum of six months within a four-year
residency program is permitted for research, although each program has its own restrictions. A few
programs offer positions in a Clinical Investigator Pathway in PM&R residency training which is a
five-year track, allowing an extra 12 months for research.
Fellowships are available in pediatric rehabilitation, spinal cord injury, head injury, stroke, sports
medicine, musculoskeletal rehabilitation, pain medicine, EMG, and research. These are typically one to
two years in length.
Lifestyle, Salary and Benefits
For the most part, the lifestyle of a PM&R resident is quite reasonable and predictable. You can pursue
a life outside of the hospital in many cases. As a general rule, inpatient services tend to be more
strenuous than outpatient ones. The PM&R resident may or may not manage a large portion of the
patient's acute medical problems, depending on the particular institution's threshold for admitting acute
rehabilitation patients. This is something to keep in mind when looking for a residency program,
particularly if you feel strongly about the amount of "internal medicine" you wish to practice.
Call varies a great deal in terms of frequency and whether it is from home verses in hospital. This can
range from in-house call every fourth night to at-home call every 11th week. Typically, most programs
schedule call five to six nights per month with one weekend call each month.
Salaries for PM&R residents in their PGY-2 year range from $33,000 to $39,000 per year, consistent
with other specialty residencies. The annual salary does vary with region of the country and the local
cost of living. There is typically a $1,000 to $3,000 raise in salary with each advancing year of
residency.
Moonlighting is the opportunity to work outside of your residency program, for example, in a private
clinic or emergency room, to earn extra money. Moonlighting is permitted at many programs within
certain guidelines, provided it does not interfere with your ability to fulfill your duties as a resident.
Benefits vary tremendously among residency programs. Any of the following may or may not be
provided:
o paid insurance (health, life, disability)
o expenses for meetings, review courses
o professional dues
o licensure fees
o parking, uniforms, meals
o textbooks
o audiovisual services and equipment including photocopying, slides
o computer literature searches and library support services
o counseling
Most programs allow three to four weeks of paid vacation per year. Some also permit additional time
for academic trips (e.g., research presentations, board review).
Education
The amount of teaching you will receive depends on the faculty-to-resident ratio and the emphasis on
didactics and clinical tutorship in any particular program. Further, if you are interested in teaching
medical students or junior residents during your training, inquire if such opportunities exist.
As a medical student, you may wish to consider rotating through a clerkship in PM&R or a
complimentary specialty. This provides you with more insight into the specialty and gives the program
a chance to get to know you. See Table 2 for suggested clerkships.
In order to be Board certified, physiatrists are required to take both a written and an oral examination.
Part I is typically scheduled for August after completion of your 4th year and Part II is taken in the
spring of the following year. Review courses are offered by a number of institutions.
Table 2: Specialties/Clerkships that Compliment PM&R
Specialty
Usefulness
neurology
to learn a good neurologic examination-this is a very important skill in
differential diagnosis and is of great benefit in EMG
neurosurgery
to learn neuroanatomy; many rehabilitation patients will have had or will
undergo a neurosurgical procedure
orthopedic
to learn a good musculoskeletal examination as well as how to manage
surgery/
patients after orthopedic procedures and acute musculoskeletal injuries
sports medicine
pediatrics
to learn functional development; important for pediatric rehabilitation
radiology
to better understand and interpret radiological studies appropriate for
specific ailments
rheumatology
to learn joint injection techniques; rheumatic diseases comprise a significant
portion of the physiatric population
urology
to learn how to order urologic studies; bladder management is an integral
part of caring for patients with spinal cord injury, stroke, and many other
disorders
After Residency
The Practice Setting
The physiatrist may choose a solo practice or a group setting-partnership or multispecialty group. He or
she may affiliate with an academic institution, a private community hospital or clinic, a VA hospital, a
skilled nursing facility, or a freestanding rehabilitation facility. The practice may consist of solely
outpatient care (e.g., sports medicine clinic), inpatient care (e.g., stroke unit), or a combination of both.
In many cases, the patient population will be referral-based and the physiatrist will act initially in a
consulting role. Referrals come typically from neurosurgery, orthopedic surgery, neurology, oncology,
vascular surgery, cardiology, rheumatology, trauma, and internal medicine. If the patient is admitted
into an inpatient rehabilitation unit, the physiatrist usually assumes more of a primary care role.
Salary
Typical annual salary offers for the first year out of residency can vary greatly from $95,000 to
$200,000. The lower end of the spectrum consists primarily of academic positions. The higher end may
include medical directorships or interventional oriented practices. In most cases, the harder you are
willing to work, the more you have the potential to make. There are also significant regional
differences, with more saturated markets offering lower pay and under-represented areas offering
higher salaries. One must consider further the cost of living in any particular part of the country when
comparing salary offers.
Professional Organizations
There are a few major professional organizations to which physiatrists usually belong:
The American Academy of Physical Medicine and Rehabilitation (AAPM&R)
o founded in 1938, with membership open to medical students, PM&R residents, board eligible
and board certified physiatrists
o primary sponsorship of the specialty board
o AAPM&R Annual Assembly provides a forum for continuing medical education, research
presentations, a technical exhibition, special interest group meetings, career network services,
and a program developed for residents including an educational symposium and business
meeting of the Resident Physician Council.
The Resident Physician Council (RPC) of AAPM&R
o Formed to allow residents the opportunity to assist the Academy with administrative planning
in the areas of medical education, practice, membership, residency review, health legislation,
research, and marketing. The RPC also publishes the PM&R Resident newsletter and endeavors
to educate medical students, other residents, non-physiatric physicians, and the lay public about
the field of PM&R. The RPC is divided into an executive board, standing committees, and
liaisons to the Academy committees and other organizations. The members consist entirely of
peer-elected, appointed, or volunteer PM&R residents.
The Association of Academic Physiatrists (AAP)
o membership open to PM&R residents, board eligible and board certified physiatrists who are
affiliated with an academic setting
o official journal: American Journal of Physical Medicine and Rehabilitation
o AAP Annual Meeting offers continuing education for physicians interested in improving their
skills as practitioners and academicians, nonphysician academicians who teach and conduct
research in PM&R departments, PM&R residents, and physiatrists interested in education and
research
The American Congress of Rehabilitation Medicine (ACRM)
o founded in 1923 with membership open to physicians and allied health professionals with an
interest in PM&R
o co-owner of the Archives of Physical Medicine and Rehabilitation
o ACRM Annual Meeting provides a forum for continuing medical education with an emphasis
on multidisciplinary perspectives, along with research presentations and a technical exhibition.
For more information regarding medical student involvement in the American Academy of Physical
Medicine and Rehabilitation, including information about the medical student mentorship program,
please go to the AAPM&R website at www.aapmr.org.