physical med. and rehab. residency

[Guest desiguy8179]

can any one guide me regarding scope of rehab. medicine.howz residency life in this speciality.

[Guest UWOMED2005]

I looked into PM&R for a while. There won't be any UWO PM&R residents to talk to until next year (they're restarting the program here again after a 10-15 yr hiatus) but everything I've heard is that PM&R is one of the most reasonable specialties lifestyle wise. When I was doing an elective in PM&R this year, clinics rarely ran past 4. . . and one day I started at 10am, finished at 2pm, and had a one hour lunch break in between. (Compare that to Gen Surg where I'll go from 6am to 7-8 pm with NO lunch break!)

 

The trauma surgeon who tries to clean up after a motor vehicle accident has to rush to the scene. Rehabilitation, however, can pretty much be scheduled any time.

[Guest ssup]

i was wondering where we can learn more about this speciality since it is barely mentioned in medical school....is this the same as "physiatry"?

 

What sorts of procedures/patients can we expect? is there on-call in rehab? does anyone have an idea of the average salary?

 

Thanks,

Ssup

U of A Med 2007

[Guest Ian Wong]

Physiatry = Physical Medicine and Rehabilitation = PM&R.

 

One of my very good friends just started her 5 year PM&R residency at UBC. There's a huge range in what you can do, depending on practice preferences. Much like OT's or PT's, your job is to maximize function for patients who have suffered either a musculoskeletal or neurological impairment. The difference is that you are the quarterback of the treatment plan, so you work in consult with those ancillary health care providers (and nurses and social workers, etc) to figure out what they need, and then set up a plan to make it happen.

 

They can have practices in inpatient settings, where you might be working on people who are too impaired to live on their own (ie. post-stroke, post-spinal cord injury, etc), or do outpatient work (ie. Worker's Comp patients with work-related injuries, sports medicine injuries, repetitive stress injuries, etc). There's also a lot of room for medicolegal work with disability claims which can be very lucrative. You can get into procedures doing things like EMG's or nerve conduction studies for muscular diseases, or doing interventional nerve blocks for chronic pain.

 

Call is basically non-existent; there's no such thing as a Rehab emergency, kind of like how there's basically no such thing as a Derm emergency. The money can be extremely high, particularly if you are heavily involved in the private disability/medicolegal stuff, which pays much better than the fee-for-service public-type work. Potentially, we are talking several hundreds of thousands in PM&R, with the same lifestyle benefits as Derm. Lots of money for a great lifestyle, but you have to enjoy that kind of work; many physicians don't enjoy that kind of practice, which is why they are in other specialties and not in PM&R.

 

As you mentioned, PM&R isn't even on the radar in most med school curriculums; you'll need to seek out preceptors on your own time and try to set up electives/observerships in order to get the exposure to see if the specialty might be right for you.

 

Ian

[Guest macdaddyeh]

Hi there:

 

The only addendum I would make Ian is that the time and energy and effort that goes into that medico-legal work is *insane.* I have a few friends who are OT's (itself a potentially lucrative career wrt disability claims), and they tell me that physiatrists regularly complain of the mountains of paperwork and phone calls that accompany such claims. Moreover, one must really cover one's !@# when doing those claims. Although the same is true with many medical careers, what I am saying is that I hear this is especially true for (some aspects of ) physiatry. Essentially, it becomes an age-old tradeoff; do you want the money or the time?

 

BTW, Ian any idea on physiatry salaries?

[Guest UWOMED2005]

From talking to some of the physiatrists on my elective. . .

 

From OHIP billings (ie traditional physician income) physiatrists make about the same as a family doc ($100-150k)

 

Then you need to add WSIB billings - WSIB usually pays doctors outside of OHIP for assessments. I'm under the impression that many physiatrists make as much on WSIB as they do on OHIP (so add another $100-$150k)

 

Then there's the medico-legal work. No idea how much that is worth, but I know of one guy in the physiatry department who made about $850k and another made over $1,000,000 last year. Most of the others were closer to $500k.

 

No, most specialties do not make this much money. The number of specialties where you can pull in over $1,000,000 per year is extremely limited, and situational.

[Guest desiguy8179]

from your assessment,it depicts a very rosy picture of salaries but i just browsed a canadian physician survey and majority of phyiatrists were unsatisfied with income and considered it well below other specialities.

[Guest UWOMED2005]

Well, PM&R is one of the lowest paying specialties in terms of direct OHIP billings.

 

If someone wasn't doing WSIB and medicolegal work, they wouldn't make much at all. . .

[Guest ssup]

A few more Qs for you guys:

 

1) How many electives would we need to do in physiatry to stand a competitive chance for residencies? I was looking at UBC's PM&R website and their elective is 4 weeks...They also mention that they want 2 letters of references out of the 3 to be from physiatrists....in other words, you would need to do 2 physiatry electives at least. Since we have somewhere between 10-13 weeks total elective time, I'm not sure that fitting in 2 physiatry electives is really feasible...

 

2) If we were to do an elective in 1rst/2nd year in physiatry, would that be weighted the same as doing one in 3rd/4th yr?

 

3) I'm trying to figure out how you would assess competition for a specialty...from what I can tell, 100% of people interested in PM&R last year were matched to their first choice...is it safe to say then this isn't one of the most competitive specialties?

 

Thanks,

Ssup>:

[Guest ssup]

sorry not sure how the angry face got there.....i'm definitely not >: though...I'm probably better described by :hat

[Guest Ian Wong]

Heya,

 

At the very minimum, you definitely want to do 4 weeks elective in PM&R. Do note that many/most/all electives offices are willing to work with you, and it's often possible to do two 2 week electives in different places, instead of a single 4 week elective in one location. That's one method to get two reference letters, although really, two weeks is the absolute bare minimum time you should spend with someone before asking for a letter.

 

Also, you could start up a research project with a physiatrist, during medical school, and that could be your second letter; it'd probably be a very strong one as well, as this person would have the benefit of knowing you and working with you over a longer period of time.

 

An elective in Med 1/2 isn't going to be taken very seriously, if at all. The electives that really matter are the ones taken during your senior medical school/clerkship years (ie. Med 3 and Med 4). On that topic, if you are still very interested in PM&R by clerkship time, it will probably be very easy for you to justify spending 8+ weeks in PM&R electives. After all, you are choosing a specialty for your career (you want to try it out as much as possible), and you probably want to visit a few different programs since it is a five year residency.

 

PM&R isn't very competitive right now, with several programs in Canada not completely filling after the first round (Queen's, U of M, U of S, U of A):

 

p084.ezboard.com/fpremed101frm25.showMessage?topicID=206.topic

 

It is probably safe to say that if you are an enthusiastic med student and are fun to work with, that you'll most likely find a residency spot in PM&R.

 

Ian