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  • 3 weeks later...

Sure I'll give this one a go, I'm a current PM&R resident. I'm pretty convinced it's the best specialty in medicine as long as you like neuro and MSK. That said, it's a really tough specialty to get any exposure to because there's few lectures in pre-clerkship and rarely rotations in clerkship (school-dependent), so try your best to shadow and learn more about it. 

Scope: The scope is very broad. The primary practice areas are inpatient rehab (MSK, amputee, brain injury, stroke, and/or spinal cord injury), outpatient rehab (clinics to follow those patients, with other domains like cardiac and cancer rehab), sports medicine, electromyography (EMG), and pain (both interventional and non-interventional). You can also create areas for yourself, for example, there's a new staff physiatrist who recently created a niche in "pain during/after pregnancy". 

Bread and Butter: As you can imagine, this is highly variable depending on what area you're in. In inpatient MSK, you're typically dealing with patients with polytraumas (ex: car accident with a fractured femur and humerus). Brain injury is typically patients who have had fairly significant traumatic brain injuries, but in outpatient settings, you can also fairly frequently see patients with moderate-severe concussions. Amputee, stroke, and spinal cord injury rehab are probably self-explanatory. EMG is for patients with likely peripheral nerve dysfunction (radiculopathies, compression neuropathies, ALS, myasthenia, etc.). And in interventional pain, you're typically doing joint injections, spinal facet injections, nerve blocks, epidurals, radiofrequency ablations, etc. for patients with joint/back pain.

Daily Routine: Again, highly variable depending on your type of practice. Most people work in either inpatient and outpatient rehab or exclusively outpatient clinics doing EMG/pain/sports, both of which are nice because you don't have to do the same thing every day. The general work schedule for the vast majority of physiatrists in all settings is 8-5, Monday to Friday (typically with Friday afternoon off), with no evenings and no/minimal call. In inpatient rehab, you'll typically spend your day rounding on patients and seeing new consults. It's a relaxed pace because most of the follow-up patients won't have many new findings from the prior day, so you can spend more time seeing the new patients and ensuring you do a thorough assessment. In outpatient settings, it's a very similar daily routine to any other outpatient clinic. 

Miscellaneous: Just want to address two things that people tend to misconstrue about PM&R. First, physiatrists essentially never do physical therapy with the patient. We prescribe physical therapy all the time, but that's the domain of the physiotherapists and the occupational therapists. Our domain is similar to any other physician - prescribing medications, non-pharmacologic treatments, and performing interventions (such as the pain interventions above) when necessary. We certainly work closer with the therapy team than most/all other specialties, but there is a pretty clear line between their domain and ours. Second, the patient population varies tremendously depending on what area you go into. Most people rotate through general medicine and see patients who are "discharged to rehab" and assume that's the main population physiatrists deal with. In fact, we're not involved at all in the vast majority of internal medicine patients discharged to rehab. The population varies from pediatric to elderly, with a typical outpatient being around 40-50 and typical inpatient around 65 (trauma skewing much younger, stroke skewing older). 


Let me know if you have any other questions! 


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