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Training of Rehabilitation Physician

To become a rehabilitation physician, individuals must graduate from medical school followed by four additional years of postdoctoral training in physical medicine and rehabilitation residency. This includes one year of fundamental medical or surgical clinical skills. There are currently 80 accredited residency programs in physical medicine and rehabilitation in the United States.

Many rehabilitation physicians choose to pursue additional advanced degrees, (i.e. MS, PhD, or complete fellowship training in a specific area of the specialty). Fellowships are available for specialized study in such areas as musculoskeletal, pediatrics, traumatic brain injury, spinal cord injury, and sports medicine.

Description:

Most PM&R residencies are three-year programs, and offer positions starting at the PGY2 level; which means that the medical student must seek a transitional/preliminary year in addition to an advanced residency spot. 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 from an allopathic or osteopathic medical school are required. Residency in physical medicine and rehabilitation consists of one year of general clinical training (internship / PGY1) followed by three years of physical medicine and rehabilitation training (PGY2-4). Most residents complete a preliminary medicine, transitional, or surgical internship to fulfill this requirement. Other acceptable internships can be done in family medicine, pediatrics, or a traditional osteopathic internship.

Some PM&R residency programs offer an internship along with a three years of PM&R training (PGY 1-4), which are known as categorical positions. However, a majority of PM&R residencies offer advanced positions which include only PGY2- Program requirements for a three-year program are 12 months of inpatient rotations and 12 months of outpatient rotations.

The remaining 12 months are a variable inpatient/outpatient mix depending on the program as follows:

GENERAL REHABILITATION

* Severe deconditioning and general debility
* Neurologic disorders: multiple sclerosis, ALS, Guillain-Barré syndrome, and myasthenia gravis
* Complicated amputations, Arthritis, fractures
* Joint Replacements
* Stroke
* Brain injury: traumatic, cancer, stroke
* Spinal cord injury
* Pediatrics: including cerebral palsy, spina bifida, muscular dystrophy and trauma

The remainder of the residency is filled with outpatient rotations, which may include the following:

* amputee
* arthritis
* burn rehabilitation
* cancer rehabilitation
* cardiopulmonary rehabilitation
* chronic pain management
* electives
* EMG
* general consults
* geriatrics
* hand clinic
* impairment evaluation
* industrial rehabilitation
* injection clinic
* musculoskeletal clinic
* pediatric clinic
* prosthetics and orthotics
* spine center
* sports medicine
* work hardening
* wound care center

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.

ACGME-accredited fellowships are available in pediatric rehabilitation, spinal cord injury, neuromuscular medicine, sports medicine, hospice and palliative care medicine, and interventional pain medicine. Non-accredited fellowships are available in cancer rehabilitation, neurorehabilitation, multiple sclerosis, spine, musculoskeletal, and research. These are typically one year in length with some exceptions.

To become board certified in physical medicine and rehabilitation, rehabilitation physicians are required to pass both a written and oral examination administered by the American Board of Physical Medicine and Rehabilitation (ABPMR). The ABPMR also has agreements with each of the boards of pediatrics, internal medicine, and neurology to allow special training programs leading to certification in both specialties.