DOs a natural fit for physical medicine and rehabilitation
- Posted April 27, 2012, 12:26 p.m.
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More than 800 osteopathic medical students currently are involved in the AOCPMR’s campus chapters. Student members can participate in clinical workshops sponsored by the society to gain exposure to PM&R diagnostic techniques, such as nerve conduction studies and musculoskeletal ultrasound. In conjunction with the AOCPMR’s midyear meeting, students can take part in a national student conference that provides the chance to meet with PM&R educators, program directors and residents.
“We’ve had hundreds of osteopathic medical students from all over the country attend our two major annual conferences,” Dr. Kamen says. “There is tremendous student interest in our field.”
“We find that the students who are interested in going into PM&R tend to be extremely well-informed,” Dr. Richardson adds. “They are so focused, so driven, so goal-oriented and such strong supporters of not just PM&R as a profession but also the osteopathic world in general.”
Because of its desirability, PM&R is a moderately competitive specialty. For example, each year approximately 300 students apply for 12 positions in the ACGME-accredited Temple University-MossRehab Hospital PM&R residency program in Philadelphia. “We interview 60 candidates,” says Dr. Kamen, a preceptor in the program. “So you need to have good credentials to get that far.”
Osteopathic PM&R physicians by state
More than 800 DOs specialize in physical medicine and rehabilitation.
PM&R residency candidates need to have at least average scores on the Comprehensive Osteopathic Medical Licensing Examination—USA or the United States Medical Licensing Examination. Because interest in the field is growing, high examination scores can make a candidate stand out among well-qualified peers, Dr. Richardson says.
A former program director for Michigan State University’s dually accredited PM&R residency program, Dr. Wieting offers a number of tips to students interested in becoming physiatrists:
- Serve at least one, preferably two, PM&R elective rotations and more if one’s schedule allows.
- Choose elective rotations in fields closely related to PM&R, such as orthopedic surgery, neurology and sports medicine.
- Get involved in organizations that provide services to people with disabilities. Students can serve as counselors in summer camps for children and adults with physical or developmental disabilities, and they can participate in fund-raising events for United Cerebral Palsy, the Muscular Dystrophy Association and similar organizations.
- Participate in research projects to gain an understanding of the research process because every PM&R resident must complete a scholarly project.
Dr. Wieting encourages PM&R candidates to participate in both the AOA Intern/Resident Registration Program and the National Resident Matching Program (NRMP) but not to rank any program they wouldn’t want to take part in. Because the AOA and the NRMP do not have a joint match, any candidate who matches into an AOA-approved PM&R program must pull out of the allopathic match.
Training and certification
PM&R offers two training paths. Traditionally, osteopathic medical students would serve a rotating internship and then complete a three-year PM&R residency. While this option is still available, many graduates today head right into a four-year PM&R program.
“I’m a big supporter of the rotating internship because you will get experience you will never get again in your career and you’ll be exposed to things that will be helpful in your residency,” says Dr. Richardson, who trained at the Rehabilitation Institute of Chicago and was among the eight out of 12 residents who served a rotating internship. “For example, a dermatology rotation will help you understand the rashes that you will see among rehab patients.”
Dr. Richardson cautions students to be familiar with the requirements of any states they might practice in. Certain states require osteopathic physicians to have served osteopathic internships.
Beyond residency, many physiatrists also serve fellowships or obtain certificates of added qualification in subspecialties such as pain management, pediatric rehabilitation and traumatic brain injury.
Dr. Wieting advises DOs who train in ACGME-accredited programs to become certified, as he is, by both the allopathic American Board of Medical Specialties’ American Board of Physical Medicine and Rehabilitation and the AOA’s American Osteopathic Board of Physical Medicine and Rehabilitation (AOBPMR). Both certification processes have virtually identical educational requirements and assessment procedures: a written examination soon after completing residency training and an oral examination after a year of full-time practice.
“A DO who goes through an allopathic PM&R residency program and wants to become AOA board-certified simply has to contact the AOBPMR, fill out the application, send in documentation of training, pay a fee and sit for the exam,” Dr. Wieting says.
DOs who are interested in becoming osteopathic residency program directors, deans of osteopathic medical schools or AOA leaders must be AOA board-certified.
PM&R versus OMM
DO physiatrists commonly use OMT, but manipulation isn’t necessarily their main approach to treating patients. “If you want to have your primary approach to patients be OMT, then I’d recommend becoming an osteopathic manipulative medicine specialist who is AOA board-certified in neuromusculoskeletal medicine,” Dr. Wieting suggests. “If you want OMT part of your armamentarium but not the principal part, then PM&R is a good way to go.”
Still, the similarities between PM&R and OMM are striking. “PM&R is a specialty that requires a physician, even an MD, to think exactly like every DO is taught to think from the beginning of medical school,” Dr. Wieting says. “Every PM&R doctor must think about a patient from a functional standpoint and a holistic standpoint.
“Physiatrists have to deal with not only the diagnosis but also how that diagnosis affects the patient’s function and interactions at home, in the community and on the job.”
In addition, physiatrists develop highly individualized treatment plans. “What I need to accomplish to get one stroke patient home may be very different from what I need to do to get another person with the exact same kind of stroke home because of differences in family support, the patients’ occupations and comorbidities,” Dr. Wieting explains. “PM&R is a specialty that requires physicians to think osteopathically every day with every patient.”