Physical Medicine and Rehabilitation Medicine (PM&R) is a relatively new specialty that arose to address the functional needs of patients. The main focus of the field is to help patients achieve the highest level of function that their impairment/disability/or handicap will allow. The specialty addresses many different issues and aspects of patient care, allowing for the development of long-term doctor-patient relationships. Physiatrists also work closely with other specialties including orthopedics, neurology, neurosurgery, rheumatology, anesthesiology, and internal medicine as well as with PTs, OTs, neuropsychologists, speech therapists, and athletic trainers.

A PM&R doc, or physiatrist, can be thought of as a combination of a non-surgical orthopod as well as a functionally oriented neurologist. On the orthopedic side, we address issues such as arthritis, amputations, limb fractures, orthotics and prosthetics, sports medicine, and general musculoskeletal medicine. On the neurology side, we address issues such as traumatic brain injury (TBI), spinal cord injury (SCI), stroke, and pain management. Other areas that are addressed include cardiac, pulmonary, pediatrics, cancer, and burn rehabilitation. Routine procedures can include nerve blocks, EMG, facet joint injections, botulism toxin injections, epidural steroid injections, and trigger point injections.

PM & R is a young, dynamic, and relatively undefined field which offers a wide variety of practice choices (e.g. sports medicine, cardiac rehabilitation, spinal cord injury, etc.), patient populations, diagnostic and therapeutic modalities. Opportunities to do research, and to develop novel, innovative treatments and diagnostic techniques abound. Continuity of care is a factor, unlike the prevalent McDonald’s style health care currently seen in many outpatient clinics where a patient may never see any one physician more than once. Also, the vast majority, if not all, patients tend to be self-motivated individuals who want to get better and will work with the physiatrist toward that goal. Finally, jobs still readily exist in both academic and private environments, and the lifestyle is quite enticing (regular hours, average salary $150,000, and relatively few emergencies).

BU has a PM&R department and fourth years are welcome to rotate through. Dr. Shanker Nesathurai is probably the best person to contact. Boston also has two other PM&R programs, including Tufts and Harvard (Spaulding). A good intro text is Susan J. Garrison’s Handbook of Physical Medicine and Rehabilitation Basics (about $35).

PM&R is a PGY-2 program that requires either a Preliminary Internal Medicine year or a Transitional year. Top programs include (in no particular order): University of Washington in Seattle, WA; University of Colorado in Denver, CO; Baylor/ UT PM&R Alliance in Houston, TX; UMDMJ (Kessler) in West Orange, NJ; Harvard (Spaulding) in Boston, MA; Northwestern in Chicago, IL; University of Michigan in Ann Arbor, MI; and Mayo in Rochester, MN. For further listings, consult the green book in the library.

Availability and quality of faculty and facilities; location; elective time; schedule (balanced vs. mostly inpatient--SCI, TBI, etc. vs. mostly outpatient--musculoskeletal, sports med., etc.); call schedule; didactic schedule; research requirements; allowed conference time; and, of course, how happy the residents are. Good luck with your match whatever you decide to do!