I get this question a lot when I tell family (and even med school friends) what I’m interested in specializing in. In fact, it was a question I had to ask initially, as well. So what am I talking about? Physical Medicine and Rehabilitation, or PM&R as we’ll call it, and it’s the field of medicine that has me motivated and excited for the future.
To quote the AAPMR:
“Physical medicine and rehabilitation (PM&R), also called physiatry, is the branch of medicine emphasizing the prevention, diagnosis, and treatment of disorders – particularly related to the nerves, muscles, bones and brain – that may produce temporary or permanent impairment”
Physiatrists focus on function. Everything they do is about restoring/maintaining function in their patients. This can be done in various realms, including sports medicine, pediatric rehab, traumatic brain injury, spinal cord injury, general rehab, prosthetics/orthotics, and even regenerative medicine! Physiatrists aren’t the brilliant diagnosticians of internal medicine, they don’t make life or death decisions like an emergency medicine doctor, and they definitely aren’t regarded as one of the prestigious fields of medicine. But what they are doing, in my mind, is part of the whole foundation of being a physician – working to restore a certain quality of life and daily function in our patients. Some people might not view this as the most glamorous or exciting of things, but I feel like it’s one of the most valuable.
The start of any medical treatment is to know what is going on and causing the disease or impairment. But what happens after that? Let’s say a child is diagnosed with cerebral palsy. Or a patient suffers a traumatic spinal injury that leaves them with impaired walking. These patients get diagnosed and treated with whatever medicine or surgical procedures is deemed necessary, but then what? These children and adults have to work to return to their normal life or the closest they can get with their disabilities. They can have tremendous disabilities or impairment affecting their quality of life. Their illness might have been cured or treated, but they are now left with limitations that keep them from living their life to the fullest. This is where PM&R comes into play. Physiatrists learn the skills necessary to help these patients regain function and work to improve their quality of life.
To me, this is the whole reason I wanted to be a doctor. It feels distant and impersonal, at times, to see a patient for 10 minutes, check some blood work, get on the computer and scroll through the records, order some antibiotics and fluids, and then send them on their way. I know its a necessary and foundational part of medicine, but I wonder at times how much the patient is truly helped, or feels like they have been helped. I want to go to work every day with the intent to work to improve the LIFE of my patients. I want to help them learn how to walk or talk again following a stroke, or work to fit them with prosthetics so they can get out of their wheelchair, or help to relieve the pain they have suffered with for years. The perfect way of fulfilling this goal as a physician, to me, is within PM&R.
I’ll be completely honest. I knew nothing about PM&R until earlier this year. I had seen it listed at the bottom of charts showing Step 1 scores for certain specialties and thinking “hmm, I guess nobody really wants to do that and it must not be too exciting”. It wasn’t until I had a change of heart about ortho surgery and got a lower than expected Step 1 score that I began to look for different options. Embarrassingly, a google search on “best kept secrets in medicine fields” led me to read more about PM&R. After learning about it, I felt blessed to have gotten that lower step score and subsequently sought out something else. I always enjoyed the neuro and musculoskeletal portions of my learning, and naturally these are the areas of focus in PM&R. It felt like the perfect fit for me. You have more long term relationships with your patients and you can really make a profound difference in improving their actual daily life and function.
Another benefit of the field is how broad it is. In many other specialities you become very focused on one organ or system of the body. In PM&R, you are responsible for the entire body. Also, there are tons of fellowships you can do including sports medicine, peds rehab, prosthetics, brain injury, spine injury, and even the developing field of regenerative medicine. Finally, it offers a great lifestyle, something that is really important to me. Physiatrists are some of the happiest doctors i’ve ever met. They have really low stress and burnout, things becoming more abundant in medicine these days.
Last of all, I really enjoy the goal directed care found within the field. I find myself wanting to ask patients all the time, “what is your goal in treatment?”. For most patients in the hospital, they just want to “get better” and go home, but they don’t have any tangible goal that they are working towards. It can be really frustrated to try and impart goals onto our patients, especially when it comes to routine things like blood pressure, sugars, or need to exercise. In PM&R, patients want to be able to walk again or be able to return to sports. They can be very motivated and I think this adds a huge benefit and positive aspect to the patient/physician relationship and quality of care.
Within the field, I’m most interested in sports med, peds rehab, and prosthetics given my engineering background, but we’ll see how it all develops. I’m currently applying to an elective rotation in the field next June and can’t wait to learn more about it on a daily basis. I think its really important to have something motivating you that you can look forward to during the long clerkship days of medical school, and i’ve found exactly that in physical medicine and rehab.
btw, I just finished my inpatient month of internal medicine and will have some thoughts on that soon. But in the meantime, it’s time for christmas break and some much needed family time and relaxation!
All the best, and merry christmas to all!
-Brian
