As a medical student, do you ever wonder what it’s like to specialize in physical medicine and rehabilitation (PM&R)? Here’s your chance to find out.
Meet John Vasudevan, MD, a physiatrist and featured physician in AMA Wire’s “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties.
Read Dr. Vasudevan’s insights to help determine whether a career in PM&R is a good fit for you.
“Shadowing” Dr. Vasudevan
Specialty: PM&R, with a sub-specialty of sports medicine
Practice type: Academic and employed
A typical week in my practice:
My practice is essentially an outpatient, non-operative musculoskeletal and sports medicine practice. I typically work 40-50 hours per week. I usually see patients from 8 a.m. to 4 p.m., finish documentation and calls by 5-5:30 p.m. and return home by 6 p.m. I take three weekends of inpatient call (at an acute rehabilitation hospital) per year.
The most challenging and rewarding aspects of caring for patients as a physiatrist:
The most challenging part is not much different from the most rewarding part. It can be very challenging when many of my patients either have chronic or overuse conditions with no easy “fix.” At the same time, it is rewarding to work in a specialty that is better prepared than any other to treat that which can be improved, manage that which cannot, and even prevent recurrent or progressive injury. Physiatrists (specialists in physical medicine and rehabilitation) maximize the functional ability of patients, regardless of their activity level.
Three adjectives that describe the typical physician in PM&R:
Comprehensive. Open-minded. Collaborative.
What my lifestyle is like in PM&R:
Some people joke that PM&R stands for “plenty of money and relaxation,” which assumes that the relatively good work-life balance the specialty provides means that it is easy. But that is far from the truth. Physiatrists must work diligently to ensure that our patients get the most benefit with a minimal amount of medical intervention. In our current health care environment, this is a very valuable skill set to have.
The main skills every physician in training should have for PM&R but won’t be tested for on the board exam:
Almost everyone in medical school is excited to make decisions and have authority in determining the best treatment for a patient. Board exams are focused on the doctor making the decision for the patient. Physiatry is relatively unique in that it demands physicians to lead a team of many different disciplines (physical, occupational, speech, psychological therapies and nursing, at the least) and to embrace the collaborative decision-making of a group. A physiatrist has to be smart enough to make the right decision but humble enough to respect the expertise of those who contribute to that decision.
One question every physician in training should ask themselves before pursuing PM&R:
Are you comfortable with treating people with disability? Disability can be as stark as those with spinal cord injury, stroke, brain injury or cerebral palsy, but as subtle as those who struggle with chronic and slowly progressive osteoarthritis. Managing disability is not easy, but to do so is very powerful to those who benefit from proper treatment. All medial disciplines encounter disability, but physiatry is best prepared to handle it.
Three books every medical student interested in PM&R should read:
- The definitive text on PM&R is Physical Medicine and Rehabilitation: Expert Consult by Randall Braddom.
- For ready reference on the wards and in clinics, grab a Physical Medicine and Rehabilitation Pocketpedia by Matthew Shatzer.
- For anyone interested in doing a proper musculoskeletal examination, I recommend the 3-Minute Musculoskeletal and Peripheral Nerve Exam by Alan Miller, MD, Kimberly DiCuccio Heckert, MD, and Brian A. Davis, MD.
An online resource students interested in my specialty should follow:
The Academy of Physical Medicine and Rehabilitation the best starting point for anyone interested in PM&R (including a section for interested medical students). The site and association are instrumental throughout a career in psychiatry.
Additional advice for students considering my specialty:
We all go into medical school to help people and (hopefully) save lives. Even though a beating heart and breathing lungs keep a person alive, they do not a guarantee that a person can satisfactorily “live” their lives. In other words, quantity of life does not equal quality of life. If your interest is in maximizing the comfort and ability of those who suffer from chronic disease, or even enhancing performance of an active and healthy population (as I do in a sports medicine practice), then you should strongly consider a career in PM&R.
If I had a mantra or song to describe my life in this specialty, it would be:
Theme from the movie Rocky. (Just imagine the song playing as you work out in the physical therapy gym … or maybe I picked it because I practice in Philadelphia!)
Want to learn more about life in PM&R?
- Hear what it’s like to practice in the field from Dr. Wolfe, another physical medicine and rehabilitation specialist featured in AMA Wire’s "Shadow Me" Specialty Series
- Check out the June issue of the AMA Journal of Ethics, which takes a close look at ethical issues in this “quality-of-life specialty.”
