Session 13

This week, I am interviewing Dr. Chris Sahler, a community-based Physiatrist, who has been doing outpatient work and private practice for about two and a half years now.

Not to be confused with Psychiatry, Physiatry is a totally different field of medicine. Physiatry is also known as Rehab Medicine and as Physical Medicine & Rehabilitation (PM&R). Today, Dr. Sahler shares what Physiatry is, why he chose this field, what he likes about it, his work/life balance, and he gives you advice on how to be competitive.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[1:47] Physiatrist, not Psychiatrist

What is a physiatrist? A physiatrist is a non-operative musculoskeletal physician who works with muscle problems, tendon problems, bone problems, joint problems, and nerve problems. Physiatry is also called Physical Medicine and Rehabilitation (PM&R).Physiatrists diagnose patients and perform non-operative treatment through medicines, therapies, and injections.

Although quite similar to a non-operative orthopedic surgeon, they do get good training with neurology and they work very closely with physical therapists. They also have a different perspective on some of the common orthopedic problems.

Another big distinction of a Physiatrist is its focus on functionality, specifically how it impacts your activities, daily living, or your sports. They practically have various ways of helping patients get back to increased functionality and helping treat their pain.

[3:28] Other Names: Rehab Medicine, PM&R

Physiatry is also named as Rehab Medicine or Physical Medicine & Rehabilitation which has been around for a while now and has evolved over time. The part of physiatry that is growing the quickest is the role of the community musculoskeletal physiatrist.

Dr. Sahler personally doesn’t know the reason for the origin of these other names. The titles don’t really tell you the answers that even physiatrists are being asked about it so they come up with different ways to explain what they do.

[5:06] Reasons for Choosing Physiatry

Dr. Sahler grew up playing sports and has always been interested in the body and its own mechanics. Getting into medical school, he initially thought of getting into orthopedics until je got into 2nd year when he heard 3rd and 4th year medical students talk about the field of physiatry. He then started to talk to them and learn about the field for the first time.

By the end of 3rd year medical school, he got the chance to do rotations in both orthopedics and physiatry so he basically got to have a good comparison between.

Orthopedics and physiatry both offered much of what he wanted, getting involved in sports medicine and helping people with their bodies whether pain, functionality, or performance. He realized that physiatry allowed him to get involved with patients and the things he wanted to see in his practice.

[Tweet ““Physiatry really allowed me to get involved with the patients and things I wanted to see in my practice.””]

Ultimately, Dr. Sahler chose psychiatry over orthopedic surgery for a few reasons. For one, he didn’t love the O.R. Second, physiatry offers diversity in the way they approach the patient where they touch on aspects of neurology, biomechanics, anatomy, and physiology and how they play into treating patients.

[Related episode: Private-Practice General Orthopedics and More.]

[7:37] Traits that Lead to Being a Good Physiatrist

Dr. Sahler enumerates the traits of being a good physiatrist including one’s ability to enjoy social interaction. They must be able to dig deep into the problems of their patients and spend full, dedicated time to work with the patients. Being personable is probably the most common trait of physiatrists.

[8:38] A Typical Day in the Life of a Physiatrist

Usually, Dr. Sahler is in the office working standard business hours (Monday-Friday, 8am-5pm). About 60%-70% of his time involves seeing new patients or follow ups. He also administers a lot of injections so he uses ultrasound guidance for peripheral injections (tendons or joints).

Dr. Sahler also uses x-ray guidance or laparoscopy for spinal injections. He spends half day per week doing EMG or nerve conduction studies. He doesn’t take any call on weekends or weekdays outside his business hours.

[9:45] Types of Patients Seen in Physiatry

Most of his patients have general musculoskeletal issues. Half of his practice is composed of patients with spinal-related pain while the other half is mixed through the rest of the body. Dr. Sahler also did a fellowship in Sports Medicine, and 10-25% of his weeks involves seeing athletes with various issues including nerve injuries such as peripheral nerve problems and drop foot.

Speaking of pain management in the face of our healthcare system and opioid crisis, Dr. Sahler does not see this as a major problem because when they see new patients with these problems, they fairly know how to appropriately use those medications when applicable.

Dr. Sahler further stresses the importance of patient education right off the bat. By setting such precedent, these problems no longer necessarily become problems. It’s all about being open with that initial discussion.

[12:32] Physiatry Lifestyle Considerations

Dr. Sahler considers Physiatry as one of the best fields with regards to getting that work/life balance. Some physiatrists may have to take various forms of call but not to the point of getting called in the middle of the night to go see a trauma in the emergency room.

He is working standard business hours and still gets to spend time with his two kids at home, make dinner and have baths, and spend weekends with them. This field gives you a great deal of flexibility that allows you to adjust your schedule especially when you have a young family.

Is There Such Thing as Physiatry School?

Physiatrists attend MD or DO medical schools, just like any other kind of physician. After the four years of medical school, physiatrists must do a one-year internship in medicine and then a three-year physiatry residency program. There is no separate “physiatry school.”

[13:30] Residency and Matching for Physiatry

After medical school, you go through one year internship through medicine. So you will have a prelim medicine internship and a three-year residency program, which is split up between inpatient conditions, spinal cord injury, traumatic brain injury, and a few other things. The other parts would involve outpatient management that includes a lot of musculoskeletal training.

After the three-year residency, there are various Fellowship options that you can pick including Sports Medicine, Brain Injury, Neuromuscular, Pain Management, Palliative Care.

In a prelim year, you’re basically applying for two “residencies” where one is your one-year internship and the other is going to be your three-year Physiatry residency. So it’s basically equivalent to applying to two programs.

Is Physiatry Competitive to Match Into?

Although Dr. Sahler thinks it’s one of the easier specialties to match in, it still all depends on the programs you’re looking to get into.

The more people that have now learned about the field and what it has to offer, the more people are interested in it, so matching has become more competitive (but not as competitive as classic dermatology, orthopedics, and the like).

In fact, he found out from their old program director a few years back that for the first time, PM&R had U.S. applicants that didn’t get into PM&R programs.

[Related episode: A Deep Dive into Physiatry Residency Match Data.]

[16:22] What Makes a Competitive Applicant for a Physiatry Program

Just like any applicant in any field, it’s important to know yourself. With physiatry where not a lot of people know about the field, you basically want the program directors to know that you understand the field and that you’re going into the field because you are interested it what it has to offer.

It’s about knowing what Physiatry is and why it fits you both on personal and intellectual aspects. Being able to convey that is the most important thing.

[Tweet ““It’s really knowing what Physiatry is, and why that fits for you personally and intellectually. So if you can convey that, that I think is the most important thing you can do.””]

[17:54] Is There MD Bias Against DOs in Physiatry?

Dr. Sahler thinks Physiatry is very accepting of DOs in that there is a concentration of DOs in Physiatry more than any other specialty. Physiatry also embraces that even through residency. What caught his eye is the diversity into the approach to a patient seeing how DOs may approach the patient differently than an MD would.

[Related episode: MD vs DO: What Are the Differences (and Similarities)?]

[19:00] Subspecialties of Physiatry

The outpatient kind of musculoskeletal care is growing most rapidly. You can simply get a job straight out of residency doing that. As for Dr. Sahler, he chose to do accredited sports medicine to add additional training onto it.

Several physiatrists also go into Pain Management Fellowship which can be run either through Physiatry or Anesthesia Pain Fellowships accepting Physiatry residents, many of them are in fact excited to accept Physiatry residents because they’re able to bring something different to the table and often teach Anesthesiologists something.

Other Fellowships include Spinal Cord Fellowships, Traumatic Brain Injury Fellowships (often goes along with Stroke Fellowship), and Palliative Care. Most of the fellowships run for a year except when you choose to go through the specific academic research track. The board exams are composed of both written and oral exams.

[21:11] Working Alongside Other Physicians as a Physiatrist

What Dr. Sahler wished primary care physicians knew about Physiatry to make their job easier is that it’s the job of the physiatrist to educate the primary care physicians on what they do. You have to meet who you’re going to be working with and sharing patients with. Talk about your interests, your expertise, and that will take care of the problem you may have with any of the referrals.

But in general, primary care physicians need to know that physiatrists can handle most orthopedic or even peripheral nervous system problems. And if they can’t, they know the appropriate triage and when to consult neurosurgeons or orthopedic surgeons and get into tertiary care, if needed. Dr. Sahler is working closest with orthopedic surgeons, neurosurgeons, and other physiatrists.

[23:20] Opportunities Outside of Medicine for Physiatrists

With sports medicine, you can get involved in the training room, game coverage, seeing athletes and onsite participation in football games, marathons, and other events that are in need of physiatrists.

[23:57] What Dr. Sahler Wished He Knew About Physiatry

Chris would just have given himself the reassurance that this is what he wanted to be because he’s basically making a lifelong education. There is uncertainty and it’s what everything he thought it would be, but it opened up a lot of opportunities for him too. If he could go back, he would just reassure himself that he’s making the right decision and to just go for it.

[24:44] The Best and Worst Things about Being a Physiatrist

Patient education is the most rewarding thing for Chris because such patients end up doing better. What’s most rewarding is when you can teach people about their body, what’s potentially going wrong, how to make it better, and coming up with a plan together with them.

The stuff he likes least about Physiatry is everything related to the administrative work, insurance, documentation, billing, and coding. This is all the normal doctor stuff that you can’t get away from because it’s a necessary evil. It’s basically the least fun part of the job to be taking care of all that.

[26:20] Future Changes in Physiatry

The newer parts of the field that are most promising are in regenerative medicine, a multidisciplinary medical field that deals with biologics such as stem cell treatments, PRP, growth factors, all these different naturally-occurring things that try to find ways that the body can heal itself. It’s quite different than just injecting a steroid to reduce inflammation. This particular field is indeed growing and we will continue to hear more and more about this.

Dr. Sahler ends with a conviction that if he had to do things all over again, he would absolutely choose the same specialty.

[27:45] Words of Wisdom for Premeds Considering Physiatry

Physiatry embraces a diversity of thoughts and different approaches, and they’re always open to new ideas on how to help people in a number of different ways. If you’re interested in these things, then Physiatry is a great way to explore the human body in a little bit different way than other residency trainings may take you through.

The best way to find out if physiatry is for you is to get out there and shadow a physiatrist. Find a physiatrist in your school or community. Talk with them and sit down with them. Spend time with them and their day-to-day activities. See the patients they’re seeing. Get in there and see what they do.

Links and Other Resources:

• Check out my Premed Playbook series of books (available on Amazon), with installments on the personal statement, the medical school interview, and the MCAT.
• Related episode: Important Details About (Almost) Every Medical Specialty.
• Related episode: What Is Pain Medicine? A Community Doc Shares His Story.
• Need MCAT Prep? Save on tutoring, classes, and full-length practice tests by using promo code “MSHQ” at Blueprint MCAT (formerly Next Step Test Prep)!