SS 13 : What is Physiatry? (Physical Medicine & Rehabilitation)

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.

[1:47] Physiatrist, not Psychiatrist

A physiatrist is a non-operative musculoskeletal physician who works with anything from muscle problems, tendon problems,bone problems, joint problems, nerve problems, to working up with diagnosis and 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 physiatrist that is growing the quickest is 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 them considering 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.

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.

[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). He 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

Most of his patients have general musculoskeletal issues where 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. He further stresses the importance of patient education right off the bat and by setting such precedent, these problems no longer necessarily become problems. It's all about being open with that initial discussion.

[12:32] Work/Life Balance

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. For the most part, he is working standard business hours and still get 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.

[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.

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 quite competitive. (But not as competitive as classic dermatology, orthopedics, and the likes.) 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.

[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.

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

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.

[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

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] Special 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 Then that He Knows Now

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. So he would then 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 least thing the he likes about Physiatry is things related to administrative work, insurance, documentation, billing, coding, and 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 is most promising is 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 the 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 it's for you is to get in 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 and who they're treating them. Get in there and see what they do.

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Transcript

Introduction

Dr. Ryan Gray: Specialty Stories is part of the Med Ed Media network at www.MedEdMedia.com. Don't forget to check out our newest member of the Med Ed Media network, The Short Coat Podcast over at www.TheShortCoat.com.

This is Specialty Stories, session number 13.

Whether you’re a premed or a medical student, you've answered the calling to become a physician. Soon you'll have to start deciding what type of medicine you will want to practice. This podcast will tell you the stories of specialists from every field to give you the information you need to make sure you make the most informed decision possible when it comes to choosing your specialty.
Welcome to the Specialty Stories Podcast. My name is Dr. Ryan Gray, and I am your host here as well as the host of many other shows on the Med Ed Media network. Again that's www.MedEdMedia.com.
This week I have a physiatrist that I'm going to be speaking to, somebody that Allison and I went to medical school with, Dr. Chris Sahler, and he's going to talk all about Physiatry as a community-based physiatrist.

Meeting Dr. Chris Sahler & Physiatry

Dr. Chris Sahler: I'm Chris Sahler and I'm a physiatrist.

Dr. Ryan Gray: Now are you a community physiatrist or academic physiatrist?

Dr. Chris Sahler: So I'm a community physiatrist, I do all of my work outpatient at part of a private practice.

Dr. Ryan Gray: And how long have you been practicing?

Dr. Chris Sahler: About two and a half years now.

Dr. Ryan Gray: Now go ahead and just for clarification, you are saying physiatrist, not psychiatrist, correct? Can you explain that a little bit more?

Dr. Chris Sahler: It's a big, big difference, and a question I get quite frequently. So a physiatrist is- and in my scope of the field, is essentially a non-operative musculoskeletal physician working with anything from muscle tendon problems, bone problems, joint problems, nerve problems, working up a diagnosis and then treatment kind of through all non-operative measures whether it's medicines, different types of therapies, injections, helping to direct management that way.

Dr. Ryan Gray: I've heard it in lay terms being called a non-operative orthopedic surgeon. Is that about right?

Dr. Chris Sahler: Yeah it's similar, and some of the other cool parts of the field is we definitely get some good training with neurology as well, and we work very closely with physical therapists. So definitely a different perspective on some of the common orthopedic problems that you may see. And one of the other big distinctions I think that Physiatry focuses on is the functionality. So not just, ‘what do you have, what's your pain,' but ‘how does that impact your activities of daily living or your sports,' and we have a lot of different ways to help patients get back to increased functionality as well as helping to treat your pain.

Dr. Ryan Gray: Now Physiatry also goes by a different name. Why is there another name for it?

Dr. Chris Sahler: You mean like rehab medicine, or physical medicine, or rehabilitation?

Dr. Ryan Gray: Yeah.

Dr. Chris Sahler: That is a great question. To be honest I don't know. The field's been around for a while and it's kind of evolved over time. I think the largest part of the field at this point, and certainly the part that's growing the quickest, is the part of Physiatry that I'm involved in, so kind of the community musculoskeletal physiatrist, and that part I think is really exploding, and that's where I think you're going to hear more about the field and how it's really growing. But yeah, as far as the origins and all the other names, I still struggle sometimes coming up with those answers.

Dr. Ryan Gray: So rehab medicine is one, and then PM&R or physical medicine and rehabilitation is the other.

Dr. Chris Sahler: Yeah I mean I think that would be kind of the full formal title, but sometimes if the title doesn't tell you the answer, and you just came up with some other explanation, so even physiatrist even sometimes people ask what it is, so you've got to come up with different ways to kind of explain what you do. So PM&R, unless you're in the medical field, I don't think it's all that helpful so I'll say physiatrist or non-operative musculoskeletal physician, or variations of that.

Dr. Ryan Gray: Just an overall cool guy, that's how it should go.

Dr. Chris Sahler: That's right.

Dr. Ryan Gray: Alright. When did you know you wanted to be a physiatrist?

Choosing Physiatry as a Specialty

Dr. Chris Sahler: So I grew up playing sports, I was always interested in the body, my own mechanics and everything like that, so really I didn't know anything about the field, and you get into medical school and I'm like okay, obviously the only thing available is orthopedics. So once I got into second year, I just heard some third and fourth year medical students talk about Physiatry, they sent out some emails, and I just started to talk to them a little bit about the field. So I just learned about it for the first time the second year of medical school, and after just talking with some of the third and fourth years, I actually got a chance to do both an orthopedic surgery rotation as well as Physiatry rotation by the end of third year medical school, and got a good comparison of the two. So really it was fourth year medical school when I was just comparing the two fields, because they both offered a lot of what I wanted; getting involved in sports medicine, and helping people with their bodies whether it's their pain, functionality, or their performance, and Physiatry really allowed me to get involved with the patients and things that I wanted to see in my practice.

Dr. Ryan Gray: What do you think was the reason Physiatry over orthopedic surgery?

Dr. Chris Sahler: It was a couple of reasons. One is to be honest I didn't love the OR. I had fun there, but I think if you talk to any surgeon, they love being in the OR, and they love that environment. And I just- it just wasn't catching me as much as I knew it really should be to dedicate that much to that. So that was definitely one deciding factor. And the other like I was speaking about earlier, just the diversity and the way we approach the patient, and having some more background from the neurology standpoint, and really working on biomechanics and the anatomy and physiology, and how that may play into treating the patient. So making gait alterations on how somebody runs, helping their back pain, or doing other things that I think are very interesting for me and Physiatry really allowed me to explore those interests of mine.

Traits of a Good Physiatrist

Dr. Ryan Gray: What traits do you think lead to being a good physiatrist?

Dr. Chris Sahler: I definitely have not met many physiatrists that don't enjoy just being around people, talking, being- enjoying that social interaction, and you get certain personalities sometimes people are like, ‘Yeah the surgeons are all mean, and want to spend two seconds with the patient,' or whatever. But Physiatry, I think we enjoy spending time with the patients, really digging deep into their problems, and really spending that time, so having full dedicated office hours to work with the patients and not spending half my time in the OR. So I think just that very personable personality for lack of a better term is probably the most common trait that I'll see.

A Day in the Life of a Physiatrist

Dr. Ryan Gray: Describe a typical day.

Dr. Chris Sahler: So usually I am in the office kind of standard business hours, in the office from 8:00- seeing patients from 8:00 to about 5:00. I'd say about 60% to 70% of my time is just seeing new patients, or follow-ups. With my specialty I also do a lot of injections. So I use ultrasound guidance for a number of peripheral injections whether it's tendons or joints, things like that. I also use x-ray guidance or fluoroscopy for spinal injections including epidural injections, things like that. I also spend about half a day per week doing EMG, or nerve conduction studies. So things are split up like that, and again just in the office business hours Monday through Friday, I'm not taking any call on weekends or weekdays, so pretty standard business hours.

Dr. Ryan Gray: What types of patients do you treat?

Dr. Chris Sahler: A lot of it is again, general musculoskeletal. I'd say about half of my practice has various spinal related pain, and the other half is kind of mixed through the rest of the body. I am also- I did a fellowship in sports medicine so I am board certified in sports medicine, so anywhere between 10% to 25% of a given week is seeing athletes with various things whether it's the simple ankle sprain, or knee injury, things like that. And I also see some neurologic injuries so specifically peripheral nerve problems, and drop foot, and things like that. So helping to diagnose and manage those things.

Dr. Ryan Gray: So a non-standard question for you because you brought up pain management stuff, and the state of our healthcare system and opioid crisis in this country, how much of that do you deal with on a day-to-day basis?

Dr. Chris Sahler: I think the fortunate thing whether it's due to where I practice, or the reputation of our group, or just the way that I practice along with the other physicians, we have a lot of similar mindsets, it's not a major problem because when we see new patients with these problems, I feel we know how to appropriately use those medications when it is applicable and it's all about patient education. So when a patient comes in, and whether they ask for the medication or you think it's appropriate, you need to have a talk right off the bat about the medication, the risk and benefit, why it's appropriate or why it's not appropriate, and set very specific treatment guidelines and say, ‘We're using this medication for this particular reason, and this will either be the duration or this is our goal with this.' And usually I have that discussion if I'm going to give them any kind of medication like that, we just explain, ‘This is being used in conjunction with these other therapies. So it's just a part of it and it's not a permanent part of the treatment.' So it's really patient education, and the onus falls on the physician to do that right off the bat. So I think that that's the most important part. So when you set that precedent I feel like a lot of these problems don't necessarily become problems. So I think that's the way that I handle it, and I think I've been pretty fortunate to not really be concerned with a lot of the patients that I deal with just because I'm very open with that initial discussion.

Work Life Balance

Dr. Ryan Gray: Yeah, okay. How do you feel your work life balance is?

Dr. Chris Sahler: I think with Physiatry that's one of the best parts of the field too, and again some physiatrists will have to take some various forms of call, but again it's not like I'm getting called in the middle of the night to go see a trauma in the emergency room. I think it's one of the best fields with regards to the work and lifestyle balance. Again I'm working for the most part standard business hours, and I have two kids at home, I'm able to get home, give everybody dinner, we do baths, spend time with them on weekends, so there's great flexibility with the work to adjust the schedule with a young family here. So I love it, it's perfect for me.

Residency and Physiatry

Dr. Ryan Gray: What does the residency path look like for Physiatry?

Dr. Chris Sahler: So the training after medical school, you do a one year internship through medicine, so you'll have a prelim medicine internship, and then you'll have a three year residency program, and that residency will be split up between some inpatient conditions; spinal cord injury, traumatic brain injury, and a few other things. And the other parts of that will be outpatient management including a lot of the musculoskeletal training. I also went into, as I said, sports medicine fellowship, and there's other fellowships whether it is the brain injury, neuromuscular, some pain management, a lot of different fields. You can even get into palliative care, there's a lot of options even after the three years of residency.

Dr. Ryan Gray: So just for clarification, if you're listening and don't understand that prelim year. So Chris, you said you did a prelim medicine year. Can you do a surgery or transitional, or does it have to be a medicine year?

Dr. Chris Sahler: No that's a good point. You can do surgery or transitional year.

Dr. Ryan Gray: Okay.

Dr. Chris Sahler: Yeah or the medicine prelim year, yeah.

Dr. Ryan Gray: And again just for clarification, I get this question a lot, so prelim year as you're applying for residencies, you're applying basically to two ‘residencies.' The one is your one year internship and then the other is going to be your three year Physiatry.

Dr. Chris Sahler: Yeah and that's the majority of the time. I think there are a few programs where you may be accepted to the prelim at that hospital and go into transition to the PM&R residency program, but the majority of the time, yeah it's equivalent to applying to two programs.

Dr. Ryan Gray: Okay. Is matching hard?

Dr. Chris Sahler: It's at least classically, I mean I don't know in the last couple of years, but it's one of the easier I think specialties to match in. But it all depends on what programs you're looking to get into. I think the more people learn about the field, everything that it has to offer, I have heard more and more interest so I think it is becoming a little bit more difficult to match into. For the first time- I was talking to my old program director maybe a couple years ago, and for the first time PM&R had US applicants that didn't get into PM&R programs. So it is becoming more competitive but it's certainly not as competitive as some of I think the classic dermatology, orthopedics, or things like that.

Dr. Ryan Gray: Back when you applied obviously a couple years ago, what do you think made a competitive applicant for the bigger programs?

Dr. Chris Sahler: Good question. Number one, I think any applicant in any field, just knowing yourself. So again with Physiatry, not a lot of people knowing about the field, when you apply, you want the program directors in that program to know that you understand the field and that you're going into the field because you are interested in what it has to offer. So again for me, I'm like I love biomechanics. I could talk about neuromodulation and like all this stuff all day long, so for me that was kind of an easy sell. I'm like this is a great field for me, I can get a lot out of this, and I feel like I can bring a lot to the field. So 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.

Dr. Ryan Gray: Cool. Now a lot of what you've been talking about, it seems to me that osteopathic physicians could make great physiatrists because they talk about treating the whole body, and the manipulation that they learn, and just understanding how everything works together. Do you see any bias towards DOs or against DOs in Physiatry?

Dr. Chris Sahler: I think Physiatry is very accepting of DOs. I would say out of any specialty, of course I may be biased just being in the field, but I think there's more DOs in Physiatry than probably- more of a concentration of DOs than any other specialty. So very accepting and kind of embraces that even through residency. We would have some of the DOs give talks about again, how they may approach the patient maybe differently than your standard MD, and some of the other techniques that they use to treat patients that standard MD training wouldn't give you. So again that's where the diversity into the approach to a patient caught my eye. So it's very interesting from that standpoint. So I think very, very accepting of DOs, absolutely.

Sub-Specialties of Physiatry

Dr. Ryan Gray: You talked about it a little bit before, but can you go over one more time the opportunities to sub-specialize as a physiatrist?

Dr. Chris Sahler: Yeah so again, I think the most rapidly growing part of it is getting into this outpatient kind of musculoskeletal care. You can just go through residency and then get a job straight out of residency doing that. I chose to do an accredited sports medicine fellowship just adding additional training onto that. A lot of people go into pain management fellowships, a lot of those can be run either through Physiatry, but often times Anesthesia pain fellowships accept Physiatry residents, and many of them are very excited to get Physiatry residents because again, we bring something different to the table and often can teach the Anesthesiologists something. There are spinal cord injury fellowships, traumatic brain injury fellowships that oftentimes goes along with stroke, like palliative care is another one that I think is growing in popularity from physiatrists. I think those are kind of the main sub-specialties that people are getting into.

Dr. Ryan Gray: And are those fellowships usually a year long? Are they longer?

Dr. Chris Sahler: Yeah most of the standard fellowships are one year. It'd be pretty rare to have anything longer than that unless it's on some specific academic research track, but typically you're just going to have a one year fellowship.

Dr. Ryan Gray: Okay, what do boards look like for Physiatry?

Dr. Chris Sahler: So we have the standard written, but there is as of when I took them, there was also an oral exam as well. I think pretty similar to maybe some of the steps where the written I think was more challenging, and then the oral I feel most people were prepared for and had a pretty high passing rate, so I wasn't quite as concerned with that. But yeah as of right now there's both written and oral.

Working alongside Other Physicians

Dr. Ryan Gray: Okay. What do you wish primary care physicians knew about Physiatry to make your job easier?

Dr. Chris Sahler: You know I think it's still- this may be regional, I feel like it's on the physiatrist to educate the primary care physicians on what we do and what we have to offer. So I don't necessarily need anything different from them. One thing that we do in our area, is we have our physicians in our group go out and meet the primary care physicians in the community, and just tell them, ‘Okay this is who I am, and this is what I do.' So I think the onus is really on me to educate on what I do, and how the primary care physicians can best help me, and I can best help them. So I think anybody getting into their practice in the first few years, you've got to meet who you're going to be working with and sharing patients with, and talking to them about your interests, your expertise, and that will kind of take care of any of the problems you may have with any of the referrals. But I think if you just want to generalize the question, just knowing that we can handle most orthopedic or even kind of peripheral nervous system problems, and if we can't handle it, we kind of know the appropriate triage and when to consult whether it's neurosurgeons, orthopedic surgeons, and get it onto the kind of tertiary care if needed

Dr. Ryan Gray: What other specialties do you work closest with?

Dr. Chris Sahler: So my group's comprised of orthopedic surgeons, Neurosurgeons, and physiatrists. So I'm most closely working with orthopedic surgeons and neurosurgeons. A lot of the other physiatrists in the group, we don't share as many patients, but we do continue to have conferences, and we'll bounce ideas off each other, things like that. So those are kind of the specialties I'm working with mostly.

Dr. Ryan Gray: Are there any special opportunities outside of clinical medicine for physiatrists?

Dr. Chris Sahler: Yeah so with sports medicine, so whether it's in the training room, game coverage, seeing athletes, that's all been a part of my training and on site participation whether it's football games, the marathons, all these different events there are plenty of needs that physiatrists can get involved with too.

What Dr. Sahler Wishes He Knew Then

Dr. Ryan Gray: What do you wish you knew then going into Physiatry that you know now?

Dr. Chris Sahler: Just the reassurance that this is what you wanted to be, because even once you make the decision it's like, well you're making a lifelong decision and when you think about it sometimes you're like, ‘Well I have one month of experience to extrapolate what I'm going to do the rest of my life.' So you're trying to make an educated decision but there's still a little bit of uncertainty. But it was everything that I thought it would be, and it's opened up a lot of opportunities for me, and it's just been great. So I would just reassure myself and say just, ‘You're making the right decision, and just go for it.'

Best and Worst of being a Physiatrist

Dr. Ryan Gray: What do you like the most about being a physiatrist?

Dr. Chris Sahler: I would say when you are able to educate the patient, and whether you cure them or not, educate them and that lightbulb goes off, and they finally get what they have, how to get better, and really it's the education that I find most rewarding. Because I think those patients end up doing better, but I think that that's our job, so for me that's the most rewarding when you can teach people about their body. Because I think it's so interesting when you can teach them about their body, what's potentially going wrong, about how to make it better, and coming up with a plan together with them, and when they understand that, I think it's very, very rewarding.

Dr. Ryan Gray: On the flipside, what do you like the least?

Dr. Chris Sahler: The administrative stuff, the insurance stuff, the documentation, billing, coding.

Dr. Ryan Gray: All the normal doctor stuff.

Dr. Chris Sahler: All the normal doctor stuff that you can't get away from, so it's important to know it because it takes some of the teeth out of the bite, but it's a necessary evil. So I understand that, but certainly that's the least fun part of the job, just having to take care of all that.

Future Changes in Physiatry

Dr. Ryan Gray: Whether it's technology, or treatments, or anything else, do you see any major changes coming to the field?

Dr. Chris Sahler: I think one of the newer parts of the field that kind of has the most promise is regenerative medicine. So regenerative medicine is this kind of multidisciplinary medical field having to deal with biologics. So if you heard about stem cell treatments, PRP, different growth factors, all these different things that kind of occur naturally, try to find ways where the body can heal itself. So kind of different than it's been done before. Instead of just taking like a steroid and injecting it trying to reduce inflammation, or taking a lot of these different treatments and trying to get the body to heal when it wasn't able to do that before. So I really think that that's growing and you'll continue to hear more and more about that. And I think it might be one of those things where in twenty years we're going to look back and say to each other, ‘Can you believe that we were doing this twenty years ago? Can you believe that we were putting steroids in people's tendons?' Or things like that. So I think that that's what we're on the verge of kind of in some of the outpatient non-operative musculoskeletal care.

Dr. Ryan Gray: Okay. I think I know the answer to this, but if you had to do it all over again, would you choose the same specialty?

Dr. Chris Sahler: Absolutely.

Words of Wisdom to Premeds Considering Physiatry

Dr. Ryan Gray: Any last words of wisdom for those thinking about going into Physiatry?
Dr. Chris Sahler: Yeah again, it's a very diverse field and the field embraces a diversity of thoughts, and different approaches, and we're always open to new ideas on how to help people in a number of different ways. So I mean anybody interested in some of the things I was talking about, I mean it's just a great way to explore kind of the human body in a little bit different way than a lot of other residency trainings may take you through. So if you're interested, I think the best way to find out if it's for you is to get in there. So find a physiatrist whether it's through school or in the community, and talk to them. Sit down with them and try to spend some time with them and their day-to-day activities. See the patients that they're seeing, see how they treat the patients because that I think is really what will kind of grab you. So definitely get in there and see what we do.

Final Thoughts

Dr. Ryan Gray: Alright there you have it, Physiatry, not to be confused with Psychiatry. Physiatry also known as rehab medicine, also known as physical medicine and rehabilitation, also known as PM&R. So there are a lot of names for Physiatry and I hope that Chris was able to clarify some of the things about Physiatry if you are were interested in going into it, or maybe you weren't and now you are. Go back and take another listen, and hopefully get a clearer and better understanding of what a community based physiatrist does.

If you have any thoughts about a specialty you want me to cover here on the Specialty Stories Podcast, shoot me an email, Ryan@medicalschoolhq.net. Better yet, if you have somebody that you would like me to interview, I would be grateful for you to pass along a name to me.

I hope you have a great week, I hope these podcasts are helping you on your journey to choosing your medical specialty. Don't forget to leave us a rating and review in iTunes if you haven't done so yet, or better yet just share this with a classmate or friend. I hope you have a great week. We'll see you next week here at Specialty Stories and the Med Ed Media network.

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