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• What is Physiatry
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• What is a Residency in PM&R Like
• How Can I Best Prepare to be a Good Residency Candidate
• How Should I Prepare for a PM&R Rotation
• What Rotations are Good for Someone Going Into PM&R
• What is a Career in Physiatry Like
• How Much Do Physiatrists Make
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A Step-by-Step Guide to Applying for a PM&R Residency

Career support.

Applying for a residency can be a complicated process. Learn more about the 4 steps of applying to residency by clicking on the links below. Also make sure to check out the  Medical School Roadmap  to PM&R 4th year medical student section on information about details of the application itself (e.g., personal statement, letters of recommendation, USMLE Step 2 testing, and away rotations.)

Finding an ACGME-Accredited PM&R Residency Program

Pgy1 training, pediatric pm&r, interviewing, match program: the pm&r match.

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Ways to research both intern year (PGY1) and residency training programs include:

• Visit the  Residents  section of the AAPM&R website and view a  map of PM&R  programs in the U.S. and find out more information on PM&R residency training.
• Use the American Medical Association Fellowship and Residency Electronic Interactive Database Access System (AMA-FREIDA). For more information, visit the  AMA-FREIDA  Web site.
• Talk with current PM&R residents and attendings at your institution.

Selecting a Program for Application

Facts and Figures

• 83 ACGME-accredited programs across 28 states
• 30 Categorical programs (4-year programs)

Seek advice about specific residency programs from a wide variety of sources including:

• Attend the AAPM&R Annual Assembly’s Residency Fair as part of the Medical Student Program.
• If you are at a medical school with no associated PM&R department or program, please contact the American Academy of Physical Medicine & Rehabilitation (AAPM&R) to identify resources in your area.
• Talk with your PM&R department chair, program director, or other PM&R faculty.
• Ask PM&R residents and fellows at your institution.
• Talk with your PM&R student interest group.
• Check with your Graduate Medical Education office and see if there are any alumni that matched into PM&R who might be able give you some insight.
• Talk with your medical school advisor.
• Check program websites directly—application requirements, curriculum, research opportunities, etc.

Consider the following factors when selecting programs:

• Education curriculum (Lecture schedule, protected study time, etc.)
• Conference schedule
• Research activity and opportunities
• Some programs are based at a free-standing rehabilitation hospital and others have an inpatient rehabilitation floor within an acute care hospital.
• Availability of PM&R subspecialty expertise (i.e., Spinal Cord Injury, Traumatic Brain Injury, Pediatric Rehabilitation, Musculoskeletal, or Pain Specialists).
• Academic career:  Consider university-based programs with a well-balanced faculty involved in full-time teaching and research commitments
• Subspecialty interest:  Seek out programs with a well-developed division in a specific area to facilitate introduction to research and more specialized practice (e.g., spinal cord injury, traumatic brain injury, pediatrics) and to determine which programs might offer a fellowship in that area after completion of residency.
• Accreditation:  Check the  ACGME website  and research the accreditation status of residency programs. Residency programs are routinely reviewed and given accreditation status. It is good to know if the program you are applying to is accredited or on probation. After ACGME review, a program is issued accreditation for a certain number of years before requiring another site visit, with a 10-year accreditation being the highest. If a program is on probation, make sure to inquire why they were cited and what is being done to remediate any problems identified.
• Benefits:  Inquire about resident benefits at each program, including ability to attending conferences locally and nationally, reimbursement for conference participation, reimbursement for memberships to professional organizations such as the AAPM&R, book money, salary, and health benefits.
• If you want to go into clinical practice, remember that many residents go into practice in the same geographical area where they trained. During the training process, you usually become familiar with employment opportunities and practicing physiatrists and groups in the area.
• Residency can be a stressful time so proximity to family, friends, and your social support network should not be undervalued.
• Consider your own hobbies and interests. Its important that you train in a location where you feel you will be happy to live for at least 3-4 years.
• Cost-of-living varies by location. Consider your expenses, expected stipend, and the cost-of-living in each city to determine if it’s within your budget.
• Size of residency program:  The size of PM&R residency programs can range from 2–14 residents per class. Having a small versus large residency has both pluses and minuses and is program dependent. Reflect on your learning style and what would be the optimal environment for your education. Make sure to speak with current residents to determine if the program is a good fit for you.
• Patient-to-resident ratio:  Ask specifically about the patient-to-resident ratio on the inpatient service and the structure of the team. Some programs have senior residents that round on the inpatient service whereas, in other programs you may be interacting with the attending directly. You should also inquire about the average inpatient consults seen per month.
• Selectivity/competitiveness of the program:  Ask your medical school's PM&R department chair and other PM&R faculty for assistance in estimating both the selectivity of training programs and applicant competitiveness. You can also check out the  NRMP Program Director Survey  for specific information.
• Quality of Resident Life:  There are several factors that play into the quality of life of a resident. A good way to gauge quality of life is by talking with the current residents. Inquire about call schedules, camaraderie among residents, local recreational activities, etc.
• Board Pass Rate and Post-Graduate Plans of Residents:  Ask each residency its board pass rate for the last several years as well as the steps taken to ensure their residents are prepared for the boards (doing a SAE-P or AAPM&R’s Qbank questions together, mock oral boards, etc.). Inquire about the post-graduate plans of the residents in the program. Did their graduates go into private practice or academic medicine? Did they pursue fellowship training? How successful have their residents been in obtaining a fellowship?

There are a number of residencies (i.e. radiation oncology, neurology, dermatology, etc.) that start residency after a year of preliminary training. There are some PM&R programs that include a PGY1 year and PGY2-4 years, which are called categorical positions. However, a majority of the PM&R residency programs offer only PGY2-4 or advanced positions. Therefore, you typically will have to apply for a separate preliminary year (i.e. internship) along with your PM&R residency program during the summer of your 4th year in medical school.

Internships can be done through Internal Medicine, Surgery, Family Medicine, Pediatrics, a rotating osteopathic (DO) or transitional year (MD).

If you are applying to:

• A residency program that  offers both categorical and advanced positions , it is the applicant's advantage to rank both positions and maximize their chance of matching.
• Only advanced positions , you will need to apply and rank for a separate internship year along with your PM&R Residency.
• Programs with a variety of categorical and advanced options , you still need to rank and apply for a separate internship in case you do not match for a categorical position.
• Also consider ranking preliminary year positions only at the bottom of your rank order list in the event you do not match into a categorical or advanced position.

There are currently two ways to enter into pediatric rehabilitation:

• Medical students can apply for a combined pediatrics / PM&R residency program, which is a 5-year combined pediatrics/PM&R residency program that is offered. There are only a few programs that provide this option (may change each year): Cincinnati Children’s/University of Cincinnati PM&R (1 spot each year), Jefferson/DuPont Hospital for Children (1 spot each year), University of Colorado Denver (1 spot each year), and Detroit Medical Center/Wayne State University (1 spot each year). Alternatively, you can also apply for a 2-year pediatric rehabilitation fellowship following completion of your PM&R residency. 
• Medical students can also complete PM&R residency and then apply for a pediatric rehabilitation fellowship. After completion of this two-year fellowship, graduates are eligible to sit for PM&R and pediatric rehabilitation board certification. Applicants typically apply for pediatric rehabilitation fellowships in the spring of their PGY-3 year.

Talk with each program to get an idea of scheduling. Most PM&R programs start interviewing in late October/November and as late as January/February. Most interview invites will be sent via email, so it is important to check your email early and often during interview season. Each program has a limited number of interview dates and spots may be filled rather quickly, thus a timely email response will increase your chances of getting your desired interview date. If you are interested in a program and cannot schedule an interview, it is important to be proactive and ensure they know you are interested in an interview if a spot were to become available.

You will be invited for interviews based on your timely and completely submitted credentials, personal statement, Dean's letter, transcript and letters of recommendation, all of which can be uploaded onto ERAS. The interview day is the best opportunity to gather more information about the program and to learn more about the resident’s perspective. You will likely be interviewed by several interviewers (usually 2-4), and they will include faculty, chief residents, and fellows. It is best to prepare for interviews by reading more about specific programs (residency websites are often a great place to start.) You should be prepared to answer expected questions such as why you are applying to their program, what makes you a great fit, why you are entering the field of PM&R, what your career goals are, etc.

It is also useful to prepare a few specific questions that you want to ask your interviewer, as they will ask and expect you to have questions. Interact with the current residents at each program as much as you can as this is a great opportunity to get an idea of how they feel about the program and whether you feel you would fit well with the people at that program. Some programs offer a dinner or social event the night prior to the interview day. It is strongly encouraged to attend these events if possible so that you can interact with the residents in an informal setting, ask informal questions, get a feel for the camaraderie and atmosphere of the program, and sense whether the residents like their program and are genuinely happy. After your interview day is complete, you may also choose to send a thank you email to your interviewers and program coordinator. However, this does not affect your ranking and is often just viewed as common courtesy.

After your interviews are complete, you must prepare and submit a ranking list of programs to the National Resident Matching Program (NRMP) which is typically due in the middle to end of February. You can rank as many or as few of the programs for which you had interviews. The rank is often the most important step in the application process, so it is highly advised to choose your list wisely!

PM&R Programs utilize ERAS (Electronic Residency Application Service) for resident applications and the NRMP to match the residency positions. All allopathic and osteopathic PM&R and internship programs use ERAS for the application process. You will typically upload all necessary documents (i.e., personal statement, USMLE/COMLEX scores, MSPE, transcript, Dean’s letter, letters of recommendation, photo) onto ERAS. NRMP is the matching program where you finalize your program rank list. Contact ERAS and NRMP for more information about the Match process and specific deadlines. 

The Match process in PM&R is generally quite favorable. The percentage of U.S. medical school seniors matching to programs has generally been 95-98% over the past 10 years. It is also important to keep in mind that PM&R has also become an increasingly popular and competitive specialty amongst medical students. View the ERAS Match Timeline for all the latest dates.

Final Thoughts

Applying for residency is a very exciting process that requires a lot of planning and organization. This period can also become easily overwhelming (i.e., traveling, scheduling, etc.), so it is important to also try to find some time for yourself throughout this process.

These recommendations are an outline to help guide your decision in choosing a residency. Every person is different and we all have our priorities that play into our choices. The right program for you is usually the one that you feel is the best fit from your interview day. If you still have questions after your interviews or are stuck between ranking two programs as your top choice, it may be helpful to take a second look at a program (or a couple of programs) for a day or two. Most programs are more than willing to set this up if you contact the chief residents or program coordinator.

Don't forget to use all the resources available through the AAPM&R to guide your application process. Contact chief residents and other residents through the AAPM&R PhyzForum , check out sample CVs on the resident resources website, map-out PM&R residencies  in your desired areas, and much more.

So You Want to Be a Physiatrist (PM&R)

• By Kevin Jubbal, M.D.
• June 5, 2021
• Accompanying Video , Medical Student , Pre-med
• So You Want to Be , Specialty

So you want to be a physiatrist, or a physical medicine & rehabilitation doctor, also known as PM&R for short. You like the idea of dealing with chronic physical illness and having a chill lifestyle. Let’s debunk the public perception myths, and give it to you straight. This is the reality of PM&R.

What is PM&R?

PM&R is the jack-of-all-trades specialty focusing on both inpatient and outpatient management of non-operative orthopedics and neuro-rehabilitation. These are the primary physicians for certain nervous system or non-surgical orthopedic disorders, offering both medical and procedural treatment modalities. These are the doctors handling their unique conditions on an ongoing and outpatient basis.

Some patients present with spinal cord or traumatic brain injuries, for whom you’ll manage their pain, neuropathy, and bowel and bladder care. Other patients may have other mixed connective tissue or nervous system issues that you’ll treat, such as mallet finger or jersey finger.

There are a few ways to categorize the specialty.

Non-Operative Orthopedics vs Neuro-Rehabilitation

Non-operative orthopedics includes diagnosing and treating peripheral nerve diseases. This often includes procedures with ultrasound or fluoroscopy assistance or injections of various types. For example, trigger point injections with lidocaine or steroids are used at sites of myofascial pain, whereby there is tightness around a muscle focal point.

This is a rapidly evolving area of PM&R, with research and new therapies in regenerative medicine such as platelet-rich plasma, mesenchymal stem cells, or peripheral nerve stimulators.

Neuro-rehabilitation focuses on traumatic brain and spinal cord injuries and is primarily inpatient in nature. These physiatrists serve as the patient’s primary hospitalist, not as a consulting service, for patients requiring neuro-rehabilitation. Their main area of specialization is in dealing with neuromuscular diseases and related issues, and they may consult other specialties, like pulmonology, neurology , and other specialties for specific concerns.

This is very collaborative and highly interdisciplinary, working with a wide variety of specialists and therapists, from physical therapists and occupational therapists to speech therapists, recreational therapists, and respiratory therapists.

Academic vs Community vs Private Practice

The practice of physiatry varies substantially between practice settings.

Academic physiatrists deal primarily with brain and spinal cord injuries. These tend to be more severe cases than in other practice settings, and are heavy on neuro-rehabilitation. As with any academic position, research and teaching residents and medical students is part of the job. On the other hand, some clinical aspects are more relaxed because you’ll have residents to help carry out various clinical responsibilities. Overall, there are fewer procedures, and therefore lower compensation, because more of your cases will be traumatic brain, spinal, or stroke in nature.

Community physiatrists deal with less severe cases in comparison to academia. On average, you’ll have more outpatient orthopedics, more procedures, and higher compensation. While your academic colleagues will be dealing with more amyotrophic lateral sclerosis, also known as ALS, or unique cases of Guillain Barre syndrome, you’ll be doing more EMG’s as a community physiatrist, for things like ulnar entrapment, carpal tunnel, and basic radiculopathies.

Private practice physiatrists are uncommon, unless they specialize in pain or sports. Part of the reason private practice is uncommon is that owning your own rehabilitation center is expensive, requiring a large interdisciplinary team to treat a small number of patients.

Common Misconceptions

There are a handful of misconceptions about PM&R, as it’s a smaller specialty most laypeople haven’t even heard of.

First, get used to people asking if you’re a physical therapist, or your friends and family requesting stretching exercises. PM&R doctors are physicians, not PT’s. While physical therapists are prescribing exercises and therapy treatment plans, the physiatrists manage the medications, pain, spasticity, neuromuscular dysfunction, and general medication management.

Second, because it’s a newer and smaller specialty, many of your physician colleagues won’t even know what you do. You’ll get random consults for things that are not appropriate, like a hospitalized patient who hasn’t gotten out of bed in several days.

How to Become a Physiatrist

After medical school, PM&R residency is 4 years. As with any specialty, intern year will be a mix of various specialties, many of which are less clinically relevant to your future as a PM&R doctor. As a PGY2, you’ll be focused primarily on inpatient rehabilitation. Every residency requires at least 12 months of acute inpatient rehab, and you’ll get the majority of that in your second year. The rest will be clinic and consult months cycled throughout. As a PGY3 and PGY4, you’ll have more elective time, usually with more relaxed schedules and relaxed call. These will also be the years where you can gain greater exposure to procedures, such as EMG’s and injections.

In terms of competitiveness, you’re in luck, as PM&R ranks second to last, above only family medicine. While the match rate is lower than expected at roughly 90%, USMLE Step 1 has averaged 224 and Step 2CK at 238. Given the relative lower competitiveness, it tends to be more DO and IMG friendly as well, although it’s been trending upward. To see the full list of specialties by competitiveness, check out my videos explaining the methodologies and the full data set.

Because it’s less competitive, the stereotype is that it’s for students who didn’t do well on their USMLE or who wanted to do orthopedics but couldn’t get in, but I don’t think that’s fair to the specialty. Medical students that apply to PM&R are generally optimistic, as it’s an almost necessary trait in the rehabilitation setting. You’ll have to be encouraging to your patients and help inspire hope.

Subspecialties within PM&R

After completing a PM&R residency, you can subspecialize further with fellowship.

Pain is a 1-year fellowship and is the most competitive, resulting in the highest compensation for PM&R doctors. You can go into pain through PM&R, but also after residency in anesthesia, neurology, or psychiatry.

You’ll be dealing with chronic pain patients, which some find depressing, but others find deeply meaningful. A large part will be prescribing pain medications, although, given the opioid epidemic, physicians are moving more toward procedures. These include radiofrequency ablations for facet pain, epidural injections, and spinal cord stimulators. This is great for those who like working with their hands, as it’s more procedural than other PM&R subspecialties.

Pediatrics is a 2-year fellowship focusing primarily on cerebral palsy. You’ll be managing spasticity and doing a few procedures like botox injections in spastic muscles.

You’ll also come across some rare conditions like Duchenne’s muscular dystrophy, Becker’s dystrophy, spina bifida, myelomeningoceles, and meningoceles. Because these are so rare, you’ll more or less become these patients’ primary care physician, often continuing care into their adulthood.

This is the fellowship for those who not only enjoy working with kids, but who are also very patient.

Sports Medicine

Sports medicine is a 1-year fellowship and is the second most competitive subspecialty. You can also get into a sports medicine fellowship after a residency in family medicine or emergency medicine as well.

It’s a procedure-heavy subspecialization, including primarily steroid, hyaluronic acid, and platelet rich plasma injections, and also the occasional EMG. Sports medicine also includes regenerative medicine, ultrasound, and sideline coverage on sports games.

This is the fellowship for physiatrists who love sports and working with their hands.

Palliative Care

Palliative care is a 1-year fellowship that focuses on improving the quality of life for patients living with serious chronic illnesses. It’s not quite hospice care, which is more focused on the terminally ill, but you will still have some end-of-life patients who can make substantial improvements and prolong their lives beyond the initial prognosis.

Cancer is common amongst this patient population, and you’ll be helping managing pain and making patients more comfortable. This is for the physiatrists who are positive and wouldn’t mind dealing with a great deal of death and end-of-life care.

Traumatic Brain

Traumatic brain is a 1 year fellowship that’s more academic in nature and is more heavily concentrated at larger research centers. You’ll be dealing with traumatic brain injury sequelae, including headaches, changes in attention, and behavioral changes. New innovative therapies are on the horizon, such as stem cells and other regenerative medicine to regrow damaged tissue. On average, you’ll have more complicated patients and more complicated rehabilitation management.

This is for the physiatrists who don’t mind some research, are ok with uncertainty, as there is more trial and error, and want to work in an academic center.

Spinal Cord

Spinal cord is also a 1 year academic fellowship, focusing on spinal cord injuries rather than brain injuries. Thankfully, spinal cord injuries are becoming less common in modern era with improvements in safety technology, such as airbags in cars. Most spinal cord injuries are the result of either elderly patients falling or hyperextension injuries.

What You’ll Love about PM&R

There’s a lot to love about PM&R. It’s heavily team-focused, and you’ll be working with PT, OT, and speech therapy on the regular, in addition to case management and liaisons to help coordinate care at outside hospitals.

In terms of lifestyle, your hours are predictable and not too long – expect no more than 8 hours per day, and no nights or weekends, with minimal call. For the lifestyle demands, you will be getting compensated quite well, around $300,000 on average.

If you enjoy the musculoskeletal system but don’t enjoy the operating room or being scrubbed in, PM&R allows for an office-based practice with shorter and smaller procedures.

What You Won’t Love About PM&R

While PM&R is a great specialty, it’s definitely not for everyone. It’s slower-paced and requires a great deal of patience. After all, rehab takes time. You’ll have to enjoy the small victories and the ups and downs of treatment and management, as patients aren’t generally getting back to 100% baseline functional status. For some, this can grow quite frustrating.

Patients and families can often have unrealistic expectations and hope to return to their prior baseline. The reality of them eventually seeing that long-term assistance is part of their future is difficult and disheartening.

And chronic pain patients are not everyone’s cup of tea. Even if you don’t specialize in pain, you will be seeing some of these patients.

Should You Become a Physiatrist?

How can you decide if PM&R is the right field for you?

Those who are happiest in the field tend to be optimistic, seeing the potential for patients who present with terrible disease and finding the silver lining and ways to improve.

It’s not nearly as hands-on as something surgical, but you should enjoy procedures, as it is more procedural than the average office-based specialty.

And finally, if you’re collaborative and enjoy working with others in an interdisciplinary team-based approach to patient care, you’ll get a great deal of that with physiatry.

Thank you all so much for watching! If you enjoyed this article, check out S o You Want to Be a Sports Medicine Doctor . In this series, we highlight a specific specialty within medicine, such as physiatry, and help you decide if it’s a good fit for you.

If you’d like to see what being a physiatrist looks like, check out my second channel, Kevin Jubbal, M.D., where we’ll be covering a day in the life of a PM&R doctor in the future.

Kevin Jubbal, M.D.

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This Post Has 2 Comments

I was disappointed you stated that physiatrists typically work 8 hrs per day max. As a physiatrist who is an interventional pain physician in a multiple speciality practice & the only medical spine specialist I frequently work 11-12 hour days .

PM&R doc here as well. Some right but a lot wrong here. Hours vary greatly based on type of work with inpatient generally being less demanding on a day to day basis. Call varies greatly as well, with outpatient clinics typically having little call but inpatient facilities needing 24/7 coverage. For instance, I spend about 4-5 hours a day doing hospital work to see 10-15 patients but have call every other weekend and take call on my own patients every day. I work in private practice as a 1099 provider, and don’t have any ownership in the hospital where I see patients. A typical interventional pain practice is run more closely to an ortho clinic, seeing high volumes of patients but having standard clinic hours and procedure days with call being rare to very frequent depending on the number of providers. PM&R is a great specialty for those who aren’t sure what exactly they want to do coming out of medical school. Options vary to doing employed or 1099 contractor work as a consultant at an acute hospital, to being the medical director of an inpatient unit/hospital, to running a 100% outpatient neuromuscular, non op ortho or pain clinic, or doing SSD and worker’s comp/personal injury evals and treatment all day.

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