Physiatry is a broad field including the treatment of various conditions, from musculoskeletal to neurological. Once you complete a residency in physical medicine and rehabilitation (PM&R), you may pursue a subspecialty to hone your knowledge in a particular area. You can do this through fellowships and subspecialty certification. The American Board of Physical Medicine and Rehabilitation (ABPMR) currently offers six subcertifications in physiatry.
1. Brain Injury Medicine
This subspecialty deals with the prevention of brain injury. It also focuses on evaluation, treatment and rehabilitation of disorders of brain function due to injury and disorders of the central nervous system. Those with a subspecialty in brain injury medicine often work with interdisciplinary teams to guide recovery and improve patient health. This treatment may involve dealing with the patient's psychosocial, educational or vocational life.
A fellowship in brain injury medicine typically lasts a year or up to three for research. During this time, you will train in areas like:
- Neurotrauma consults
- Neuropathology
- Neuropharmacology
- Headache management
- Neuroradiology
- Acute inpatient neurorehabilitation
After completing a fellowship, you can get certification through the ABPMR. They have offered accreditation since 2014 in partnership with the American Board of Psychiatry.
2. Pain Medicine
Training in the pain medicine subspecialty focuses on diagnosing and treating many painful disorders that cause acute or chronic pain. It could also include treatment of pain related to cancer. Physiatrists in this subspecialty often coordinate with other specialists in hospital and outpatient settings.
Your training may vary widely depending on the fellowship since pain has many causes and treatment options. Fellowships in pain medicine typically focus on:
- Musculoskeletal and sports medicine
- Functional restoration
- Interventional spine and electrodiagnosis
ABPMR has offered this certification since 2000 in partnership with the American Board of Anesthesiology and the American Board of Psychiatry and Neurology.
3. Sports Medicine
Physiatrists specializing in sports medicine deal with physical fitness, including diagnosing and treating sports injuries. They also treat illnesses and diseases affecting performance in sports or other exercise-related activities.
As a physiatrist, your work may involve various diagnostic and treatment procedures, including musculoskeletal ultrasounds, casting and splinting, and injections of joints and tendons. Some professionals work in spinal procedures and electrodiagnostics.
If you decide to pursue this subspecialty, your fellowship training may include:
- Exercise prescriptions
- Treatment of musculoskeletal problems in athletes
- Pre-participation physical exams
- On-field assessment and triage
- Event administration
- Musculoskeletal imaging
- Functional anatomy
- Ergogenic aids
- Sports nutrition
- Bracing and orthoses
ABPMR has offered sports medicine certifications since 2007 in partnership with the American Board of Family Medicine and three other boards.
4. Neuromuscular Medicine
Those with a subspecialty in neuromuscular medicine deal with disorders affecting the nerves and muscles. They provide diagnosis, evaluation, treatment, management and counseling. Here are a few conditions neuromuscular subspecialists might work with:
- Abnormalities of the motor neuron (e.g., amyotrophic lateral sclerosis)
- Muscular dystrophies
- Peripheral neuropathies (e.g., diabetic)
- Neuromuscular transmission disorders (e.g., myasthenia gravis)
- Congenital and acquired myopathies
- Inflammatory myopathies (e.g., polymyositis)
Your fellowship training in neuromuscular medicine involves at least six months of neuromuscular focus. After this, you may spend six or more months in medical genetics, muscle pathology, research or electrodiagnosis.
The American Board of Psychiatry and Neurology and ABPMR partner to offer this certification. ABPMR has offered accreditation since 2008.
5. Spinal Cord Injury Medicine
The subspecialty of spinal cord injury medicine primarily deals with preventing, diagnosing, treating and managing spinal cord injuries. Physiatrists in this subspecialty often deal with nontraumatic causes of spinal cord dysfunction as well. These may include multiple sclerosis, arthritis, cancer, spina bifida and Guillain-Barré syndrome.
They work on inter-specialty care teams providing lifelong medical, physical, vocational and psychological assistance or work in acute care settings. Their work may involve prescribing equipment and therapies to enhance mobility and self-care. Spinal cord subspecialists may manage secondary complications of spinal cord injuries, ranging from mood disorders to pressure ulcers and pain.
Spinal cord injury fellowships last one year and consist of a range of training, including:
- Inpatient rotations
- Consultations
- Outpatient rotations
Outpatient rotations may include pulmonary care, orthopedics, neurosurgery, pediatric clinics and spasticity. Those interested in spinal cord injury medicine may take a two-year research fellowship.
The ABPMR has offered certifications in spinal cord injury medicine since 1998.
6. Pediatric Rehabilitation Medicine
If you pursue a subspecialty in pediatric rehabilitation medicine, your work will involve preventing, diagnosing, treating and managing congenital and childhood-onset physical conditions. Conditions may include cerebral palsy, acquired brain injuries, cancer and amputations.
Physiatrists in this subspecialty often work on care teams aiming to improve mobility and daily function at home, school and beyond. You may prescribe equipment and therapies and manage secondary conditions like bladder dysfunction and spasticity.
Fellowship programs may last one to two years in this subspecialty, depending on whether you completed a traditional PM&R residency or a combined pediatric and PM&R residency. During your fellowship, you will gain clinical experience like:
- Inpatient pediatric rehabilitation
- Outpatient pediatric clinics
- Subspecialty rotations
- Consults
- Research
The ABPMR has offered certifications in this subspecialty since 2003.
Begin Your Physiatry Career
Whether you pursue general physiatry or one of the physiatry subspecialties, Medrina provides support to connect you with skilled nursing facilities (SNFs) and inpatient rehab facilities (IRFs). Talk to our team about the range of opportunities we offer for employment to professional growth.
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