How to Become a Physiatrist

The world of medicine is a world of specializations, some well-known, others more obscure. Physiatry falls into the latter category, even though its field of practice—musculoskeletal ailments—encompasses millions of patients.

What are physiatrists? They are also called rehabilitation physicians; their field is sometimes referred to as physical medicine and rehabilitation (PM&R), or, more informally, rehab medicine.

Based on that description, you might suspect that physiatrists work primarily with patients who’ve suffered an injury (e.g., a spinal cord injury or hand injury), but in fact, they also frequently treat people with illnesses, disabilities, and chronic conditions. In all of these scenarios, a physiatrist’s goal is to either restore as much movement and function as possible or to help patients maintain their ability to move.

Physiatrists accomplish this by developing expertise in the construction and function of muscles, joints, tendons, ligaments, and bones (known as the musculoskeletal system). They also master treatments and therapies that utilize medicine, movement, bracing, neurological, and other non-surgical approaches to treat impairments in these parts of the body.

In many ways, physiatrists are similar to non-operative orthopedic surgeons—they may even work closely together in the same office—with the chief difference being that physiatrists undergo additional training in neurology.

There is one other key difference between these two specialists: orthopedists are often more focused on healing specific injuries, while physiatrists typically focus on regaining, maintaining, or enhancing the functionality of an affected body part. Patients seek treatment from physiatrists to cope with pain and to restore lost functionality so they can get back to doing the activities they enjoy.

In this article, we’ll cover:

• What physiatrists do
• Where physiatrists work
• The educational commitment to become a physiatrist
• Licensure and accreditation for physiatrists
• Reasons to become a physiatrist

Where physiatrists work and what they do

On any given day, a physiatrist will:

• Create strategies for treating pain
• Prescribe physical therapy
• Work with patients to prevent further injury or loss of functionality
• Order imaging tests like CT, MRI, and PET scans
• Prescribe or administer medication
• Recommend orthotics
• Work closely with other doctors

Physiatrists use most of the same diagnostic and treatment tools as other musculoskeletal practitioners, but they also employ additional tools such as:

• Electromyography (which measures muscle response to nerve stimulation)
• Somatosensory evoked potentials (which test the nerves between the spine and the brain)
• Nerve conduction studies (which evaluate the speed of nerve impulses to assess damage)

Physiatrists may pursue many career paths. Some work in private practice as part of a larger treatment team, but many others work in outpatient specialty clinics, inpatient hospitals, sports medicine facilities, and surgical settings.

Where they work may depend on their specialty, as physiatrists are often further subspecialty-certified in:

• Hospice and palliative medicine
• Pain medicine
• Spinal injury medicine
• Brain injury medicine
• Sports medicine
• Neuromuscular medicine

The educational commitment to become a physiatrist

Like all doctors, physiatrists undergo substantial training and education before becoming full-fledged practitioners. If your goal is to become a physiatrist, you’ll likely begin your academic career in an undergraduate program that confers a bachelor’s degree in biology or chemistry.

Most universities don’t have a dedicated pre-med major, but some do a better job of preparing students for the rigors of medical school. Look for schools that offer specialized resources for aspiring doctors such as advisors who specialize in pre-med advising, research and clinical experience opportunities, and pre-med tutors.

Harvard University, for instance, has a peer pre-med advising program. Johns Hopkins University offers a pre-med advising program track that includes one-on-one advisement and special programs for pre-med students.

The University of Pennsylvania does a lot to help aspiring doctors choose the right courses and apply to medical schools. And Georgetown University has an Early Assurance Program that lets high-achieving pre-med students apply for assured admission to the Georgetown School of Medicine.

You can boost your chances of acceptance to medical school by not only taking undergraduate courses that medical schools commonly require as prerequisites (biology, physics, inorganic and organic chemistry, calculus, and English), but also by joining pre-med and health organizations, studying earlier than necessary for the MCAT, shadowing a physician or interning at a medical practice, and doing community service at a health center.

Completing medical school

From there, you’ll complete a medical school program. Some programs are focused on primary care, while others emphasize specialty medicine. Some are intensely competitive, while others are collaborative. The only way to find the right medical school is to do your research, but keep in mind that the average medical school student applies to 16 schools—so don’t narrow your options too much.

If you already know you want to specialize in physiatry, look for schools that have strong PM&R residency programs, like Johns Hopkins University, the New York University School of Medicine, Pennsylvania State University – College of Medicine, and Thomas Jefferson University.

Once in medical school, you’ll begin your studies in a classroom setting, diving deep into subjects like anatomy, pathology, biochemistry, psychology, and ethics.

Your education will continue in the classroom, though the focus of your education will grow increasingly clinical. In your third and fourth years of medical school, you’ll begin taking part in clinical rotations that will help you gain hands-on experience and learn more about the different areas of specialization in medicine.

Your residency program

Next, you’ll complete your internship and residency. As a PM&R resident, you’ll gain experience in general physical rehab, muscle disorders, fractures, stroke, traumatic brain injury, and neurological disorders like ALS and multiple sclerosis.

All residency programs will involve a lot of musculoskeletal training, and after your residency is complete, you’ll probably want to further your studies by working in a subspecialty such as pediatrics or sports medicine via a fellowship. In general, it’s a good idea to complete your residency in the state where you’ll eventually practice medicine, so you have a firm grasp of the regulations in that state before pursuing your license.

The licensure and accreditation for becoming a physiatrist

Licensing requirements for doctors vary from state to state, but the chances are that the final step before becoming a physiatrist will involve sitting for the required exam in the state where you’ll practice medicine.

You can, at that point, become board certified—for instance, through the American Board of Physical Medicine and Rehabilitation Maintenance of Certification (MOC) Program—though it is not mandatory to do so to practice. The typical advancement path for a physiatrist will involve continuing education, board certification, and possibly opening a practice.

Earning an MD versus earning a DO

Most people assume that a Doctor of Medicine (MD) degree is required to practice medicine, but there is another, albeit less well-known, option: the Doctor of Osteopathic Medicine (DO) degree. A DO degree is similar to an MD degree; applicants to both programs must meet similar prerequisites, and each program involves four years of school plus three to seven years of residency.

MDs and DOs can both treat patients, prescribe medication, and perform surgery. However, there are far fewer DO programs (Michigan State University and Lake Erie College of Osteopathic Medicine have two of the best), and DOs take the COMLEX Level exams whereas MDs take the USMLE Step exams.

DOs make up less than 10 percent of practicing physicians in the US, but if you want to specialize in physiatry, it’s worth looking into DO programs because there are more DOs in this specialty than in any other.

Five great reasons to become a physiatrist

While a lot of people have never heard of this specialty, physiatry has been around since World War II, when physiatrists helped soldiers suffering from neuromuscular disabilities regain their ability to function. There are more than 6,000 physiatrists practicing in the United States today. Why be one of them? There are more pros than cons of becoming a physiatrist. Here are some compelling reasons to pursue this specialty:

1. According to Salary.com, the average physiatrist earns between $212,000 and $316,600 annually.
2. Physiatrists see a wide variety of patients. Some have sustained injuries, while others were born with musculoskeletal conditions. Many will have pain related to spinal issues, but physiatrists also see patients with peripheral nerve problems, loss of function, or pain related to muscles, tendons, and bones. Every case will be different.
3. You can achieve work-life balance as a physiatrist (unlike most physicians and surgeons). This is not one of those medical specialties where you’re likely to be fielding calls in the middle of the night or dealing with trauma in the emergency room.
4. Physiatry is evolving. In this field, you’ll see some of the newest and most exciting treatment options like regenerative medicine. You’ll do ordinary things like inject steroids into joints, but you may also be working with stem cells and growth factors to find ways to encourage patients’ bodies to heal themselves.
5. Your work will literally change people’s lives. The time and energy you invest in your patients will result in measurable quality-of-life enhancements. If you were drawn to medicine because you want to help people, physiatry is a great specialization.

Is physiatry right for you? The best way to discover the answer to that question before investing in medical school is to talk to a physiatrist. Reach out to one in your community and ask if you can interview them about what they do. Or ask if you can shadow them for a day. You’ll learn a lot about what these doctors do and don’t do, and that will go a long way toward helping you start to build your own career in medicine.

(Updated on January 23, 2024)

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