Name: 你想成為一名物理學家（PM&R）[第26集]。 (So You Want to Be a Physiatrist (PM&R) [Ep. 26])
Uploaded: 2021-06-05T18:00:40.000Z
Duration: 12 min 21 s

So you want to be a physiatrist, or a physical medicine & rehabilitation doctor, also known

所以你想成為一名物理學家，或物理醫學和康復醫生，也被稱為

副詞型分詞構句

as PM&R for short. You like the idea of dealing with chronic physical illness and having a

簡稱PM&R。你喜歡處理慢性身體疾病的想法，並有一個

chill lifestyle. Let's debunk the public perception myths, and give it to you straight. This is

寒冷的生活方式。讓我們揭穿公眾認知的神話，並直接告訴你。這就是

the reality of PM&R. Dr. Jubbal, MedSchoolInsiders.com.

醫學與康復的現實。Jubbal醫生，MedSchoolInsiders.com。

Welcome to our next installment in So You Want to Be. In this series, we highlight a

歡迎來到《你想成為什麼樣的人》的下一期節目。在這個系列中，我們將重點介紹一個

specific specialty within medicine, such as physiatry, and help you decide if it's a

醫學中的特定專業，如物理學，並幫助你決定它是否是一個

good fit for you. You can find the other specialties on our So You Want to Be playlist. If you

很適合你。你可以在我們的 "你想成為 "播放列表中找到其他專業。如果你

want to vote in upcoming polls to decide what future specialties we cover, make sure you're

想在即將舉行的民意調查中投票，以決定我們未來涵蓋的專業，請確保你是

subscribed. If you'd like to see what being a physiatrist

已訂閱。如果你想了解作為一名物理學家的情況

looks like, check out my second channel, Kevin Jubbal, M.D., where we'll be covering a day

看起來像，看看我的第二個頻道，凱文-朱巴爾，醫學博士，在那裡我們將涵蓋一天的

in the life of a PM&R doctor in the future.

PM&R is the jack-of-all-trades specialty focusing on both inpatient and outpatient management

婦產科是全能型專科，專注於住院和門診管理。

of non-operative orthopedics and neuro-rehabilitation. These are the primary physicians for certain

非手術骨科和神經康復科的醫生。這些醫生是某些

nervous system or non-surgical orthopedic disorders, offering both medical and procedural

神經系統或非手術性骨科疾病，提供醫療和程序方面的服務。

treatment modalities. These are the doctors handling their unique conditions on an ongoing

治療方式。這些是持續處理其獨特情況的醫生。

and outpatient basis. Some patients present with spinal cord or

和門診的基礎上。一些患者出現脊髓或

traumatic brain injuries, for whom you'll manage their pain, neuropathy, and bowel and

腦外傷患者，你要為他們處理疼痛、神經病變、腸道和胃病。

bladder care. Other patients may have other mixed connective tissue or nervous system

膀胱護理。其他患者可能有其他混合的結締組織或神經系統

issues that you'll treat, such as mallet finger or jersey finger.

你要治療的問題，如棒狀指或澤西指。

There are a few ways to categorize the specialty.

有幾種方法可以對專業進行分類。

Non-operative orthopedics includes diagnosing and treating peripheral nerve diseases. This

非手術骨科包括診斷和治療周圍神經疾病。這

often includes procedures with ultrasound or fluoroscopy assistance, or injections of

通常包括在超音波或透視的協助下進行的手術，或注射藥物。

various types. For example, trigger point injections with lidocaine or steroids are

各種類型。例如，使用利多卡因或類固醇的觸發點注射是

used at sites of myofascial pain, whereby there is tightness around a muscle focal point.

用於肌筋膜疼痛的部位，即肌肉焦點周圍有緊繃感。

This is a rapidly evolving area of PM&R, with research and new therapies in regenerative

這是一個快速發展的醫學和康復領域，再生醫學的研究和新療法在不斷髮展。

medicine such as platelet rich plasma, mesenchymal stem cells, or peripheral nerve stimulators.

諸如富含血小板的血漿、間充質幹細胞或外周神經刺激器等藥物。

Neuro-rehabilitation focuses on traumatic brain and spinal cord injuries, and is primarily

神經康復的重點是腦部和脊髓的創傷，主要是

inpatient in nature. These physiatrists serve as the patient's primary hospitalist, not

在性質上屬於住院病人。這些理療師作為病人的主要住院醫生，而非

as a consulting service, for patients requiring neuro-rehabilitation. Their main area of specialization

作為一項諮詢服務，為需要神經康復的病人提供服務。他們的主要專業領域是

is in dealing with the neuromuscular diseases and related issues, and they may consult other

在處理神經肌肉疾病和相關問題方面，他們可能會諮詢其他機構。

specialties, like pulmonology, neurology, and other specialties for specific concerns.

像肺病學、神經病學和其他專科的具體問題。

This is very collaborative and highly inter-disciplinary, working with a wide variety of specialists

這是一個非常協作和高度跨學科的工作，與各種各樣的專家合作。

and therapists, from physical therapists and occupational therapists to speech therapists,

和治療師，從物理治療師和職業治療師到語言治療師。

recreational therapists, and respiratory therapists.

The practice of physiatry varies substantially between practice settings.

在不同的實踐環境中，物理醫學的實踐有很大的不同。

Academic physiatrists deal primarily with brain and spinal cord injuries. These tend

學術型物理學家主要處理腦和脊髓損傷。這些人往往

to be more severe cases than in other practice settings, and are heavy on neuro-rehabilitation.

與其他實踐環境相比，這類病例更為嚴重，而且重在神經康復。

As with any academic position, research and teaching residents and medical students is

與任何學術職位一樣，研究和教授住院醫生和醫學生是

part of the job. On the other hand, some clinical aspects are more relaxed because you'll have

工作的一部分。另一方面，一些臨床方面的工作則比較輕鬆，因為你會有

residents to help carry out various clinical responsibilities. Overall, there are fewer

居民幫助履行各種臨床職責。總的來說，有較少的

procedures, and therefore lower compensation, because more of your cases will be traumatic

程序，從而降低了賠償，因為你的更多案件將是創傷性的

brain, spinal, or stroke in nature. Community physiatrists deal with less severe

腦部、脊柱或中風的性質。社區理療師負責處理不太嚴重的

cases in comparison to academia. On average, you'll have more outpatient orthopedics, more

與學術界相比，你會有更多的門診骨科病例。平均而言，你會有更多的骨科門診病人，更多的

procedures, and higher compensation. While your academic colleagues will be dealing with

程序，以及更高的報酬。當你的學術界同事將處理

more amyotrophic lateral sclerosis, also known as ALS, or unique cases of Guillain Barre

更多的肌萎縮性脊髓側索硬化症，也被稱為ALS，或吉蘭巴雷的獨特病例

syndrome, you'll be doing more EMG's as a community physiatrist, for things like ulnar

作為一名社區理療師，你將會做更多的肌電圖檢查，比如尺橈骨肌電圖。

entrapment, carpal tunnel, and basic radiculopathies. Private practice physiatrists are uncommon,

纏結、腕管和基本的根管病。私人執業理療師並不多見。

unless they specialize in pain or sports. Part of the reason private practice is uncommon

除非他們專門從事疼痛或運動。私人診所不常見的部分原因是

is that owning your own rehabilitation center is expensive, requiring a large interdisciplinary

是，擁有自己的康復中心是昂貴的，需要一個龐大的跨學科的

team to treat a small number of patients.

There are a handful of misconceptions about PM&R, as it's a smaller specialty most lay

對PM&R有一些誤解，因為它是一個較小的專業，大多數人都不瞭解。

people haven't even heard of. First, get used to people asking if you're

人們甚至沒有聽說過。首先，要習慣於人們問你是否是

a physical therapist, or your friends and family requesting stretching exercises. PM&R

物理治療師，或你的朋友和家人要求進行拉伸練習。物理與康復

doctors are physicians, not PT's. While physical therapists are prescribing exercises and therapy

醫生是內科醫生，不是物理治療師。當物理治療師在開具練習和治療處方時

treatment plans, the physiatrists manage the medications, pain, spasticity, neuromuscular

治療計劃，物理治療師負責管理藥物、疼痛、痙攣、神經肌肉等問題。

dysfunction, and general medication management. Second, because it's a newer and smaller specialty,

障礙，以及一般的藥物管理。第二，因為它是一個較新和較小的專業。

many of your physician colleagues won't even know what you do. You'll get random consults

你的許多醫生同事甚至不知道你是做什麼的。你會得到隨機的諮詢

for things that are not appropriate, like a hospitalized patient who hasn't gotten out

對於那些不合適的事情，比如一個還沒有出院的住院病人。

After medical school, PM&R residency is 4 years. As with any specialty, intern year

醫學院畢業後，PM&R住院醫生是4年。與任何專業一樣，實習年

will be a mix of various specialties, many of which are less clinically relevant to your

將是各種專業的混合體，其中許多專業與你的臨床相關性較低。

future as a PM&R doctor. As a PGY2, you'll be focused primarily on inpatient rehabilitation.

作為一名PM&R醫生的未來。作為PGY2，你將主要專注於住院康復。

Every residency requires at least 12 months of acute inpatient rehab, and you'll get the

每個實習生都需要至少12個月的急性住院康復治療，你將獲得

majority of that in your second year. The rest will be clinic and consult months cycled

其中大部分是在你的第二年。其餘的將是診所和諮詢月的循環。

throughout. As a PGY3 and PGY4, you'll have more elective time, usually with more relaxed

自始至終。作為PGY3和PGY4，你會有更多的選修課時間，通常有更多輕鬆的時間。

schedules and relaxed call. These will also be the years where you can gain greater exposure

時間表和輕鬆的通話。這些年也將是你可以獲得更多曝光的年份

to procedures, such as EMG's and injections. In terms of competitiveness, you're in luck,

到程序，如EMG和注射。在競爭力方面，你很幸運。

as PM&R ranks second to last, above only family medicine. While the match rate is lower than

因為醫學與康復部排名倒數第二，僅高於家庭醫學。雖然匹配率低於

expected at roughly 90%, USMLE Step 1 has averaged 224 and Step 2CK at 238. Given the

預計約為90%，USMLE第1步平均為224，第2CK步平均為238。鑑於

relative lower competitiveness, it tends to be more DO and IMG friendly as well, although

競爭力相對較低，它往往也對DO和IMG更友好，儘管

it's been trending upward. To see the full list of specialties by competitiveness, check

它一直呈上升趨勢。要查看按競爭力分類的全部專業名單，請查看

out my videos explaining the methodologies and the full data set.

請看我解釋方法的視頻和完整的數據集。

Because it's less competitive, the stereotype is that its for students who didn't do well

因為它的競爭性較小，人們的刻板印象是，它是為那些成績不好的學生準備的。

on their USMLE or who wanted to do orthopedics but couldn't get in, but I don't think that's

在他們的USMLE考試中，或想做骨科但不能被錄取的人，但我不認為那是

fair to the specialty. Medical students that apply into PM&R are generally optimistic,

對該專業來說是公平的。申請進入PM&R的醫學生一般都很樂觀。

as it's an almost necessary trait in the rehabilitation setting. You'll have to be encouraging to

因為這幾乎是康復環境中的一個必要特徵。你必須要鼓勵

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

在完成PM&R住院醫師培訓後，你可以通過獎學金進一步細分專業。

Pain is a 1 year fellowship and is the most competitive, resulting in the highest compensation

疼痛是為期1年的研究金，競爭最激烈，報酬最高。

for PM&R doctors. You can go into pain through PM&R, but also after residency in anesthesia,

為PM&R醫生。你可以通過PM&R進入疼痛領域，但也可以在麻醉科住院醫師培訓後進入。

neurology, or psychiatry. You'll be dealing with chronic pain patients,

神經病學或精神病學。你將與慢性疼痛患者打交道。

which some find depressing, but others find deeply meaningful. A large part will be prescribing

有些人認為這是令人沮喪的，但有些人認為這是深具意義的。很大一部分將是開出

pain medications, although given the opioid epidemic, physicians are moving more toward

儘管鑑於阿片類藥物的流行，醫生們正更多地轉向使用止痛藥。

procedures. These includes radiofrequency ablations for facet pain, epidural injections,

手術。這些手術包括射頻消融治療面痛、硬膜外注射。

and spinal cord stimulators. This is great for those who like working with their hands,

和脊髓刺激器。這對那些喜歡用手工作的人來說是很好的。

as it's more procedural than other PM&R subspecialties.

因為它比其他PM&R亞專業更具有程序性。

Pediatrics is a 2 year fellowship focusing primarily on cerebral palsy. You'll be managing

兒科是一個為期兩年的研究項目，主要側重於腦癱。你將負責管理

spasticity and doing a few procedures like botox injections in spastic muscles.

痙攣和做一些程序，如在痙攣的肌肉中注射肉毒桿菌。

You'll also come across some rare conditions like Duchenne's muscular dystrophy, Becker's

你還會遇到一些罕見的病症，如杜興氏肌肉萎縮症、貝克爾氏肌肉萎縮症。

dystrophy, spina bifida, myelomeningoceles, and meningoceles. Because these are so rare,

營養不良症、脊柱裂、脊髓膜炎和腦膜炎。因為這些都是非常罕見的。

you'll more or less become these patients' primary care physician, often continuing care

你將或多或少地成為這些病人的主治醫生，經常繼續照顧他們。

into their adulthood. This is the fellowship for those who not only

進入他們的成年。這是為那些不僅是

enjoy working with kids, but who are also very patient.

喜歡和孩子們一起工作，但也很有耐心。

Sports medicine is a 1 year fellowship and is the second most competitive subspecialty.

運動醫學是一個為期1年的研究項目，是競爭最激烈的第二個亞專業。

You can also get into a sports medicine fellowship after a residency in family medicine or emergency

你也可以在完成家庭醫學或急診住院醫師培訓後，進入運動醫學研究室。

medicine as well. It's a procedure-heavy subspecialization,

醫學也是如此。這是一個重程序的亞專業。

including primarily steroid, hyaluronic acid, and platelet rich plasma injections, and also

主要包括類固醇、透明質酸和富含血小板的血漿注射，還包括

the occasional EMG. Sports medicine also includes regenerative medicine, ultrasound, and sideline

偶爾的EMG。運動醫學還包括再生醫學、超音波和邊線。

coverage on sports games. This is the fellowship for physiatrists who

關於體育比賽的報道。這是為物理學家提供的研究金，他們是

love sports and working with their hands.

喜歡運動和用他們的雙手工作。