The Role of a Rehabilitation Medicine Doctor:
Are you looking for a specialty that involves patients and their families as much as possible in their treatment? If so, rehabilitation medicine may be what you are looking for. This article aims to provide you with great insight into rehabilitation medicine as a profession and guide you on your journey to becoming a rehabilitation medicine doctor.
A rehabilitation medicine doctor’s job is to provide interventions to patients with complex disabling conditions. Their focus lies in optimising recovery following severe injuries and improving function, thus facilitating participation in society for all individuals.
Accordingly, they manage a varied group of patients; neurorehabilitation encompasses patients with traumatic brain injury, stroke and progressive neurological conditions such as multiple sclerosis; spinal cord injury rehabilitation is concerned with patients with acute or progressive spinal cord injuries; musculoskeletal medicine includes a wide range of chronic conditions; limb loss medicine includes a large proportion of patients with widespread vascular disease or congenital limb abnormalities. Some conditions such as cerebral palsy have a combination of neurological and musculoskeletal problems (1).
Common interventions and duties include (1):
Specialist rehabilitation prescriptions for patients in the acute care pathways
Hyper-acute rehabilitation – taking patients directly from critical care services
Practical procedures to reduce pain, spasticity, and other impairments
Assessing patients for complex assistive technologies, such as specialist wheelchair seating
Working in the assessment and management of patients with disorders of consciousness (PDoC)
Interactions with the courts for medico-legal issues, including litigation and mental capacity
In rehabilitation medicine, you get to know the patient and provide holistic care over a long period of time, fostering a strong doctor-patient relationship. Rehabilitation medicine doctors work in a variety of settings including neurological rehabilitation centres for the most complex cases, stroke units, other wards (including pre-amputation), and outpatient as well as inpatient clinics.
The rehabilitation of people with spinal cord injuries takes place in supra-regional centres. Rehabilitation medicine specialists work within a diverse multidisciplinary team consisting of other medical specialists, acute services, healthcare professionals, social services and other agencies to assess and care for patients (1).
Apart from the necessary skills employed by all doctors, aspiring neurologists should demonstrate certain qualities and traits. Working with such a varied group of patients demands highly developed diagnostic abilities. Skills in managing both acute and chronic complications are essential. Rehabilitation physicians have the advantage of developing the ‘long view’, managing patients for months or even years from soon after an acute event, through to discharge and ongoing rehabilitation in the community.
It is highly rewarding to restore individuals to full health or to improve the wellbeing of people with a learning difficulty or disability (1). Furthermore, rehabilitation medicine has been witnessing an increase in the proportion of female trainees and consultants (2).
A Typical Week:
Rehabilitation medicine offers great variety and flexibility in daily and weekly work patterns. Job plans usually comprise one or two main areas, such as spinal cord injuries and other neurological rehabilitation, or amputee rehabilitation and other musculoskeletal disabilities.
A working day may include ward rounds, multidisciplinary team meetings, case conferences, best interest meetings, phone calls and meetings with patients, families and community professionals, outpatient clinics, out-reach assessments on the acute wards, home visits, and reviewing people in nursing or other residential settings.
Although most rehabilitation medicine consultants do not take on emergency rotas, those that work in acute or post-acute hospital settings are often required to be on-call. The EU Working Time Directive limits the working week to 48 hours (1).
The Route To Becoming A Rehabilitation Medicine Doctor:
Interested undergraduate medical students can join the medical society at their university and attend conferences for an opportunity to explore the specialty and network with potential future colleagues.
You may also want to consider joining associated societies, institutes or professional bodies such as the British Society of Rehabilitation Medicine (BSRM) and the British Medical Association (BMA) (1).
During your foundation years, if a rotation in rehabilitation is not possible, aim to do it in related fields. Try speaking to your clinical and educational supervisors about how to get involved (1).
After completion of your foundation programme, you can either complete a three-year internal medicine training (IMT) – formerly a two-year core medical training (CMT) – or three-year acute care common stem (ACCS) (1). Although both meet the entry requirements for specialty training (ST3) recruitment to neurology, IMT and ACCS trainees emerge with different skill sets.
For instance, IMT provides a more diverse grounding in medical specialties, but compromises procedural skills, whereas ACCS focuses on handling acute and critically ill patients, but puts less emphasis on chronic illnesses. (3). Once either is completed, you must obtain full Membership of the Royal College of Physicians (MRCP) prior to ST3.
Additionally, rehabilitation medicine is open to those who have completed core surgical training including the MRCS examination, core psychiatry training including MRCPsych, or general practice specialty training including MRCGP (1).
Nevertheless, completion of these programmes does not guarantee an ST3 training post due to the level of competition; in 2020, there were 1.33 applications per place (4). Be ready to move to a different location as certain training programmes – such as the National England (North West) Mersey Training Programme in Merseyside – are renowned for their excellence in this specialty and would prove beneficial to your career prospects (5).
Once you acquire a post, training will last a minimum of four years. Academic-minded trainees may choose to pursue a research degree, usually an MD (2-3 years) or a PhD (3-4 years), before or during specialty training; however, this is not essential. At the end of training, you will be awarded the certificate of completion of training (CCT) to go on to work as a consultant. Trainees may wish to dually train and accredit in rehabilitation medicine and neurology or rheumatology to achieve two CCTs.
In this case, they must have applied for and successfully entered a training programme which was advertised openly as a dual training programme (1).
Many rehabilitation medicine consultants develop specific interests and complete post-CCT subspecialty courses, including (1):
Spinal cord injury rehabilitation
Limb loss or deficiency rehabilitation and prosthetics
Assistive technology, including environmental control equipment, wheelchairs and orthotics
If you wish to work in stroke medicine, you should express your interest before your final year of specialty training so that the first year of stroke training can be integrated into your main specialty training. A second year of advanced stroke medicine training is required for CCT qualification (1).
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
Consultant rehabilitation medicine doctors may also wish to run private practices to supplement their salary; a “purely” private consultant is rare in the UK. On average, they can make a profit of an additional 25% of their NHS salary by working in the private sector. This is higher than some specialties, e.g. geriatric medicine (20%) or paediatrics (16%), but lower than other specialties, such as neurology (50%) (6).
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
If you are interested in deepening your knowledge in rehabilitation medicine, you may find it useful to consult relevant journals, such as the ones listed below:
Topics in Stroke Rehabilitation
Disability and Rehabilitation
Journal of Neuro-Engineering and Rehabilitation
BMC Sports Science, Medicine and Rehabilitation
The following societies and institutes offer a wealth of information on conferences, podcasts, essay prizes, research, tutorials, courses, and learning resources relevant to rehabilitation medicine:
Related Job Sources With BMJ Careers
Other Complete Guides By BMJ Careers
1. Rehabilitation Medicine [Internet]. Healthcareer | NHS. [cited 2020 Nov 7]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/rehabilitation-medicine
2. Focus on Physicians 2018-2019 consensus. Royal College of Physicians. 2019.
3. Nazir MS, Sharp C, Fryer J, Edwards M. Acute care common stem pathway. BMJ [Internet]. 2011 Dec 2;d7640. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.d7640
4. Specialty Recruitment Competition Ratios [Internet]. Specialty Training | NHS. 2020. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/2020 Competition Ratios.pdf
5. Rehabilitation Medicine [Internet]. Health Education England. [cited 2020 Nov 7]. Available from: https://www.nwpgmd.nhs.uk/Specialty_Schools/Medicine/Rehabilitation_Medicine
6. Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D, et al. Analysis of consultants’ NHS and private incomes in England in 2003/4. J R Soc Med [Internet]. 2008 Jul;101(7):372–80. Available from: http://journals.sagepub.com/doi/10.1258/jrsm.2008.080004