A career in rehabilitation medicine

What is rehabilitation medicine?

Rehabilitation medicine consists of four main clinical areas: neurological, musculoskeletal, amputee, and rehabilitation following spinal cord injury.

Neurological rehabilitation entails working with people who are recovering from acute brain injury, including stroke. Services are also provided to people with long term neurological conditions such as multiple sclerosis and cerebral palsy, generally as outpatients within community settings.

Musculoskeletal rehabilitation is closest to rehabilitation medicine’s origins in physical medicine. This area covers the medical management and rehabilitation of disabling rheumatological conditions such as the arthritides, chronic soft tissue injuries, and back pain.

Amputee rehabilitation is focused mainly on outpatient care, although an important role is pre-amputation counselling, which includes inpatient assessment. Many doctors working in this branch of the specialty also provide medical input to orthotics clinics, wheelchair centres, and other services providing technological solutions.

In recent years much has changed in the management of spinal cord injury, with developments in spinal cord regeneration, advances in helping patients to walk again, and the key part that spinal cord injury centres play in bringing expertise and specialist management to patients coming to the major trauma centres. Doctors who work in one of the 12 spinal cord injury centres in the United Kingdom and Ireland are involved in the acute management, rehabilitation, and lifelong care of people affected by spinal cord injury.

Why choose a career in rehabilitation medicine?

Rehabilitation medicine is a bright, exciting specialty especially suited to doctors who want to work with a team to develop creative and innovative solutions to their patients’ problems. Doctors working in rehabilitation medicine need a wide range of competencies to provide holistic and lifelong care to their patients.

The core clinical skills of making a diagnosis, formulating a prognosis, and providing expert medical care—common to all specialties—are important in rehabilitation medicine. However, the diagnosis of a spinal cord injury, for example, may be made in the context of multiple traumatic injuries, and in an older person after a fall, as part of a complicated presentation. Furthermore, the prognosis is given to a frightened patient at a time that their life is changing, sometimes irreversibly.

Doctors in rehabilitation medicine also provide information, support, and counselling for patients and their families and carers. This service will include functional and prognostic information as well as information about vocational rehabilitation or return to work. Combining these skills with the specialised medical interventions that you can provide, and an ability to lead the multidisciplinary team in challenging situations, make rehabilitation medicine a tremendously satisfying career.

Career path

Training in rehabilitation medicine takes four years and starts at specialty training year 3 (ST3) after core training in medicine, acute care, surgery, psychiatry, or general practice. Specialty trainees work in each of the four main clinical areas in rehabilitation medicine before developing advanced competencies in one, leading to a certificate of completion of training in the specialty. Academic clinical fellow and clinical lecturer posts are available in programmes with links to academic rehabilitation medicine.

Rehabilitation medicine has difficulty recruiting suitable trainees at ST3 level: in 2011 the fill rate was only 55%.1 As a result the Royal College of Physicians describes the competition ratio for ST3 posts as “particularly favourable.”2 Roughly 20 training places will be available in the next round of national recruitment, which is coordinated centrally by the Royal College of Physicians. Applicants must have the same experience and qualifications as any other applicant for an ST3 post; however, the advantage for applicants to training posts in rehabilitation medicine is that membership of the Royal College of Physicians, Royal College of Surgeons, Royal College of Psychiatrists, and Royal College of General Practitioners are all acceptable entry qualifications.

Trainees are expected to develop advanced competencies in one of the four main clinical areas of rehabilitation medicine and will spend most of their training in one of these areas. There are ample opportunities to develop these competencies but not all deaneries offer advanced training in every clinical area, so talk to the director of the training programme in the deanery in which you would prefer to work.

There is an excellent balance between training posts and consultant posts in rehabilitation medicine, so career opportunities for dynamic, proactive doctors are good. As of April 2011, there were 159 (134 whole time equivalent) consultants in rehabilitation medicine employed in England.3 The consultant workforce in rehabilitation medicine has expanded by 4.2% in the past five years1 and is expected to increase by 4.6% a year to about 170 full time equivalent posts in 2020 (around 180 head count).

Consultants in rehabilitation medicine provide rehabilitation to critically ill and injured patients by working in general hospitals alongside the acute medical and surgical teams. They also work in post-acute rehabilitation units to facilitate patients’ recovery and safe discharge. These posts have on-call commitments, particularly those attached to major trauma centres, where there is an expectation that rehabilitation prescriptions are completed rapidly once a patient is stabilised. Often these roles include outpatient and community rehabilitation—managing people with long term conditions in their own environments.

Consultants in rehabilitation medicine have the knowledge and skills to confirm medical and functional diagnoses and prognoses, prevent and treat secondary and tertiary complications, manage symptoms, facilitate treatment, and contribute to life decisions. In addition, consultants lead and coordinate the activities of the multidisciplinary rehabilitation team.

Conclusions

Rehabilitation medicine has a promising future. As a result of the national stroke strategy and the more recent trauma network initiative, clinical services in rehabilitation medicine are expanding across the United Kingdom. Advances in restorative rehabilitation technology are promoting research opportunities and shaping how rehabilitation is delivered.

If you want a career that is challenging and rewarding, arrange a taster day at one of the rehabilitation centres around the United Kingdom to experience the passion that doctors in this field have for the specialty.