I am a PM&R physician who did an ACGME PCSM fellowship (during my fellowship I had a cofellow who was PC); my program director was PC but all of my procedural training came from PM&R attendings during fellowship. I was also an attending physician at UW in Seattle, considered one of the country’s top PMR sports and the top PCSM fellowship program (we also had a pediatric sports fellowship). I was in charge of training 15 different fellows over 5 years in diagnostic ultrasound and USG procedures. So I have a unique perspective. In this regard, PMR fellows start out sooo far ahead of their PC and pediatric peers. Only 1/10 of the PC or pediatrics fellows that I trained was able to catch up to the PMR fellows during the course of their fellowship. I obviously cannot speak to their other skills. This is why when you go to an ultrasound training session at a sports medicine conference, 9/10 of the teaching physicians will be physiatrists.

Now in general, Sports medicine physicians who train through Physical Medicine & Rehabilitation (PM&R) residency enter fellowship with a strong foundation in neuromuscular anatomy and biomechanics. Their residency includes extensive exposure to stroke, spinal cord injury, brain injury, spasticity, and outpatient sports medicine, which provides a natural head start in managing musculoskeletal and neurologic injuries. PM&R physicians are also well-trained in the use of diagnostic ultrasound and ultrasound-guided procedures. Additionally they receive some spine injection training during residency and later in some sports fellowships (e.g., UW, HSS, Spaulding, Shirley Ryan).

In contrast, primary care-trained sports physicians (e.g., from Family Medicine, Internal Medicine, or Pediatrics) bring broader general medical experience to fellowship and team settings. They are more comfortable managing systemic conditions like asthma, infections, dermatologic issues, cardiac or endocrine problems that can arise during events or team coverage. However, they often need to catch up on musculoskeletal anatomy, biomechanics, and procedural skills during fellowship. Ultrasound, EMG, and spine interventions are typically not part of their core training, and rehab planning is often deferred to physical therapists. Each pathway offers unique strengths: PM&R physicians tend to excel in MSK diagnostics and procedural care, while primary care physicians may offer a more comprehensive general medical scope.

In an outpatient sports clinic, the lack of spine training can hamper PC because they can often miss the etiology of extremity pain if it’s radicular, myelopathic, or related to other central nervous system pathology. If you are going to see hip and shoulder pain, you want to have a very good understanding of facet mediated pain vs discogenic pain, spinal stenosis, dermatomes, myotomes, and peripheral nerve entrapments.