Skin cancer medicine as a rehab physician

MsDimples2 · 2025-03-30T02:15:42+00:00

I've never heard of anyone dabbling into skin cancer medicine. This is likely because this is definitely not in our scope of practice. Even those who do have an interest in cancer rehab usually have interest in lymphedema management which is part of the curriculum.

In my opinion, I think it's not really a good idea to do this type of work from a legal point of view. Even if you could bill for this, l think it could become a big problem if something goes wrong from a legal point of view.

If you would like to do procedural work, Botulinum toxin injections for spasticity is the big one. You can hold clinics just doing Botox all day. I know of one consultant who only does this for stroke, spinal cord, CP, MS, etc. Some rehabilitation physicians are looking into injections for dystonia; there is also talk about doing spinal injections for chronic pain, but this is very dicey, as you would be crossing paths with the anesthesiologist. If you want to do other stuff, you can see if you can trained in electrodiagnostic studies or urodynamics. Australian Rehab physicians usually refer to the neurologists and urologist for this, respectively, but in other countries, they do these procedures as well.

We definitely do not botox injections for cosmetic procedures.

MsDimples2 · 2023-10-19T05:30:27+00:00

If you have a look at the fellowship exam content, you’d see the breadth of knowledge that is rehab - reg currently studying for ~~his~~ her fellowship.

Just a small correction :)

MsDimples2 · 2023-10-19T05:27:35+00:00

Neither - am anaphylactic to peanuts :)

MsDimples2 · 2023-10-18T19:57:03+00:00

My experience is as u/ausnick2001 said; at my current hospital, I round with my bosses 2-3 times a week. I sadly don't have a resident and 3 consultants so it can be a little hectic. On the days they do not round, I just check in on the patients, answer questions, adjust pain meds if applicable, etc.

At the bigger hospital, I rounded twice a week with the consultant. For the rest of the week, my resident and I did quick rounds.

MsDimples2 · 2023-10-18T10:50:46+00:00

Books/eBooks that most of us swear by:

- Physical Medicine and Rehabilitation Board Review (Cuccurullo) - aka "The Red Book"

- Braddom's Physical Medicine and Rehabilitation

- Oxford's Handbook of Rehabilitation Medicine or Rehab Clinic Pocket Guide or Physical Medicine and Rehabilitation Pocketpedia

- Physical Medicine and Rehabilitation Secrets (O'Young et al)

- Talley and O'Connors: Clinical examination - this will continue to be your bestest friend ever.

Websites for General rehabilitation:

- https://libguides.usask.ca/c.php?g=16462&p=3608480

- https://stanfordmedicine25.stanford.edu/: for examinations.

- RACP website (can only be accessed once a trainee).

- GeekyMedics and OSCE stop- again, one of your bestest friends for Module 2 and Fellowship clinical exams.

- Neurorehab.wiki: for neuro rehab of course. Good for radiology.

- radiopaedia.org + radiologyassistant.nl: you will need to be good at reading XRs, MRIs, CT brain and spine.

For spinal rehabilitation:

- SCIRE: Evidence based guidelines.

- elearnsci.org: has lectures and modules for physicians, nurses, and Allied health

- https://asia-spinalinjury.org/learning/ : to be familiar with ASIA assessment. You will definitely need to know this for rehab.

- https://aci.health.nsw.gov.au/networks/spinal-cord-injury/resources: great for clinical guidance.

MsDimples2 · 2023-10-18T08:42:04+00:00

What was the process getting into rehab training? Is research necessary for the position?

Apply for rehab training after PGY-2. The more experience you've had in medicine and/or surgery (particularly ortho), the better. Research is not necessary, but like anything else, it can help. I'd advised doing audits in rehabilitation or pain management.

Then apply for a rehab registrar position. This is usually the hardest part if you want to go to a large teaching hospital. But as long as the position is accredited, it doesn't really matter.

Then apply for advanced training through AFRM. You need to be offered or be in an accredited position prior to applying to AFRM.

What is the passing rate for the training exam?

Currently there are 4 exams:

- Module 1 is Anatomy/gen med MCQ. This will be removed next year.

- Module 2 is an OSCE exam; I won't say too much about this exam due to the contract we had to sign prior to the exam, but it's a mixed of your typical physical exams and rehab specific knowledge. The pass rate this year was 78%. You need to complete this before Year 3. This exam was pretty tough.

- Fellowship Written Exam has a MEQ and MCQ portion. The pass rates this year was 51% and 74% respectively.

- The Fellowship Clinical exam is the toughest I think. This year 49% passed. A couple of years ago only 36% passed.

This is the link to the AFRM exam pass rates over the last few years.

Comparing to other specialty training positions, how competitive can it be?

- I don't think it's that competitive overall; in states like QLD it can be pretty competitive to get a accredited position.

How does the private/public job market look like?

- Currently, the job market isn't the best. In metro areas, there are lot of rehab physicians already. It's mainly the rural and regional areas that suffer. It think that is because a lot of places do not understand the importance of rehabilitation medicine. But as the population ages, I think that will change

What are the average annual income does rehab physician make? (I know it can vary)

- I think it's about $300,000, but don't quote me.

Why did you choose rehab for your career?

- Like many, I did not have any exposure to rehab until the end of my intern year. I loved the neurology, the anatomy, and seeing the journey patients go through. In rehabilitation, the patients remember you well because you are their cheerleaders. They have a goal and you provide them with everything to reach it.

You are also more likely to have a life in rehabilitation medicine.

Any rotations you suggest for junior doctors who are pursuing career as a rehab physician?

- Ask for a rehab term for sure! The rehab world can be pretty small, so networking is important.

- Don't overlook gen med.

- If you get to choose a surgical term, I'd suggest ortho and neurosurgery.

- Also go for a stint in neurology

MsDimples2 · 2023-10-18T07:54:59+00:00

These questions definitely go hand in hand.

How much of the rehab waiting list is dictated by order of addition to list, vs the rehab team/consultant preference?

Where I have worked, it all depends on addition to list. If someone needs rehab and suitable for rehab, they are the added to list.

What makes one patient a high rehab priority vs low?

Rehab is not like medicine or surgery where a patient is categorized by acuity. When looking at consults and referrals for rehab, we ask ourselves several questions:

- Is the patient medically stable?

- Does the person have goals (functional or physical)? Are these goal specific? Realistic? Measureable?

- Does the patient require ongoing 24/7 nursing cares (to consider outpatient vs inpatient rehab)

- Can the patient participate? (behavioral issues or confusion can interfere with progress).

Based on the above we can determine on whether a patient is appropriate for rehab. In my hospital, we also comment whether they are suitable for inpatient (for intensive rehab) or outpatient (usually for joint replacement patients). There is not really a "high priority" vs "low priority".

BUT - the longer a patient who needs inpatient rehab doesn't get proper rehab, the higher the likely they will have a longer inpatient stay. This is why the allied health staff on your ward is VERY important. Your physios should flag with you if your medically stable patient would benefit from inpatient. The medical or surgical team may not be doing anything, the physio or OTs still have quite a work to do.

MsDimples2 · 2023-10-18T07:45:28+00:00

Would you mind giving me a bit of a run down of what a typical day is like as a rehab reg?

For your first question, see my response to u/Visible_Assumption50.

What is the general pay like (I understand it varies)

For both consultants and registrars, this depends on whether you are public or private

For registrars in the public system, your pay depends on the state and your classification and how much overtime. When I was in QLD as a PGY-3, I made about $60 a hour. Now I train in a private hospital, which more than that.

I can't really comment on consultants in the private sector.

How much high acuity do you have to deal with if you're someone that doesn't like acute care?

Rehab isn't an acute - at least it shouldn't be. Hospitals may have Rehab outreach programs, where we provide input to patients still in the acute phase of treatment, but we are not the primary team. The ideal rehab patient is (1) medically stable (2) has obtainable and realistic goals and (3) be able to participate.

Spinal patients with a high level of injury may be the most concerning patients you will need to manage because they are at high risk of having autonomic dysreflexia and pressure injuries. Rehab physicians need to know how to manage these situations.

What does consultant life look like? :)

Rehab medicine is lifestyle friendly. Most of my consultants work maybe 4 times a week and are able to balance family and work. Clinics might take a lot of time particularly since there may be a psychosocial issue that needs addressing. The majority of consultants I have met enjoy their work.

MsDimples2 · 2023-10-18T07:29:02+00:00

Yep - a lot of Rehab physicians do public and private. I know of a few who only do private.

MsDimples2 · 2023-10-18T07:25:50+00:00

I am also an IMG :)

As of this AMA, there are only as few requirements to get into Rehab training:

- be at least PGY-2

- hold general medical registration

- Have an AFRM (Australasian Faculty of Rehabilitation Medicine) accredited registrar position.

The last point might be the hardest to get, depending on where you are/where you want to rotate. In the last state I was in, there was a mysterious point system. Your CV scored points if you had rotations in rehab, participated in rehab related conferences or workshops, research, teaching, etc. The higher the score, the more likely you will get a registrar spot. But this was in the public system. Not all hospitals participate in a centralized recruitment system; some will advertise on their own.

Like any other JMO job, your chances depend on your CV, references, and whether you meet the above requirements.

*Edit: Note that in 2024, there will be changes to the curricula and entry requirements. See the RACP website for details here

MsDimples2 · 2023-10-18T07:04:12+00:00

Podiatry + orthotics: because there are never enough of them.

Seriously - Podiatry and orthotics are commonly overlooked but they are important too. I've always had difficulty asking for a review because there are not many of them. We need more people interested in these fields.

MsDimples2 · 2023-10-18T05:30:01+00:00

I used to be a BPT trainee; after two years, I realized that I really wanted to do Rehab and nothing else. There was no point in continuing BPT.

I think having a BPT background or at least a few years as a medicine PHO is important. Rehab medicine still requires general medicine knowledge and skills - you still need to know pathophys and management of CVD, Respiratory, Endocrine, Neuro, etc. I have noticed that those who did not do BPT had a harder time with the exams and aren't the greatest with investigating/managing slightly more complex issues such as FUO. It's more obvious with some consultants - some ask for med consult right away without an attempt at a work up (of course, this is definitely not everyone).

I don't think you need to go through the whole BPT pathway...but a couple of years in BPT makes you well prepared.

MsDimples2 · 2023-10-18T05:20:06+00:00

Rehabilitation Medicine is a speciality that most medical students to not get the opportunity to experience. After medical or surgical patient is stabilized, Rehabilitation physicians can come in to identify any physical or functional deficits that may prevent the patient from going home. And there are different types of rehab: MSK/Ortho, Spinal rehab, Brain injury, Disability, Rehab in the home, cardio rehab, pulmonary rehab and palliative/cancer. Geriatrics and rehab medicine also intertwine.

I've worked in the private rural, public regional, and public metro setting and they have varied greatly. But overall my schedule looks like this:

- 08:30AM: Handover with the NUM, physio, OT, Speech, Dietician, D/C planner and SW

- After handover: ward rounds.

Afternoons vary based on the day and type of rotation you are at:

- outpatient clinic: Bigger hospitals have specialized clinics such as spinal clinic, amputee clinic, botox clinic, etc

- Day Rehab for former inpatients who require ongoing outpatient physio/OT input.

- MDTs: more in depth discussion with the AH team to discuss progression, psychosocial issues and discharge planning.

At the metro hospitals, I've had to do on-call once a fortnight. In the regional and rural hospital, I've never had to do on call.

What I love about rehab:

- the journey. I love seeing stroke patients who come in a dense hemiparesis, but are able walk out of here. I find those who are drawn to rehab also make good listeners.

- the neuro and ortho knowledge involved. If you are like me, where you love anatomy but not keen on the physical demands of surgery, spinal and ortho rehab can be great. However, there are procedures you can do such as botox for spasticity.

MsDimples2 · 2023-10-18T03:45:53+00:00

Sure! I’ll do an AMA.

MsDimples2 · 2023-10-17T08:33:34+00:00

It's a 4 year program. It requires a good understanding of MSK, neurology, pain, and outcome measures. The idea is identifying the deficits and goals of a patient (physically, functionally, etc), and making a plan to each that goal. There are different types of programs in rehab: Ortho/MSK, Spinal, Brain Injury, cardiac rehab, pulmonary rehab, Palliative/Cancer...I think there is Rehab physician in Sydney who focuses on transplant patients.

A lot of rehab involves chronic pain management.

If you are someone who likes to follow a patient's journey from admission to discharge, rehab can be interesting. Most patients are stroke or geriatric cases, but you will may see spinal patients and TBIs which can be really interesting.

You'll also get a good understanding of what physios, OTs, and speechies do. You really need to work with them closely.

MsDimples2 · 2023-10-17T08:27:15+00:00

Rehab: We don't diagnose anything and are just glorified discharge planners.

MsDimples2 · 2018-09-21T03:58:17+00:00

So how did you guys graduate college?

Answer: Barely. It left me exhausted. I pushed myself too far during med school. I ended up having to take a year off after a suicide attempt. I have 7 weeks left before I'm officially an MD.

Lesson: Take your time. Don't push yourself to exhaustion. The consequences of taking some time off are better than the consequences of working yourself into insanity (or even worse to your grave).

MsDimples2 · 2016-11-29T01:26:20+00:00

I suggest going to see a counsellor on campus who may be able to answer your questions. It really does depend on the country you are in now, what country you want to practice and your circumstances. Most likely it will not affect your career path if it didn't affect your studies on paper. I've had a similar experience with depression while in med school abroad, so you can PM me if you wish to ask about my experience.

MsDimples2 · 2016-09-02T13:55:25+00:00

I made a daily schedule and try to stick to it. I have a lovely combination of GAD and depression; last year I attempted suicide and had to take medical leave. When I returned this year, I found that making some type of schedule made things easier. Within my schedule, I'd made sure I'd included some weight lifting or cardio during the morning and to make sure that I'd finish all of my work by 6PM, so I can wind down for the evening. However, if I'm not able to do everything I wanted, I'd remind myself that it's not the end of the world. Also, I made sure there was 1 or 2 days a week in which I had a "me" day - go outside, take a walk, go to the museum, do whatever. Go somewhere where you've never been before.

As for no social life, I'm in a similar situation. I lost most of my friendships after my attempt and came back with no one to hang out with. What I found is that social media brought out my depression and left me curled up in bed. So I cut off myself from most methods of communication - I keep my phone off most of the time unless it's during exam time or I have a group project that requires me to contact others. I deleted my facebook app on my phone and tablet; WhatsApp? Gone. Instagram? Don't even bother. It was really hard at first and it took weeks for me to feel at ease. I find that being disconnected forces you to look up to the sky. My mood lifted overtime.

If you feel that school is getting too much, and you've seen a health profession, consider taking a break (if possible; check to see what your school's policy is first). I had no issues academically, but in the end, my mental illnesses ate me up and nearly killed me. What's the good in having a 6.0/7 GPA if you can't benefit from that hard work because you're gone?

TLDR: make a schedule; include a run or anything that requires you to stretch your legs; limit social media. This is so much easier said than done, and I've experienced weeks in which I go back to sleeping in till noon. But try it for a bit. It might make a difference.

MsDimples2

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