can um we're being recorded all right um some people might trickle in but we can certainly get started with the group that we have um we are certainly uh very informal so feel free to interject at any point ask questions turn your camera on if you feel comfortable doing so or send any messages in the chat and we will try to um answer those as best we can but first we have a few slides that just kind of go over some of the logistics that might be a little easier in um kind of visual format and then we can open it up to more of a discussion should we do quick introductions too yeah so we're talking about pediatric rehab medicine so we can um introduce ourselves so I'll let you go first since you're first on the list here advantage of being an a um hi um I come out and I am a foster program director at Texas Children's Baylor um and I found peds rehab on the pathway we'll talk about these but a combined program in Colorado and I'm Kim Hartman I'm the program director in Kansas City um and I also did a combined program but in Cincinnati and I'm Joshua Bova I am the medical director and the fellowship director at Children's Healthcare of Atlanta and I went the really long way I did pediatrics first and then I did rehab and then I did a fellowship so I've done every possible way that you can think of to end up where I am and I'm Carl Clamar I am the fellowship director at Nationwide Children's and Ohio State in Columbus Ohio and I'm that old guy who did no fellowship and was grandfathered into everything pediatric but I am a very big supporter of specialty training in our particular specialty so Kim we're gonna let you drive okay all right well I'm guessing most of you know a little bit of something a little bit about pediatric rehab medicine if you are here but this is how the board defines our field um so it's very long and not very pediatric like um but um goes into all of the aspects of caring for kids with disability but in reality these are the kids with disability but in reality these are the kids that we see in addition to many more that I'm sure did not get included here but any kind of congenital or early childhood or childhood disorder that can lead to changes in function and how do we help them kind of live and grow and be the best versions of themselves so as we mentioned there's a couple different paths to get to becoming a pediatric physiatrist so on the left here in the orange is doing a pediatric rehab medicine or PRM fellowship and on the right is doing a combined pediatrics and PMNR residency program so you can kind of compare and contrast the two different paths and we're happy to kind of share our experiences with each if you have questions but essentially with the fellowship it is six years of training there are more programs and more spots and you're board eligible for PMNR and pediatric rehab medicine the combined program is five years but there's only four programs um and roughly five spots per year and then you're board eligible in pediatrics physiatry and pediatric rehab medicine and I did include here that you can do the Dr. Vova route and do pediatrics first and then PMNR and then plus minus a pediatric rehab fellowship so um I included this down here because it is a possible route it is a little bit more difficult because you have to get funding for two residencies and so if you know you are interested in pediatrics this certainly isn't often to get into um as I mentioned there's a handful of fellowship programs this is roughly where they are located around the country and San Diego and New Orleans are kind of our newest programs and the combined programs are all in similar locations so there's a new program at Sherwin-Williams that is starting up this year Cincinnati has a program Colorado Children's has a program and then out in Delaware at DuPont they program as well so that is just some very brief background of who we are and where we are located in terms of programs and training and so we didn't really have any kind of canned questions or anything so if anyone has any questions off the bat that we can answer we're happy to do that otherwise we can just each sort of talk about our our own paths and how we got here. So one of the things that I think is really interesting about pediatrics is that it is a really diverse field so it is kind of everything you can do in rehabilitation medicine so everybody's experience in training everybody's experience in practice is very different so my emphasis in my practice is brain injury medicine I have additional brain injury certification through the American Board of Physical Medicine so that's everything from mild injuries concussions all the way up through the most severe injuries and then additionally I run a specialized clinic for non-accidental traumatic brain injury or shaken babies but I also do neural tube defects myelomeningocele or spina bifida and then general rehabilitation spasticity management so pretty much anything that comes across my desk. I think one of the interesting things about pediatric rehabilitation medicine is that you get to do a lot of everything because there is nobody really there to fill the void there are so few of us that you really get to create what you want and it's such a developing field that my practice has developed and changed so many times in the past you know 18 years that I never thought I'd be doing what I do now I started off as you know since I did pediatrics really more of a hospitalist type of pediatric rehab physician and over the years I've really morphed into a outpatient and proceduralist even as part of my career so it's really great because it gives you so many things to explore different facets and you know five years from now I may be completely something different which is great because you can constantly that you know one of the things that people always complain about in medicine is that you kind of get pigeonholed into just doing one thing but the nice thing about pediatric medicine is it's so diverse and encompasses so much of rehabilitation medicine you can keep redefining yourself and redeveloping yourself. I would agree with that and also want to encourage y'all if you don't want to ask the question verbally feel free to drop it in the chat and then we'll manage that. For me I knew I wanted to do peds from the jump because I don't like big people and so my focus was always going to be pediatrics and I discovered PM&R in college and I was one of those people that kind of knew it before med school and then knew that that's the path that I wanted to take and so that's how I ended up in PD PM&R and I went to Colorado for the combined program like I mentioned. For me I think that the joys of it I saw them earlier on but I'm really seeing them now as I approach that mid-career point and I'm more settled in a location and really getting to know my family like deeply and watching the kids grow up and so I get that part of pediatrics but I also get this part and there's something really special about following a family from kind of diagnosis if that's the case I can CP to them growing up and then watching the family stop limiting their kids like when they first hear the diagnosis they have this like preconception of what it's going to mean for their kiddo and then as you work with them they stop limiting them and just it's really really cool to see that and then I also really appreciate being on the side when you first get a diagnosis that you didn't expect and kind of being humbled by the part that we get to play in a family's lives so it's not it's yes they had a tragedy occur but it's really different when it's a child that's growing versus when it's an adult that's already had whatever happened to them and so now you get to be a part of this family's life and helping them kind of understand what the future looks like while still accounting for like this is a kiddo that's going to grow but how they're going to grow is going to look different from what they had pictured so there's kind of like a a morning that comes with that and then also still at the end you also still get to see kind of like the finding of the joy moment that's a long answer for why I love what I do but I think that that it's a really really special specialty. Well I echo all of those I am also getting into the mid-career I guess I'm in mid-career at this point and I see kids and I'm like weren't you just a baby and now you're in high school how is that possible I don't feel like I've known you long enough for that to have happened but it is really nice to grow watch them grow and develop and I do a lot of inpatient and consults and so to see them from kind of that moment of really really low low when something relatively terrible has happened to kind of getting them back to the highs of life is really special to see and you really get a nice bond with them on the inpatient side and then following them long term is really really why I enjoy what I do as well in addition to what what everybody else has shared. The coolest thing is about every couple years we have this really interesting tradition called the Olympics and with that is also the Paralympics and it's my favorite thing is seeing patients come back and find out who's been on a sports team I had a patient come back last week who who came to me at 14 with a spinal cord injury and came back now at 23 telling me that you know she's trying out for the Olympic handball team on Friday she's supposed to tell me how it went well you know but it's great to see these you know I mean everyone has an injury right and they're scared and they're adjusting to a new body something completely different and as a teenager and they come back as a confident adult you know and so that is probably one of the most rewarding just as you know most echoing is kids growing up but really seeing them come back as adults and wanting to show your them your progress and wanting to be part of your life and they came back specifically because you weren't important to them in this journey that they're taking and you know you don't get that always with adults you know because they're going back just to their lives and children are always developing a life and so you know having them come and you know when they all go off to college and the fact that they made it and we taught them how to adapt to being independent I think that's that's the most that's the best part of the job or one of the many best parts. I have a question for you all so first thank you guys for being here and talking about your experiences I'm a rising second year medical student so I'm not you know in residency yet but I was just wondering what you guys would suggest for someone like me who's interested in peds rehab but maybe unsure about doing a combined program because it is you know right from the start that's what you apply to so how do you advise students who are interested in that but may not you know necessarily know if the combined program is right for them? The advice I always give going the really long way is kind of decide two ways I tell people to think about it is you know what would you do if you couldn't do if you couldn't do pediatric rehab would you be a rehabilitation physician or would you be a pediatrician and that kind of gives you that that advice of which path you should take if you had to pick one and you couldn't do peds rehab which path would you go on you know because you the combined and doing the pediatric path is definitely a lot more difficult I think it gives you a lot more knowledge it gives you a better base to start but it's not necessarily just because you start at one point that doesn't mean everyone's not going to finish at that same point either so I think if I were to say about that like I would just go when you're picking residencies go to a program that has a strong pediatric program if you can because they'll help develop you into pursuing that fellowship you know we've had a lot of people from our program go on to fellowship and I made sure that I've never I tried to encourage them to go other places for fellowship as opposed to staying with us because I've already taught them for you know three four years of their career I want them to go learn someone else's perspective instead of just becoming a clone of me so that I think my advice would be find a place that has a strong pediatric program if you're not sure yet and then give her a chance to develop and see what you want to be I would echo that and also if you're if you're kind of have an interest now depending on where you are in medical school and the flexibility you might have you can always seek opportunities to get clinical experience close to you so in medical school I went to conferences and I would meet attendings that were in peds rehab and then I went to go shadow them through some of the med school electives before I had to make a decision so that's one potential of doing it and like Josh said if you can't see I think for me my backup plan was general pediatrics so that's how I knew I was like this is going to be for me so really thinking about what that backup is going to look like and the other piece I would say is nothing is permanent in this life I think that's one of the things that that time has helped to understand meaning you might choose to the combined program it's still if it's five years yes but if you change your mind and decide to do something else later on theoretically it's possible is it harder yes but it doesn't mean it's impossible so you're never stuck truly yeah and I would also emphasize what the point that Josh made earlier and that you know for most of us what we thought we would be doing we're doing different things now and you can you can change so I've been the consult doctor on the inpatient side seeing the kids and and I have built programs to to meet the needs of children who who weren't getting their needs met and so I think that's true of rehabilitation medicine in general that that the field is so broad that you can be something different 10 years from now and and that has helped me to not experience that burnout that we all hear so much about because I'm I always have something that that's encouraging me to do new things and being able to train the next generation also pushes you to to always be looking at what that next great thing is and what that next if the next educational opportunity for our trainees is something that I don't know anything about I got to go learn about it and that keeps me learning all the time and that's that's been a really great part of this specialty for me and it looks like uh Dr. Takashima asked what does your day-to-day look like is there a lot of variability within the specialty in terms of mix of procedures outpatient and inpatient and the way that we do it in our practice is actually we all rotate so we you know we spend some time on inpatient then we both then we spend some time doing consults and some time doing outpatient and procedures so we're constantly rotating to keep ourselves fresh um I'm very fortunate to have a group of people that like to have variability in the work so we all rotate and share responsibilities and keeps us all uh fresh you know we don't get burnt out because we're always doing something different and yet the same so we were able to provide continuity to our patients but variability in our practice how do you guys do it there yeah yeah um so we have a larger practice I think it gives us a little bit of um flexibility for some folks to specialize so we have some people that do um primarily inpatient so when we think about inpatient we think about inpatient rehabilitation unit and then there's also inpatient consultation service and then of course outpatient so we have folks that do a little bit of everything we have folks that just do all outpatient we have folks like myself who just do consults and outpatient and procedures I think across the board we all do procedures because we all have patients that we manage their spasticity and then we also do nerve conduction studies as well so I think that's another component um there is variability and this is going to depend on where you end up practicing really is I think you'll hear from all of us so you can be anywhere from being the solo provider for please rehab in the area in which case you're probably doing everything, to being in a multi-provider practice where you may get specialized or you may not. It just really kind of varies. Kim, what's your setup like? Yeah, all of us do a little bit of kind of general rehab, sort of whatever comes in the door, but then each of us has kind of our own little areas of interest that we focus a little bit more on, so a little bit more on the inpatient and consult side, a little bit more with spinal cord injury and brachial plexus injury compared to some of my partners. Some of them do a lot more procedures than I do, but I still do some procedures, so I think going back to kind of the original points of you can kind of make it what you want, and so if you really like procedures, you could probably find a role that's very procedure heavy. If you don't like procedures at all, you could probably find a position where you have to do very few or even potentially none, but it really just depends on what your interests are and where you want to be to some degree geographically and what kind of practice you want to practice in, so we all practice at pretty large academic centers, so there's lots of teaching and research and clinical components, but you can certainly practice in a more rural setting or there's a handful of folks who do more of a private practice model, so that might look pretty different than what a lot of us do, so I think there's lots of opportunities. It was kind of alluded to earlier, but there's lots of job positions currently and in the future, so there's a huge kind of workforce issue where we need more people in our field, and so there's definitely a lot of job security in terms of if you do a fellowship, there will be three, four, five job offers for you when you're done, so the ball's a bit in your court in terms of what you're looking for and what you're interested in. I think we also have a question about pros and cons of combined residency versus PMR plus fellowship. Are there differences in what areas of practice you felt most prepared for? I think the biggest pro-con difference is time, so the combined residency being five years and the fellowship path being six. The combined pathway, you also get boarded in three different specialties, so Peds, Peds Rehab, and General PM&R, and then combined, I think it's a pro or con depending on how you look at it, but you are doing a general pediatrics residency, so I graduated feeling pretty comfortable with pediatric medicine. You do still get that in fellowship by the time that you're done at the end of the two years. It just changes your comfort level kind of coming in. I think for me, I would say that I probably felt most prepared for inpatient practice. I think the areas that pediatric medicine comes into play is in like when recognizing sick kids. One thing I will say, I don't know what it's like for you all, Kim, Josh, and Carl, is I'm noticing that on the inpatient side, we're getting kids sicker and sicker coming to rehab. Yeah, absolutely. I will say as an educator, I have to be with our residents going into fellowship who have not had that combined training. We make sure that they get extra experience in the pediatric ICU and on other services learning that because pediatric medicine, we all say kids are not just small adults. There really is a difference, and being comfortable with weight-based medication dosing, with running a pediatric ventilator, with the various things that are truly unique to caring for pediatrics, doing the combined residency program is going to get you more of those kind of basic skills. In terms of being comfortable and how much you want to manage, kind of because we all wind up doing primary care stuff as rehabilitation doctors. The greater comfort level, I think, that my colleagues who have done the combined programs have with that primary care aspect of pediatric care, I think that's a real advantage that they get. At the same time, I have fellows who come through who never had a desire to take care of strep throat or ear infections, and that's not what they were doing their training to be able to do. That's okay, too. There definitely are pros and cons, and it's really about which aspects of caring for those kids you want to make sure that you're really exceptional in. I think if you want to do a fellowship, which is when you're choosing a fellowship, I recommend choosing a fellowship that has a larger inpatient program in general, just because you get those experiences. The inpatient program can vary from four beds to 14, 15 beds, really depending on where your program is. I always say if you're interested and you don't feel comfortable in inpatient medicine, then look for a program when you're doing fellowship that's going to give you that experience, so that way you feel a little bit more comfortable. I'm the only one in my program that did a pediatric residency, and I have six other partners, and they all feel very comfortable on the unit because they've gotten that exposure. They feel very comfortable with medications and management. I trained most of them, so they got the opportunity to learn and get that experience in fellowship and feel very comfortable as practicing attendings. If you don't want to do a combined program, there are options to get you up to speed without having to do a combined program. When choosing a residency, if you know you want to do pediatrics, you want to look for a residency that has that really strong pediatric presence and that doesn't give you just the minimum pediatric experience that the board requires, because even within residency programs, there's a lot of variabilities in what the pediatric exposure is. You can probably get it in any program, but you may have to work harder. You may have to arrange some away rotations, so choosing a program that has that strong pediatric presence really gives you a leg up. How do you determine that for a program? I mean, one of the things I've been looking for is places that have a PEDS fellowship. I figured as a marker, but what else should I be looking for? Look at the block schedule. See what the pediatric rotations are. Is it just two months of pediatrics or four months of pediatrics, and then ask the residents who are there what the availability in your elective time is to do additional work in pediatrics. I would also ask how many faculty they have in pediatrics. We've had fellows come through with a variety of exposures where they've done two, three months, but they've only worked with one attending who maybe only had clinic four or five times a week or something like that, so they maybe just didn't get quite as much exposure. In general, if there's more people, there's probably a little bit more opportunities to see different things and different practice styles, but there's quite a lot of fellowships, so those would probably be the first places I'd start looking because those places are all going to have a pretty strong pediatric experience. I was going to say, I know we talked a lot about some of the pros of the combined program, and I did a combined program, and I loved it, and it was right for me. I do think, obviously, to get that one less year, some things kind of have to get shaved a bit, and so if you are really interested in research, I think in the fellowship tracks, you have a little bit more opportunity and dedicated time for research compared to some of the combined programs. You can still do research, but at least for me, I didn't have a separate dedicated time just for research, and I think where in my training, what was kind of pared back a bit was more of the musculoskeletal and pain side of things, so maybe not the things we see as commonly, but things that are certainly important, and some of my partners who've done fellowships are much more adept at that than I am, so I think if you look at what the schedules look like and see how much of everything you get and kind of decide for yourself, like, okay, I really might be interested in that area, and I don't want to give that up for a combined kind of type of program, that would be another thing to consider. I think with the fellowship, there is some procedure, definitely a little bit towards procedure, and again, when you do a, like Kim was talking about, things getting shaved off, like pain and some other aspects of adult care, you know, you have to make sacrifices. I think there is definitely a lot to learn from extrapolating from adults, so even if you decide to do a combined program, realize that that other part of rehab medicine's there and, you know, paying attention in your lectures to make sure you don't miss out on that piece of education. The one thing that I, like, I had no interest in pain at all, you know, everyone was trying to do pain, and people were fighting for pain fellowships at that time, because doing procedures in residence simply wasn't, you know, simply wasn't as common as it was back when I trained, and, you know, one of the first things people asked me when I got to my job is like, oh, you're a rehab doctor, can you do an epidural? And I'm like, no, I never learned that in residency. So, like, there are definitely, I think residencies have also become more procedure-oriented, so taking advantage of that, you know, joint injections, things that you occasionally will see in pediatrics, and just keeping yourself open to be flexible is something to take advantage of in whatever program you go to. I had a question kind of gearing back towards building your practice, what we were discussing a little bit ago, and I feel like something that attracted me to peds rehab was the flexibility in terms of, you know, doing the things that you want to do or that you're interested in. When it comes to kind of, like, finding a niche, how have you found success or difficulty building that? Like, does it have to come from administration or finding other partners in other fields that are kind of concrete, like a multidisciplinary type of clinic? I'm just kind of curious your experiences or what has worked or what might not. I think it really just depends on where you find yourself aligned in your hospital administration, because every university hospital does things different. You know, I found that it's been very easy for me because, you know, people want me as part of their clinics, and I'm sure, you know, has the same thing with, and Carl alluded to this, people want you as part of their clinics. So, as long as you come up with a good business model and you want to help your colleagues, you can do, you can make anything. You know, like, I'm developing a saliva clinic. I do so many Botox, falvary glands that ENT wanted and pulmonary would send them all to me. But they're like, but we really rather combine and have a combined clinic. So, I'm like, okay, so, you know, we're talking about starting a spit clinic that's on the books for 2025. We, you know, I don't know if spit clinic is a good word for it, but, you know, we're finding, so that's like something unique that you can do. You know, I do an oncology survivorship clinic where it's in combination with endocrine, hemonc, and neuropsych, you know, and kind of look at how, you know, now that you've gotten through your cancer, now what? And so, that's like a very interesting clinic that we, you know, that I do. So, like I said, there are a lot of different aspects that if you focus with your administration, and typically, if you're in a children's hospital, they're always looking for ways to help kids that's not necessarily always profitable for them. So, that's another advantage of pediatrics over adults is that they really try to work on these foundations as opposed to just what's going to be profitable. So, I would really emphasize what Josh said that it's what we do in rehabilitation, kind of the hallmark of what being a rehabilitation doctor is, is really building a team. So, we are team builders, team leaders. So, yeah, we wind up partnering. When I built our concussion program, I went, I immediately went to SportsMed. I knew the SportsMed docs were treating concussions because the numbers all say that the majority of kids get their concussions through sports. And so, I went to them and I said, hey, listen, we really need to be getting into this space and marketing it and building a true program. And we partnered with them, and it has worked out well. We since have brought in neurology and we really have a multidisciplinary approach to concussion that spans the entire institution. So, yeah, taking advantage and really using that team building. And if it is building a formal multidisciplinary clinic, that's great. If it is building a system that just says, hey, kids who fall into this category with this diagnosis go to neurology and this category come to us. And we talk about the patients and we have conferences. It's really that team building that really will convince an institution that what you're doing is benefiting these kids across their entire needs. I also think it's a mix of luck, circumstance, opportunity, and interest to certain degrees as well. Once you start practicing and you start your first job, you're going to get asked to do a lot of things. Some of them are going to be along your interests and some of them are not. And so I like to stress to our fellows and even our residents is to think about or start thinking about what your interests are. You don't may not know yet, but if you know, think about that and try to find a balance of gearing what you say yes to to those interests in addition to what you say yes to that also meets the needs of whatever hospital system that you're in. And so some niches end up that way. I think I have a mini tiny nation in cardiac rehab because Amy Houcher asked me to do something there and it just kind of snowballs. Amy Houcher is in Pittsburgh. And because otherwise what happens is kind of like a scattershot of things. And so you're doing a little bit of everything but not like really honing in on one. And that can kind of get hard to keep your hand on all of that. So if there is an opportunity or a need and we have can always contribute, hop on it. I think one of the things that's hard for program building, especially when you're doing is you have to take the thorn out of the lion's paw. So sometimes you do clinics you don't necessarily like for orthopedics or neurosurgery or whomever so that when you call them at one o'clock in the morning, when you want them to look at an MRI or do an emergency procedure, they're there doing it for you. And so that's one thing that we always stress in all parts of rehab. Rehabilitation is not only team building, but it's relationships. So being aware of how you're building those relationships within your hospital so that when you want to get things that benefit your patient, hey, can you get the surgery on for me? I need to get here. Would you mind doing this add on that your patients are taking care of? Because they know that your patients are going to be the most complicated ones. And so you really want to have some people that are siding with you to meet the needs of your patients. And that actually kind of dovetails into Pepper's question. So she's asking about the extent to which caring for adults with childhood onset disabilities is a part of the practice. And that depends on what your relationship with the adult providers is. So a lot of places there is transition of care is really it's a big issue. And so it's, do you take somebody under your wing and teach them to take care of what's different about pediatrics so you have someone to pass them off to? Is it finding a place, if that's something you really don't want to know, finding a place to practice where there already is a transition program that you can lean on. So yeah, a lot of that has to do with the relationships that you establish and how you manage them. And you can also, I had a, there's a graduate who came in knowing that's the population she wanted to take care of. So that kind of tailored some of her training and she, oh yep, you got her. We got her. You got her. And she graduated and kind of does the practice that way and has like a dedicated transition clinic and so partners with the adult practice. To have transition on that side and partners with the pediatric practice as well. So there's many different ways to do it and you can do as much or as little as you want. Part of, I think what you're hearing all of us consistently say is you ask the question, can you do this? The answer is yes. I think that there, in terms of like how you imagine your practice to be and that's what we are, I think highlighting that the diversity and flexibility appeals we have is you really can do a lot of different things however you want to. And if you change your mind, you can go somewhere else. Or you can just reinvent yourself. I'll ask a question. Oops, sorry, go ahead. I think Dr. Claymore, specifically, you had mentioned you had done like a brain injury certification. Again, it sounds like we can be pretty flexible in terms of how we build our practice. Is there ever a time where you have to seek out additional like certification or training in order to make that happen? Or is that something that's becoming more common or is it still kind of depending on the, I guess, population? Yeah, it depends on the population and the institution, I think, a lot. You know, there are a fair number of us who are my generation who there were no ACGME certified. So, the fellowships were not certified when I was going through. And some people chose to do the uncertified fellowships. Some people chose to do what I did, which was just I worked with one of the pediatric practitioners, worked with her as a resident, worked with her as a junior attending. And then after seven years, I transitioned and became the only pediatrics. And that's all I've done for the last 20 years. So, yes, you all will not have the luxury of doing what I did, which was just signing off and saying I've done this for more than three years. And so, I can sit down and take the test and prove that I'm competent. That pathway has been extinguished for all of our specialties at this point. But yeah, there are people who have gone from a pediatric rehabilitation fellowship to other fellowships. And that gives them that opportunity to make an even more specialized practice. But our goal, I think, as educators is to turn out pediatric rehabilitation doctors who are capable of taking care of brain injury and spinal cord injury and congenital conditions and making sure that they are competent to do all those things that they need to do. Competent in electrodiagnostics, competent in procedural medicine. So, that's really what we are doing when we're training our fellows. I think that that's what the goal of the combined programs is. And it's something that we're struggling with as a specialty in terms of how do we bring other people who have done something different, didn't do a fellowship right out of training, did pediatrics and didn't know that they would rather have done a combined program. How do we find ways to get them trained and take advantage of the talents that they have? But from the standpoint of pediatric rehabilitation training, we have the three pathways that we've talked about that will get you to be board eligible in pediatric rehabilitation medicine. It's possible there will be an additional or perhaps several additional pathways in the future. It's a big discussion point right now for us because we want to make sure we're capturing all those people who want to be treating this patient population. And Elijah, the more boards you have isn't necessarily better because you're constantly recertifying. I have four of them right now and I'm almost thinking about letting some of them go because you're constantly chasing the wheel of keeping up with all your CMEs and then your mind is lots of play throughs everywhere at once. I think it's good to grab knowledge, but I don't, you know, unless you're definite positive that you want to be a Paralympic doctor, then yeah, maybe a sports medicine or you want definitely sure that you want to do invasive pain procedures, then yes, pain, but otherwise you'll get everything you need from a PEDS fellowship. I will put a plug for palliative care too because we have a palliative care trained provider as well. That definitely is one of those that blends right into what it is that we're doing as rehabilitation doctors. I would agree with that wholeheartedly. Another question. I'm a med student at Wash U in St. Louis and in St. Louis, we have a place called Rankin Jordan Pediatric Bridge Hospital. They do a lot of post-acute care, a lot of the medically complex kids, some kids with more intensive rehab needs. And I was just wondering, are there similar students that you guys know of in your cities or elsewhere? So in other words, just saying I'm thinking about possibly working somewhere like that. So we do, we have a kind of a longer term version of that in Columbus. It's the Heinzerling communities, which takes kids and adults with developmental disabilities and gives them kind of a long-term care place to live and a place to work. So we do have a long-term care place for a long-term care place to live, sometimes longer term, sometimes transitioning towards those patients who don't have the infrastructure that they need to safely be home. And while that's happening, it's a place for them to be. So we have a lot of our patients who are there and we sometimes go out there and see them there. During COVID, we definitely had to be much more flexible in how we cared for those patients to keep them safe. So there are facilities like that elsewhere. I know Chicago has a few of them like that when I trained. I would assume that they're still around, but lots of cities have very similar facilities. We don't in Atlanta, but other cities do. We don't in Kansas City. We're close enough to St. Louis. But I think if you compare it to like the adult population, you think about like LTCH and skilled nursing facilities and that, there's certainly not as many for children, if that's kind of your area of interest. But there are some as children. Ours is called Nexus or HealthBridge. I forget what they change their name to. And in Pittsburgh, there's the Children's Home. So different cities, as mentioned, have different versions of it. I will say, I hope it's from a financial structure standpoint, it takes some, I think, creative business acumen to keep them going. I was gonna ask what you love most about your job or what's the most fun part of your day-to-day. And I'm looking at Josh. Cause I think about 2-2 Tuesdays. I got too predictable, 2-2 Tuesdays. So I kind of brought it away, but I'm thinking about bringing it back. Someone had asked me, but really the most fun about my job is I just get to play all day. You know, I make fart jokes all day. I joke around all day, chase kids down hallways, just like being a camp counselor, but with medicine, it's great. I don't think there's anything better. I have to keep my dad jokes on lists. And you go with the trends and you have a lot of fun whether or not you're trying to do a very bad version of a TikTok dance or like, you just constantly get to change your personality from room to room based on what your patient needs, you know, versus, you know, what you do during the day. You get to be a chameleon. That's my favorite thing. No day is the same. I'm gonna go with running in the halls with the kids. I tell the kids all the time, I'm not like other doctors. I'm not gonna tell you not to run in the hall. I'm gonna make you run in the hall. And then I'm gonna chase you and run with you. Yeah, there's nothing like spending a morning chasing toddlers around the halls of your clinic. It's the best. Yes, I would certainly agree with all of that with the kids and also working with the families and just kind of seeing their joy as their child accomplishes something. It's really great to see it, you know, seeing the child be proud and excited, but even before they might have the awareness of that, just watching the parents kind of have those hopes and dreams kind of come true. And maybe they thought that it wouldn't be possible for their child. So just kind of working through all of that. So, and one of my patients told me I'm not allowed to be on TikTok. So I guess I need to work on that a bit more. The most fun I have is in-clinic exams. So, you know, most toddlers don't want you messing with their limbs, but I make funny noises when I mess with their limbs or like helicopter sounds or whatever the case may be. But like I'm a noise machine and I have so much fun with that. And then my favorite day of the year is Halloween across the board. We have a Peds Rehab Facebook group and every year we all post our Halloween costumes. We all post our Halloween costumes. Halloween is serious, serious business. So by the time the days ended, we've decided next year's costumes for us anyway. So I think it's really fun to work in an environment where as you're walking around dressed as whatever, it's just part and parcel of the day. And then we also have pet therapy. So I think I get as excited as the kids when the dogs come by. Yeah, now seeing Reggie Talley in his third Halloween costume of the day. There's nothing like that. I think people often ask, and it always says when you're looking at where would you rather, and you have a very biased group here because we all practice in pediatric hospitals. Whereas you do have the option of being a rehabilitation doctor in a pediatric unit in an adult hospital. And I trained in that environment. And then I did my fellowship in a pediatric hospital and I never wanted to leave a pediatric hospital after that. And I even when invited to go back to adult hospitals, I might know I'm staying in a pediatric hospital because it's just more fun in my opinion. So, my Peter Pan syndrome has never gone away. So I'll keep it. And you have to keep up with all the kids' movies. Otherwise you're not gonna have anything to talk about. So obviously you need to go watch it. You have to be able to sing Moana and Frozen. You know, exactly. Absolutely. The only reason I had children was just to keep up with my patients. Now that my kids are older, I have no use for them anymore. One more question I have for you all. I know it's an increasing emphasis in medicine lately to think about how our physician population is or isn't representative of our patient population. So I wanted to ask if there are any openly disabled faculty or trainees in your division? So we, I had a partner, Dr. Ellen Cates, who was disabled and was a phenomenal advocate who unfortunately passed away not quite 10 years ago. And I miss her every day because she was a perspective that the rest of us can't duplicate. And having those individuals with disabilities as a part of our faculty in a larger sense is very important. So yes, there are within the country. There are quite a few, but yes, I would love to see more. Yes, we have a faculty, a former, a fellow graduate, and now will be a faculty member who is a primary wheelchair user. And I have trained other fellows that are, I'm thinking about time, that identify with various physical disabilities or have had like childhood onset, neurological conditions as well. So I think the specialty kind of, what's the word? Draw self, attract self-select to some degree, individuals that have had lived experience with disabilities or close family experiences with disabilities or something else to the like. Alright, thank you all for being on this webinar tonight. If there are no more questions, we can go ahead and end the call and give you guys two minutes of your lives back. This is going to be recorded and will be on AAP's virtual campus in the coming weeks for further viewing and sharing with your colleagues and anyone else who might be interested in pediatric rehabilitation. You all have a great night and we'll see each other soon, I'm sure. And feel free to reach out if you have any questions. Kim was kind enough to put all our emails there, so if you have anything specific, please let us know. Thank you all. Thank you all. Have a great night. Thanks, guys.

pediatric rehab medicine

pediatric physiatrist

combined residencies

PMR fellowship

team building

additional certifications

niche practices

diversity

pet therapy