the AAP's 2024 Fellowship Summer Series featuring spinal cord injury medicine. We have a very informative webinar for you tonight. And I hope that you guys ask any questions that you might have and let the moderators know any things that you might want to know. And we're all here for you to advance your journey in the psychiatry medicine. Well, we're looking forward to having an opportunity to share with you a little bit about our love of spinal cord injury medicine and hopefully convince you all that that's the area of physiatry that you want to practice. My name's Amanda Harrington and I'm so glad to be here with my colleagues. We wanted to take an opportunity just to introduce ourselves. I'm a Florida native, but I'm currently in Pittsburgh. I've been here for 15 years practicing spinal cord injury medicine. My practice is a mix of inpatient and outpatient spinal cord injury in an academic center. And I do mostly medical education and administrative work and love caring for people with spinal cord injuries. All right, so I will go next. I am Felicia Skelton. I'm the fellowship PD down here in Houston at Baylor College of Medicine. I'm a Houston native, born and raised. I spent a total of eight years of my life, not in Houston, four of them in Dallas for college and four of them in Seattle for residency. But then I came back for my spinal cord injury medicine fellowship at Baylor College of Medicine and stayed on. I got bit by the research bug. And so I did a kind of a research fellowship after that. And so now I'm part-time clinical. I work on our spinal cord injury care line at the DeBakey VA here in Houston doing home-based primary care, actually. So I'm a primary care doc for people with spinal cord injuries. And then the rest of my time, I spend doing clinical research and all sorts of different things. And then I have my education and administrative roles as well. So really, really glad that y'all could be here tonight. And I'm Yelena Svircha. I'm originally a Wisconsin native, but have spent at this point, most of my life outside of Wisconsin. I've been in Seattle, Washington for the last 18 years. I've been the CI fellowship director for the University of Washington program since 2012. I spend all my clinical time on the spinal cord injury service at the VA in Seattle, Washington, where I'm an outpatient provider. I provide both specialty and primary care to folks with spinal cord injury. The other portion of my time is spent really in medical education, doing the fellowship, as well as other administrative roles. And I'm very excited to have you all join us today. So we put together a brief PowerPoint just to make sure that we share with you all the aspects of spinal cord injury medicine fellowship training. And hopefully you can use this as a kickoff to some open questions and dialogue throughout the course of this time together. All right, so we'll go to the next slide. So just a little bit about the history. We like to think, and of course we're biased, that spinal cord injury medicine is bread and butter rehab. It is quintessential physical medicine and rehabilitation. As y'all may or may not know, our specialty was born out of veterans coming back from World War II with spinal cord injuries and amputees and all sorts of different things. And so we like to say that if you can do spinal cord injury medicine, you can do anything in rehab. It really is foundational to a physiatry practice. So just a little bit of blurb about us. Again, we address the prevention, diagnosis, treatment, management of traumatic spinal cord injury, but as well as non-traumatic spinal cord injury, which I think a lot of, especially early trainees don't think about. So we do a lot of cervical myelopathy, a lot of lumbar myelopathy. If they have spinal stenosis that you can't inject, you can't necessarily do surgery on maybe, or they do get decompressed, but they have severe enough impairment from that, we take care of them. And so we're doing all that bowel, bladder, skin, pain, spasticity, all of that good stuff. So we do the medical things, the physical things, the bread and butter rehab things, but we also, as all physiatrists do, look at psychosocial and vocational consequences during their lifetime across the spectrum. And so you can do it, pediatrics, if that's your bag, you can take care of people with little kids with spinal cord injury all the way up to, I think the oldest patient I have right now is 97. So we really treat people across the spectrum of the lifespan. So it's been an AB PM&R subspecialty since 1995. Dr. Svirchev, was it the first one or one of the first ones? It was the first one. I think it was the first one. Yeah, that was, again, I didn't wanna misspeak, but I'm almost certain that that was the first one. And it's given out 788 certificates across that time span. And we were speaking just before we got on, there's about 400 currently active spinal cord injury medicine board certificates. So next slide. So spinal cord injury medicine fellowship as defined by the ACGME is 12 months. So just an additional year after your physical medicine and rehabilitations residency, which is one of the specialties you see of which you can go into spinal cord injury medicine. Eligible candidates must have completed an ACGME accredited or osteopathic or Canadian equivalency again in one of these specialties, but it doesn't matter because y'all are going into physical medicine rehab. So you're good. Next slide. Again, the bare minimum of the clinical training is that you have to have three months of inpatient spinal cord injury rehab, a minimum of three months of outpatient spinal cord injury medicine rehab. And again, we'll talk a little bit more about what you do in those settings. But aside from that, programs can be flexible and creative. So that's six months of variation of the lots of different things. And so again, in a lot of programs, you'll either do more inpatient months, more outpatient months, pediatrics, elective time, research time. So it all just kind of depends on what you're interested in. And I know a lot of spinal cord injury medicine fellowships believe in tailoring it to the fellow. And so, you know, it's a nice thing about our programs. I think we do have a lot of flexibility and we are very receptive to our trainees. And so it just kind of depends on what you're interested in. So next slide. And I will take what Felicia had mentioned about flexibility and the ability of identifying a program that really meets your needs. When we talk about those three months of inpatient care, that inpatient care can look very different depending on what institution you train on, train in, and what type of environment you're most comfortable in. So inpatient care can happen in a freestanding rehabilitation facility. There are rehab units within the hospitals that offer both acute and chronic care. At times, SCI fellows will be on units that are working with, will be on general rehab units where you'll have SCI patients as part of that versus exclusively SCI unit. Next, as listed there, there are SCI specific units. Generally, those first four are environments that are PM&R run and operate within the guidelines of Medicare. So those are patients who are going to be receiving three hours of rehab a day and have the SCI diagnosis. Inpatient care at VA looks very different. So if you're working on an inpatient SCI unit within a VA hospital, we take all comers and we don't necessarily have to have our acute folks working three hours a day, nor do folks need to be receiving care for their acute spinal cord injury. So in the VA system, we offer lifelong care, which means that we will have folks on our inpatient teams who are there for acute or subacute level rehab. They are coming to us with medical consequences of spinal cord injury. They are coming to us for routine SCI care. And at some cases, we have the privilege of offering them end of life care. So you really have the opportunity to see the spectrum of care for folks with spinal cord injury. There are inpatient pediatric spinal cord injury units. And of course, within all of these types of rehab settings, there's always going to be the opportunity for consultation. So consultation to individuals with acute injuries, so working with neurotrauma units, consultation for individuals who are chronically injured, who are coming in with medical consequences of spinal cord injury. So you as a provider on the inpatient side during your fellowship will have lots of opportunities to interface with different types of inpatient learning environments. And next slide, please. Similarly, outpatient care is incredibly, incredibly diverse. There are general rehab clinics that see individuals with spinal cord injury. There are SCI-specific clinics. And those SCI-specific clinics sometimes are things like spasticity clinics, seating clinics, wound clinics, long-term health clinics. There's pediatric rehab clinics. There are ALS, MS, spina bifida, neurodevelopmental clinics. So those are all diagnoses. Dr. Skelton mentioned the non-traumatic spinal cord injury component of care. There are congenital disorders or acquired disorders such as ALS or MS that fall under the SCI umbrella and are oftentimes seen in the outpatient setting. And then lastly, of course, with COVID, we were given a kick in the pants and have developed a very strong telehealth prevalence. And when we think about spinal cord injury and some of the challenges that our folks have, accessing care physically, getting into a hospital to see someone or getting into an outpatient clinic, this has been an area of tremendous growth and tremendous service to our folks. And just another way that we can offer that lifelong care and comprehensive care to our folks with spinal cord injury. And next slide, please. Dr. Harrington, are you addressing this one or is that supposed to be mine? I've lost count of my three slides. I lost count too, so why don't you take this one? I will take clever and learn it. So when we're seeing folks both on the inpatient side and outpatient side, we are always communicating with our different colleagues from the specialty. So oftentimes, certainly on the inpatient side and oftentimes also seen in the outpatient side that the clinic environments that you'll be working in or some of the conferences that you'll be attending you'll be joining with your colleagues from neurosurgery, orthopedic surgery, neuro-urology, neuro-radiology, plastic surgery, neuro, and of course, the general kind of rehab colleagues that we'll work with frequently, PT, OT, speech and language pathology, right therapy, social work, rehab site, home care, palliative care at times, our pain services and vocational rehab. So it's an incredibly stimulating environment to be part of because you are not only offering really specialized care to an individual with an injury, but you are always looking to your colleagues for their expertise and they are looking to you for your expertise in spinal cord injury medicine in order to deliver that care to the individual. Yeah, I would agree. I think not a day goes by where there's not some sort of collaboration via email, text, phone about patients from other disciplines. And that's part of that multidisciplinary aspect of care is one of the things that we really love about spinal cord injury. And so when you're caring for that person with a spinal cord injury, whether it's somebody with a brand new acute injury, whether it's somebody who you're following, 40, 50 years post-injury in the outpatient setting, there's gonna be a lot of parts to medicine that you're helping to manage. Potentially that acute trauma, musculoskeletal discomfort, pain. And so with that, there's a lot of components to their care and different spinal cord injury docs do different procedures. Many will do EMGs, nerve conduction studies, ultrasounds, trigger point injections, joint injections if somebody's got some classic MSK, osteoarthritis dysfunction with spasticity, a lot of botulinum toxin injections, back health and pump management and refills. There's a lot of spinal cord docs that will participate in adaptive sports, either volunteering their time or just going as a cheerleader for the teams as they're playing. On the acute floors in particular for patients with brand new spinal cord injuries, there is a lot of medicine at play. You're managing neurogenic bowel, neurogenic bladder, a lot of pain, excuse my cat that's participating in this talk today. And so there's a lot of skincare, wound management. So there's a lot of aspects to kind of a systems-based care for the patients with acute injury. And so some systems are set up where the spinal cord doc is managing the spinal cord aspects of care and then you consult others on those other specialties to play a role in the patient's care and they have their own primary care doctor or you can actually be the role of the primary care doctor kind of in this care of that person for spinal cord injury and outsource other things kind of on an as-needed basis. But regardless of which model, it tends to be a long-term kind of relationship that you build. These are relationships you're gonna meet them when they first have a spinal cord injury, follow them through their rehab and then continue to follow them throughout their life. So it's really great feel for people that value those long-term relationships. And I think particularly for someone with a new spinal cord injury when they are very scared and very overwhelmed with their new diagnoses and you help them get through that, then that really develops kind of a unique and special relationship that you might not get in other areas of rehab. In terms of what you could do post-fellowship, I think we've emphasized that there are certain aspects to fellowship that would include inpatient and outpatient, various different types of exposures, but there's a lot of opportunities to make that fellowship year what you want. So people can kind of build a fellowship into potentially into what they think their career trajectory is gonna be. Some people do just inpatient spinal cord medicine. Some people do just outpatient spinal cord medicine. There are people that are just consultants and that can happen in an academic setting, in a kind of a multidisciplinary kind of group setting, you know, a VA setting. And so there's a lot of different ways that you could go beyond just providing clinical care, but there's certainly plenty of jobs if that's you wanna just practice spread and better spinal cord injury. So in an academic setting, you could theoretically be a spinal cord injury program director like the three of us, or teach residents, teach fellows, teach medical students, or research, if you're interested in research, you could do, you know, anything from bench to translational research, clinical research, model systems database. There's a lot of research out there and there's a lot of research dollars available through both the model systems and the Craig H. Nielsen Foundation. If you're interested in leadership and administrative roles, there's always opportunities to be a medical director of a spinal cord injury unit, a program director within say a residency program separate from spinal cord injury, obviously vice chair or chair of a department, a chief medical officer in a hospital system, so a lot of leadership opportunities. And then there are people that will also do utilization review and life care planning because of the unique costs associated with lifelong living with a spinal cord injury, it positions people to have a lot of knowledge about what someone might need longitudinally. And so if doing some more of that administrative review or working with an insurance company or life care planning company would be something you would be of interest, that would also potentially be an option. I think the biggest things that we wanted to highlight is just the flexibility in creating a program, a fellowship program that would be tailored to the fellow's interest. Most fellowship programs kind of have a 12 month curriculum and they're trying to get all the ACG&E core program requirements in, but there is some opportunities for flexibility based on a fellow's potential interest. Lots of time for interdisciplinary learning, not just across with the therapies, but also the other departments. Some fellowships have opportunities to observe surgeries, to observe therapy sessions, participate in home visits and go out and try adaptive sports, which everybody loves. And then also getting mentorship from this really little loving community that is spinal cord injury. We kind of joke that we're all like the spinal cord docs are all friends with one another. And so it's really great when we have our national meetings and it's almost like coming to summer camp year after year when you get to see everybody. And it's people that just really have a joy to care for these patients and really love sharing information and clinical pearls of how we can take care of these patients. So there's a lot of mentorship invested into each of our fellows across the country, not just from the people at your own program. So I think that's it from our little PowerPoint. We wanted to open it up for questions. So I'll start with a question that was sent to me beforehand. Do I really need an SCIN fellowship and what are the advantages of doing one? I'm happy to answer that one. So I think you're more marketable the more degrees you have, right? And so if you have fellowship training and you're going into a job market, having that extra training would potentially make you more marketable than another candidate. And it also gives you 12 months to just really focus on spinal cord injury medicine. I always tell my fellows, that's the, this is the year to really become a spinal cord injury nerd and just get all of that information, soak it all in, and it really helps make you a really well-rounded clinician so that you can provide the best care for your patients. So, I mean, we are 100% biased, but definitely feel like that fellowship year is not just extra, it's really important. Yeah, and I'll echo Amanda's concerns, or Amanda's statement. It's really an opportunity for you to deep dive into the topic of spinal cord injury. During PM&R residency, while you're on the inpatient services, such a large amount of time is taken in the direct, very important, but minutiae care of the patient. So making sure that all the orders are entered in a timely manner, making sure that all the documentation is completed in a timely manner. And sometimes residents are challenged at having time to sit back and think about, why am I ordering this physical therapy? And what exactly are they doing? And why are there four different types of commode chairs isn't one style fits all for everyone's bowel needs, for example. So having that one year of fellowship will allow you the time not only to develop that expertise and move away from being the direct order of the co-lays, to the helping a team manage neurogenic bowel, but it also gives you an opportunity to be like, hey, I'm going to go hang with the physical therapist for a while to actually see what an Aspen seating system is, or I'm going to go spend time with an occupational therapist to figure out what all these different commode chairs are about. The other piece that I would have you all consider is within PM&R residency for certain things, such as EMGs, we require residents to have X number in order to demonstrate competence. I would argue that there are certain diagnoses that we should consider setting similar parameters. So it is not sufficient to treat four people with SCI and think, I'm now an expertise. I'm an expert in that field. So if you truly want to develop that unique skillset and that knowledge base that comes to really provide someone with a spinal cord injury, holistic, holistic care, I would argue that one needs repeat exposure. You need practice doing it. And that one year of fellowship will allow you ample practice at seeing how the same spinal cord injury, T7 paraplegia presents in many different people. And I'll pause there and offer Felicia an opportunity to speak. That's from a very practical standpoint. Many positions within VA either require or strongly prefer a spinal cord injury medicine fellowship trained physiatrist. So that's just one very practical reason. If you don't do a fellowship, you're really not going to be competitive for that job market at all. But then I just echo everything that everybody else said. Again, if you want to go into academic medicine, like all of us have, I think that fellowship year is a very good on-ramp for that. We encourage our fellows to, well, they're voluntold that they have to give a lecture to the residents every month. But guess what? In their six months that they're here, they've now developed six bread and butter topics on neurogenic bowel, bladder, whatever they decide to do, and you're going to recycle those lectures for the rest of your career, I promise you. And so we like to kind of push them out into the world with a little teaching portfolio and experience in doing that. We encourage them to be junior attendings. And so not only just kind of like Dr. Church was saying, that kind of bread and butter, like nose to the grindstone, doing all the orders and the scut work, but really thinking more globally and starting to practice and develop your styles of attending, because it's not something that comes naturally. It has to be developed. And so for nothing else, it's a very practical, structured time to just kind of get ready. It's like an on-ramp to that. So. I had a question. Good evening. Good evening, everyone. Thank you so much for taking the time to talk to us. The concept of this flexibility of those potential six months for some fellowship programs is really interesting to me. What are some questions that we can be asking as residents to kind of tease out or figure out, you know, what experiences should we seek out in fellowship or what those potential six months could be? Well, I will say that I struggle every year with squeezing everything we want to do in a 12-month period, because if you remember for the Spina Chord Fellow, they finish residency, oftentimes relocate, start fellowship, have to study and take their written boards first week of August, then come around May, they got to take their oral boards again. And every year I say, oh, gosh, they've got all these experiences that we didn't get done with that I would love to have done. And so most of your fellowships have a really kind of well mapped out plan of what you're doing, which usually is like, usually it's all inclusive of all the things you want to do. So I think that most fellowships don't require a lot of tweaking because they're so great as they're how they're built. But I'll give you an example. At our program, we don't have EMGs built into the Spina Chord Fellowship here. And so I've had some fellows that say, I really like EMGs. I think I want to do EMGs in practice. Is there a way for me to add some EMGs so I don't lose my skills? And so that would be just like one example of something that we would add. And we do, you know, there's varying different modalities to say, do neurotoxin injection. So some people prefer electrical stimulation. Some people prefer EMG guided, some people prefer ultrasound guided. So if you had a certain skill set that you wanted to maintain, or opposite a skill set that you didn't get a lot of exposure to in residency that you'd want to get into in fellowship, those are things that you might want to say, hey, is there any exposure to A, B, and C? I agree. Like the core rotation, again, with flexibility, I mean, there is some flexibility in the way we have our setup, as long as you do the inpatient and the outpatient months. The research stuff is optional. I think the ACGME will allow up to 20% of protected research time within a clinical fellowship. So if you have somebody that they really see that as being a big part of their future career in practice, then you can set aside that amount of time for them. And then just kind of like Dr. Harrington was saying, if you know that you're really interested in wound care, or you feel like that's a weakness of yours, then we have you work with our geriatric wound care colleagues in addition to the wound care that you do during your inpatient months. And so I think spinal cord injury medicine teams tend to be very well connected. And so we can phone a friend and say, hey, we have a fellow that wants to do X, Y, and Z. And we can kind of tailor those experiences for you. Yeah, I think during the beginning of fellowship, there's going to be an orientation where you're going to review all the kind of the built-in program, what's included, and then you kind of can reflect and say, hmm, maybe I'd want to try something else. And then you can just bring that to your program director. And I would say, you know, everybody is very open and willing to accommodate within their power, right? So you know, if you said, I want to do 50% of my time doing sports ultrasound, I would say, well, that's not part of the spinal cord fellowship, right? But I had a fellow once who said, I'm scared to poke needles and things. I didn't do this much during residency. And my goal for the year is to feel like I can do neurotoxin injections and baclofen pumps without panicking every time I see a patient. So in that example, we added some extra spasticity clinics throughout the year, just to make sure that that goal was met. I would also add, be very comfortable talking to as many SCI fellowship program directors as you can, as you like, and do not limit yourself to talking to them when you've already committed yourself to an SCI fellowship and are on that interview pathway. All of us are thrilled to talk with our twos, our threes about, I'm thinking of maybe applying for fellowship. What can you tell me about it? And to share information about our program. Be comfortable asking folks, what is the curriculum like? So those three hours, not three hours, the three months inpatient, three months outpatient, that's minimum criteria that ACGME has set for us. But that doesn't mean that that's the way programs may offer their fellowship. So our fellowship, for example, those four months of inpatient, four months of outpatient, and then the other four months are divided between acute consults and academic productivity. And the other piece Dr. Skelton kind of mentioned, and I think Amanda also hit upon, was when we think about what historically has been called research, I think most of us have recognized that research isn't limited to classic bench work or clinical chart review research. That there's this idea of academic productivity and that folks can contribute to the wider academic knowledge in publishing chapters, in developing presentations to peer groups, to consumer groups, to writing more summary style articles, to doing case series or case publications. So when we think about how we as individuals can contribute to the greater knowledge of SCI, don't limit yourself to, I have to, you know, I kind of like research, that means I have to do this research, but rather there's this more expansive, how can I share my knowledge? And that may be more in an educational realm, and many of the programs are flexible at offering those types of opportunities to our fellowship trainees. Hi guys, my name is Hank. Sorry if this has been asked. I've been in and out a little bit because I'm on call, but my question is about like kind of what you're just touching on a little bit, but when we're looking into fellowships, how to decide and how to differentiate programs, and how much do you think the quality of a fellowship depends on the institution as a whole, or more so like specifically the mentorship of the program director? I guess just any tips that you have in terms of how to assess the right fit for that year? Thanks. So I'll start and allow my colleagues then to compliment. Know that this is an opportunity for you to choose the program that best meets your needs. I'll use myself as an example. When I was applying to medical school, I would have sold my right kidney to whatever school would accept me. At this point, when it comes to spinal cord injury fellowship programs, there are more positions than there are applicants. So it is a very unique situation that you'll find yourself in, in your ability to identify what your interests are and you finding a program that best align with that rather than you trying to get in wherever it will take you. And I'll pause there and I guess the other piece I'll comment on along those lines, that means when you are talking to programs, look to a place that is best going to meet what your needs are and where you are as a learner. And that may mean finding yourself with a smaller program that has had fewer candidates simply because they are a new program versus a more historically more well-established program. It doesn't matter the size of the institution or the name of the institution, but rather how that program is able to set up a program that best going to align with your interests. The other piece to know is that even if you choose to go to a program that is smaller, that may have three SCI staff on their team, that doesn't mean that you don't have access to the entire country of SCI positions. We are tiny and we are mighty. We all know one another. Felicia Skelton and I met when she was a resident here. Amanda Harrington and I met when we decided to align and lead the SCI Fellowship Program Director Group. Dr. Skelton and I worked together on an APS committee. Dr. Harrington and I have worked on ABPM&R and oral boards committees together. So we will all work together and we all, during that fellowship year, start facilitating connections with our fellow with that wider community. Go ahead. Oh, I would say the only thing I would add is that I think, and I think this is my bias is because I think it's so important and I've benefited from some really good mentorship, but I think mentorship should definitely be on the table during the fellowship. I think that across the country, you're going to go and get great clinical training no matter where you go. I think most of the spinal cord injury fellowships are very, very well-established programs. They have the institutional support. They have the support of the Craig H. Nelson Foundation sometimes. That's not a problem. And so I think you want to, in addition to just finding the little particulars that align with you, I think you want to go to a program that's going to develop you as a physician, as an academician. And if that's something that you're interested in, and then as a person, I think that you should find a program that wants to, that is invested in that. Because I think that's the, and again, it's not just going to be from the people there, but that are going to take you to ASCIP and introduce you to all these wonderful people from across the country and help you get involved. And again, if academic medicine is where you want to go, which again, you don't have to, but a lot of us do, that will help. I think that that fellowship year should help support you for that. So in addition to the clinical training, I think looking for good mentorship and sponsorship would be really good too. Yeah. It's kind of comes down to that gut feeling. I think sometimes, you know, where you just feel like you might click with the people that you meet on the interview, but there's a practical piece too. So there's not a spinal cord injury fellowship in Hawaii. So I could use that as an example, right? But if you have grown up every day at the beach surfing and you maybe live on the West coast, that's a pretty short flight. That sounds great. Let me go out there. I can, you know, hang loose and surf in my free time. But if you're on the East coast and you are about to, you know, have triplets born and you need your family nearby and they're right down the street, I mean, those practical geographical things we see that a lot too. And I think to Dr. Skelton's point, you're going to get a great, great training wherever you go. So I think there's a lot of things it's, do you click with the, with the people? Can you get the good mentorship and what makes sense geographically and practically for you? I've also had people say, Hey, it's one year, I'm going to just go somewhere that where I don't think I'm going to wind up or live because it's my one year to go somewhere fun, you know? So, so I think there's a lot of different, different considerations. It's the same as when you're picking other schools, things you're getting your, you know, your pros and cons. And there's probably a lot of factors at play. So good question, Hank. Other questions? So I put another question in the chat. After completing an SCIM fellowship, am I committed and or pigeonholed to practicing 100% SCI? Definitely not. We've seen that I've gone and done a little bit of SCI. People that do mostly specificity on some patients with SCI, patients with other diagnoses. So definitely not. I would argue unless you stay within the VA system, you're not going to do a purely SCI job. It doesn't, there's not too many of those out there. I had one fellow a few years back now that was actually already out in practice, but was in a smaller community, kind of in the Rio Grande Valley down here in Texas. And really just felt like he needed to brush up and on like his specificity skills and some of those kind of more nuanced rehab skills so he could take it back to his patients in the Valley. And so that's why he did a spinal cord energy medicine fellowship. Again, going back to the folks that were with us at the beginning, this spinal cord energy medicine is foundational to physiatry. The things that you learn with us, if you can do it in our patients, you can do it in just about anybody. And so that's literally the reason he did a spinal cord energy medicine fellowship. But no, he doesn't have a pure, I don't know how many patients with spinal cord energy medicine he sees down there to be perfectly honest with you. So no, you can go and do whatever you want, really, but you'll have that good foundation. So. Well said. Oh, sorry. I was just going to like piggyback that question a little bit. Similarly, if we do want to do as much SEI as possible and make our career as SEI focused as we can, how is the job market for those types of positions? I think the job market is quite good. If you choose to stay within the VA system, VA SEI centers across the country are always looking for board certified fellowship trained applicants. Spinal cord injury, I have no idea why, because I love it, is an area of rehab medicine that not a whole lot of people want to do. So if you go into a general rehab practice and say, hey, I want to take all the folks with spinal cord injury, in most centers, they will be delighted to have you provide care for those folks. You are for the most part, if you are choosing to do primarily SEI medicine, you are for the most part going to be working in a more urban environment. There are opportunities for some midsize SEI practices, and I think with the expansion of telehealth, there are some really creative opportunities to expand SEI to our less served communities and rural environments. But if you are going to be practicing primarily primarily SEI medicine, you are going to be in a larger urban city. There's a couple cities that may be a little bit saturated, and so if you have a very specific city that you might want to go to, in an academic setting, you may have to wait until somebody retires to sneak back in there. But most places are really open to having people, and even if it's like, if you want to be in a certain city for practice, if you're saying, I'm willing to take care of patients with spinal cord injury in clinic and specificity, a lot of times, I've had previous fellows that have said, okay, I will take this job and take as much spinal cord as I want, because we said, right, you're not pigeonholed into spinal cord injury. So there's definitely jobs that are, and there are markets where they're saying, we need somebody with SEI fellowship, come to us now. And it just kind of depends on at the time of finishing fellowship, where you might want to be geographically, and how flexible you are. Other questions? Are there any other tidbits of wisdom or advice you would like to give to the viewers here on the live webinar and also to the people that will be viewing this on our virtual campus later? I guess one thing that we can talk about that I think that I have found very rewarding as a spinal cord injury medicine physician is that the whole idea of a physician as an advocate, I think we all are to a certain extent because we're respected in our communities, we have a unique voice, we have a unique platform, whether we ask for it or not. But I think within physiatry and then specifically within spinal cord injury medicine, we have a really important voice and we advocate for a very vulnerable set of our population and I just find that very rewarding. And you're like, well, you know, I'm not talking about politics, that's not what I'm talking about. I'm talking about being the voice, this came up Friday actually, being the voice on your hospital committee to say, hey, can we change the clinics from walk-in clinics to same day? Because walk-in is ableist. Can we make sure that everybody across the hospital knows how to use the ceiling lift, the Hoyer lift instead of just the people in spinal cord injury, because our patients actually feel kind of unsafe going to certain places because they think that they're going to get dropped or something like that. And we make sure that the women's clinic, you know, has accessible tables and that sort of thing. And so it's the, I say the little things, but the really big things that I've had the opportunity to do being a spinal cord injury medicine physician that I have found really rewarding and then I've also chosen to do other things just because I just feel like the need is so great. And so that's another neat thing about our specialty is that you really, you really get to learn the ins and outs of a very unique population, a unique patient population, and you get to be their voice in a lot of settings to where they don't always have a seat at the table. And, you know, if we're really good, we actually get them a seat at that table too. So I just wanted to throw that out there too. One additional thing is with a specialty being so small, there are so many opportunities for professional growth within the field nationally. Within our organizations, there are committees that are always looking for new members and young members to bring in new ideas and new skills and different perspectives. So for folks who are interested in joining national committees and potentially taking on that advocacy to a more political level, be it within the governmental realm or within policy development and creation, all of the SCI organizations welcome new people and new ideas into that. And it's a very supportive community when it comes to that type of kind of leadership growth and organizational growth. Any other questions anyone has to ask our panel tonight or any other statements the panel would like to make before we close this meeting out for the evening? I think we just like to thank you all for coming and for hearing a little bit about spinal cord injury. Again, we are completely biased but we think it's the best subspecialty in all of physiatry where you can really make a great difference in the lives of your patients longitudinally. We're a close-knit community, we have a lot of fun. And so we'd encourage you to come have fun and join us. Thanks so much for your time and for answering our questions, I appreciate it. And thank you all for joining us. This webinar is recorded and will be on our virtual campus in the coming weeks. So spread the word about SCIM Fellowship. And if you have any questions, you can feel free to reach out to me. My name is Jewel Fawcett. I work at AAP as an educational specialist and we have more fellowships coming this summer. And we look forward to hearing from you guys as you go along your journey in physiatry. Thank you so much. Good night, y'all. Thank you, have a good night.

spinal cord injury

fellowship training

SCI medicine

clinical opportunities

interdisciplinary collaboration

VA centers

physiatrist advocacy

professional growth