Musculoskeletal Medicine Fellowship Provides Unique Training Opportunities

Cleveland Clinic’s Musculoskeletal Medicine Fellowship trains physicians to meet the increasing demand for musculoskeletal care, particularly in Physical Medicine and Rehabilitation (PM&R).

The fellowship, based in the Orthopaedic & Rheumatologic Institute’s multidisciplinary Arthritis and Musculoskeletal Center at Cleveland Clinic’s main campus, graduated its first fellow in 2014, says Program Director Michael Schaefer, MD.

The program focuses on the treatment of joint and muscle pain and musculoskeletal injuries and less on spine and sports medicine than do some other fellowships. Candidates are primarily sought from PM&R training programs, but Dr. Schaefer says physicians who trained in primary care programs and rheumatology are encouraged to apply, as well as those from emergency medicine, anesthesiology, occupational medicine, women’s health and other board-recognized specialties.

Nonsurgical Injury Care Spurs Need for Training

“Musculoskeletal conditions such as osteoarthritis, sprains, strains, bursitis and tendinopathy are among the most common indications for visits to primary care offices today. The need for nonsurgical care of these conditions is expected to grow with an aging and obese population,” says Dr. Schaefer, who also is Director of Musculoskeletal Rehabilitation, with a joint appointment in the Neurological Institute’s Department of PM&R and the Orthopaedic & Rheumatologic Institute.

He says other specialties do not have enough personnel to meet those needs. Rheumatology is short-staffed nationwide, and orthopaedic surgeons don’t necessarily want to do nonoperative care.

“Typical physiatry training includes musculoskeletal care, but often focuses on spine and pain medicine treatments,” Dr. Schaefer says. “Rheumatology training often focuses on medical management of inflammatory and immunological conditions, but may lack exposure to acute musculoskeletal injuries, spine and neurological ailments.”

Also, he says, many primary care providers do not have adequate training in musculoskeletal medicine and feel uncomfortable managing such conditions, especially the less common ones.

Breadth of Fellowship Is Attractive

Dr. Schaefer says the program is unique in its focus on musculoskeletal medicine.

“Quite a few fellowships emphasize spine or a combination of spine and sports through PM&R, but very few have the breadth this one does,” he says.

The 2013-2014 fellow, Srikrishnac Chandran, MD, says he appreciated that variety.

“Cleveland Clinic’s Musculoskeletal Medicine Fellowship has been a unique opportunity to learn from the leaders of medicine in a variety of disciplines treating the entirety of musculoskeletal disorders,” he says. “Its comprehensive and innovative curriculum has allowed me to learn to diagnose and treat a varied patient population in extraordinarily diverse clinical settings.”

Fellows complete subspecialty rotations in adult reconstruction (total joint replacement surgery), rheumatology, foot and ankle, hand and upper extremities, spine, and sports medicine. Experience in sports medicine is included to provide exposure to acute injury management. Exposure to electrodiagnosis and interventional spine care is available, and additional electives are encouraged. Participation in research activities is also encouraged.

The fellow also gains extensive experience in musculoskeletal ultrasound, with approximately one day per week of dedicated ultrasound exposure.

“We provide the most training in musculoskeletal ultrasound of any fellowship that I know of,” Dr. Schaefer says. Rotations also include observation time in the operating room and in physical therapy sessions.

Dr. Schaefer says the program prepares fellows for a career in an academic or large group practice as a nonsurgical musculoskeletal specialist. Dr. Chandran is moving on to a pain fellowship at a nearby hospital. The 2014-2015 fellow, Enrique Galang, MD, completed his internship and residency in PM&R at East Carolina University.

Physicians interested in applying for the Musculoskeletal Medicine Fellowship may contact the program coordinator, Colleen Vahcic, at vahcicc@ccf.org or Dr. Schaefer at schaefm5@ccf.org.