Interviewed by Brandon Barndt, DO and Austin Marcolina, DO
Zachary Bailowitz, MD, is a Physiatrist and Primary Care Sports Medicine physician in the Department of Orthopedics at Kaiser Permanente in Oakland, CA. He attended medical school at the University of Arizona College of Medicine in Tucson, AZ, and residency in Physical Medicine and Rehabilitation (PM&R) at Carolinas Rehabilitation in Charlotte, NC, before completing a Sports Medicine Fellowship in the Department of Rehabilitation and Regenerative Medicine at Columbia University in New York City.
Q: For starters, tell us your path to where you are today. How did you learn about PM&R, and more importantly, what drew you to the specialty?
Before I even knew about physiatry, I worked with my uncle, who was a chiropractor who treated athletes. He was always learning and teaching me about function in athletes and to evaluate the way an athlete moves not just their injury, and it inspired me to be interested in a career in musculoskeletal medicine. Then during 1st year of medical school I was lucky enough to attend the medical student portion of the AAPM&R annual assembly, and I knew from that brief conference that physiatry was the right field for me.
Q: Were you involved in leadership organizations, extracurricular activities, or research while in residency? Would you mind divulging into some of what you were able to accomplish?
As far as leadership, I was nominated to be on the AAPM&R PHiT council, which I served on during a PGY3 and as a Fellow. This was a great experience to learn more about the national leadership of the Academy as well as get a better understanding of where the field of physiatry is moving. I also was the chief resident at Carolinas Rehabilitation, which was a great way for me to help teach, lead, and improve my residency program.
As far as extracurricular activities, most of my time was spent doing sports coverage, as I knew I wanted to pursue a fellowship in Sports Medicine. I worked at the Charlotte Marathon and was involved with the adaptive sports program in Charlotte. I also worked with the special Olympics and ran one of our biannual medfest events to screen disabled athletes. But perhaps my favorite experience was being the team physician for a local high school football team during my 4th year of residency. This was so rewarding to be on the field each week and able to see the kids on a regular basis.
In terms of research, I did multiple projects surrounding EKG screening as part of the pre-participation exam for athletes. This is a very hot topic right now, and it was great to be a part of this discussion in a meaningful way. My colleague and I also created a novel technique for evaluating patellar tracking using musculoskeletal ultrasound, and we’re continuing that research now that I’m in my fellowship and plan to finish in the coming years.
Q: Was it always your plan to pursue sports medicine as a career, or something you realized while in residency?
I always knew I liked the idea of treating athletes in clinic, as I felt they were some of the most motivated patients to work with. However, during residency, I began to realize that there is a difference between seeing musculoskeletal patients in clinic and actually doing sideline coverage and training room coverage where you see the injury in its hyperacute stage. Seeing the entire spectrum of an injury is something I’ve really come to enjoy, so I made the decision to go for full accredited sports medicine fellowship during 3rd year of residency.
Q: What is your favorite aspect of sports medicine?
As a physiatric sports medicine physician, I often see the more complicated and challenging cases. I like using my background in physiatry and my knowledge of the spine, peripheral and central nervous system, and the musculoskeletal system to make the most accurate diagnosis for the patient and hopefully get them back to their sport as quickly as possible.
Q: How do you see the fields of PM&R and sports medicine changing within the ever-changing landscape of healthcare?
I believe sports medicine will become more procedural as time goes on. As more and more midlevel providers join our hospital systems, the day to day of seeing patients in clinic may take a back seat to team coverage and ultrasound/fluoroscopic guided injections. PM&R doctors, though, are in a unique position since we have such a wholistic approach to musculoskeletal pathologies. Always making sure to keep your history and physical exam skills sharp will ensure that you will be a cut above the average musculoskeletal provider.
Q: As there are fellowships from both physiatry and family medicine departments, could you describe the differences between the two types of fellowships?
This is not easy to answer as many programs, whether they’re based in departments of PM&R, family medicine, or other (ER, peds, internal medicine), have specifics that make them unique. However, all sports medicine programs have to meet ACGME requirements, so I would imagine there are more similarities than differences.
In general, family medicine programs may have more focus on the overall medical care of the athlete (cardiology, pulmonology, etc.) while PM&R programs may focus more on musculoskeletal and spine care of the athlete. However, this is highly variable and depends greatly on the faculty and the institution. PM&R programs are more likely to offer opportunities to do interventional spine injections, but those opportunities may also exist at other programs. Family medicine programs may have increased exposure to pediatric patients.
My best advice when trying to decide between programs is to look into the specifics of the individual program and figure out what aspects are important to you. I would base it less on the department and more on the specific faculty, interests, and focus of the program itself.
Q: What does a week in the life of a PM&R-based sports med fellow look like?
My week was pretty variable, which was one of the most exciting parts of it. In general I would spend about 8 half days total in clinic, which would vary between general MSK clinic, sports medicine clinic, and continuity clinic in my primary specialty. I spent a ½ day each week in the Columbia University training room where I was evaluating mostly non-MSK pathologies of the university athletes. This was a great opportunity for me to round out my sports medicine education and help me prepare for the boards with all of the non-MSK aspects of treating athletes. Then I had a ½ day of academic time where I could focus on research, teaching, and other administrative responsibilities. The remainder of my week was highly variable depending on the season. I would typically have 1-2 sports coverage opportunities each week, would be helping out with pre-participation physicals, or after-hours ultrasound teaching with residents.
Q: Now that you have finished your fellowship, where are headed to and how has your perspective changed?
I am heading to Oakland California where I’ll be one of 4 primary care sports medicine doctors in the Ortho department at Kaiser, Oakland.
As I was going through the process of interviewing and eventually accepting a position, I think the biggest thing is going to a fellowship that is flexible and exposes you to many aspects of sports medicine. The job market is variable from year to year and it’s important to be able to make yourself marketable to multiple types of practices (private, academic, etc). My fellowship was very flexible and allowed me to pursue multiple interests, which ultimately made me a better candidate for the different jobs I pursued.
Q: What resources/activities would you recommend for those interested in a PM&R-based sports medicine fellowship?
The American Medical Society for Sports Medicine (AMSSM) is a fantastic resource for all things related to sports medicine fellowships. There you can find descriptions of various fellowships, educational tools including phenomenal ultrasound videos, and dates of upcoming conferences. I would recommend that anyone wanting to go into sports medicine attend the AMSSM annual conference at least once during residency. The AAPM&R also has some resources on its website about pursuing a sports medicine fellowship. But honestly the best resource for me was to speak with various sports medicine physicians of multiple backgrounds, whether that’s PM&R, family medicine, or another background. I learned so much about the field of sports medicine as a whole just by talking with current fellows and physicians, and I’d be happy to speak with anyone that is interested!