Interviewed by Brandon Barndt, DO
Michael B. Furman, MD, MS is board certified in Physical Medicine and Rehabilitation physician with ACGME sub-specialization in Pain medicine and Sports Medicine. He earned his BSE and MS in Chemical Engineering from the University of Pennsylvania and Cornell University respectively, and received his MD from Temple University.
He has been in private practice since 1995 with OSS Health in York, PA. He is the Founder and Director of the OSS Health Sports Medicine and Interventional Spine Fellowship at OSS Health and has trained over 80 fellows.
Dr. Furman lectures and teaches workshops internationally on various musculoskeletal and related topics. He is a senior instructor for SIS. He has received several awards for his teaching, service, and clinical care including the PASSOR Legacy Award, AAPM&R Musculoskeletal Council Service Award, PASSOR Distinguished Clinician Award, and the Richard and Hinda Rosenthal Foundation Lectureship Award. He is the lead editor and author of Atlas of Image-Guided Spinal Procedures, now in its second edition.
He has served on numerous AAPM&R, PASSOR, RPC, NASS, and SIS committees and task forces including those covering non-operative treatments, research, medical education, clinical guidelines, maintenance of certification, credentialing, billing-coding, finance, and bylaws. He was chair of the AAPM&R Resident Physician Council (currently known as President of the Physiatrist in Training Council-PHiT), has served on the PASSOR Board of Governors and the AAPM&R Board of Governors.
PM&R is a growing field, but historically remains smaller than most. How have you seen it grow over the years?
I have seen the field of musculoskeletal medicine and the role of ultrasound take off especially in the last several years. Additionally, I have seen spine care research and interest growing as well. What is gratifying is that some of the best researchers in the fields of musculoskeletal /spine care are physiatrists.
What first attracted you to the field?
My original training is in engineering, so I tend to think very logically and pragmatically. When I was in my first year at Temple medical school, I went to a weekly PM&R elective at Moss rehab. When I did my rotation, I saw the gait lab with Dr. Esquenazi and then met Dr. Nat Mayer, who was focused on other aspects of motor control. I ended up doing an independent research position with Dr. Mayer and I was sold. Physiatry's focus on function was a great fit for my logical/pragmatic thought process
What advice would you give to those of us in-training or just starting our careers?
Do your homework for every patient and every clinical scenario that you can. Be a team player at all times. This includes working well with your co-residents, your medical teams, and everywhere you interact with others, including caregivers of patients. Regardless of whether the rotation is one that "turns you on" it is important to devote yourself to your work and your coworkers. This advice should be present at all times. This would be when you are in training, out of training, or even and in your final career. Your reputation almost always follows you…Make it a good one!
What are the various fellowship options available today for physiatry residents?
There are ACGME fellowships in many of the subspecialties of PM&R. I will focus my discussion specifically on the fields of ACGME pain, ACGME sports, and NASS recognized fellowships
What are the differences between them, especially ACGME sports vs ACGME pain vs non-ACGME sports and spine?
Sports medicine: The medical discipline concerned with physical fitness and the diagnosis and treatment of injuries sustained in sports activities.
Pain medicine : The medical discipline concerned with the diagnosis and treatment of the entire range of painful disorders. During a pain medicine fellowship, you would be expected to rotate with anesthesia, psychiatry, neurology as well as PM&R https://www.abpmr.org/Subspecialties/Pain
Spine care focuses mostly on nonoperative spine care and it typically prepares you for interventional treatment options. However, most of these fellowships also include other aspects of musculoskeletal care including diagnostic ultrasound and its use in therapeutic management. In our practice, we cover spine care, musculoskeletal care and ultrasound. Most recently, many of us have worked with NASS and have since created interventional spine musculoskeletal medicine fellowships
It is better to get the best possible training than just a "piece of paper. " I have trained almost 90 fellows, and almost none of them have had issues with credentialing. I highly encourage all of you reading this to determine where you see yourselves practicing. For example, if you want to do primarily sports medicine, that would be the appropriate fellowship. If your interest lies in doing inpatient pain medicine, treating CRPS, cancer pain, chronic opiate management, then a pain medicine fellowship is the most appropriate one.
Most of the fellows we train are interested in doing outpatient musculoskeletal care including spine and ultrasound. If that is your interest, I suggest looking into the NASS recognized fellowships. The most important advice I would give is look at the day-to-day routine you experience during your fellowship interviews. If you can see yourself practicing that way, then that is the route to take.
For those of who are going to be interviewing for fellowship interviews soon, how would you recommend that they prepare?
Applying for fellowship starts earlier than that. In particular, be a good resident. In other words, see above. If you are a hard-working resident and a true team player, your reputation is known and will be reflected in your reference letters.
As you are applying for fellowship, truly try to figure out what it is you want to do. Be sure you understand the difference between the different fellowship types I described above. Ideally, shadow folks who do these various subspecialties and make sure that is what you see yourself doing for the rest of your professional life.
Once you figure out what you want to do get your applications in early. Figure out who would give you a good reference letter. Consider doing a rotation at a place doing a practice similar to what you see yourself doing.
It seems like there is a growing number of procedures that are being done by physiatrists, such as ultrasound-guided tenotomies and regenerative medicine procedures. Where do you see this aspect of PM&R going?
This all depends on what the research shows. If, indeed, these procedures are improving patients’ function, then this field will grow. Conversely, I have seen many procedures come and go based on lack of research proving the efficacy. Conceptually, regenerative medicine makes sense. I still wait to see where the research takes this.
You are in private practice and run your own fellowship, and you do research. You must have a lot on your plate on a week-to-week basis. What is a week in your life like?
Quite busy. I work 4 to 5 days weekly but still use weekends to get caught up with the non-clinical activities. I do my early morning exercise before work or I would never be able to get it in. I spin, swim, and/or lift. After an early morning workout, I come in for our 7 AM lecture series at least 3 days a week to teach the fellows in our protected morning rounds. Most days, I see clinic patients, do interventional spine procedures, and/or musculoskeletal diagnostic ultrasound and use it for therapeutic procedures. At the end of the day, I usually try to keep up with my other academic interests: research, writing, preparing lectures, or attending practice meetings. I am in the process of writing up our research on preprocedural anticoagulation/antiplatelet management, and have another article describing proper use of the contralateral oblique in cervical procedures. On top of that, I balance my social and family life.
This year I am looking forward to helping with the translation of our atlas to Mandarin Chinese, a potential lecture/workshop in China (which was recently canceled due to COVID-19), and I just finished running our biennial past fellows’ course which was in Georgia. I am also looking forward to a lecture at Louisiana State University (LSU) where I am giving an honorary lecture. We also have our annual resident’s course at OSS Health. On top of that, I will most likely be doing some additional teaching for some of the established organizations such as SIS, NASS, or AAPM&R
What made you want to pursue the things that you do now?
I enjoy learning. Having the fellows helps me keep learning. Overall, I think there are 3 things that are independent of each other yet build on each other: research/writing, our fellowship, society volunteering (i.e. SIS, AAPM&R) contributions. These three intertwine with each other. I could not do the research without the fellows. I would not have the reputation in the academies and societies without the other two. I could not attract great fellows without the other two.
What are your research interests? Mostly spine care
What projects have you been working on most recently?
We are developing the atlas further perhaps with videos. Anticoagulation: I truly feel that stopping the medications before a procedure is riskier than continuing them. We just finished a chart review of over 6000 patients on anticoagulation/antiplatelet agents and I am writing that up right now. I am also interested in studying how we can use different techniques to do the same procedures we have been doing for years. We recently wrote about CLO (contralateral oblique) for epidural steroid injection. I am currently writing an article about why CLO works for cervical zygapophyseal procedures (i.e. medial branch blocks, intra-articular injections, radiofrequency neurotomy), and we also have other research ideas in their infancy.