Developing a Career in General Physiatry: An Interview with Dr. Maria Twichell

By Marissa Pavlinich, MD

I connected with Dr. Maria Twichell, who is currently a general physiatry attending at the University of Pittsburgh Medical Center, to discuss her experiences pursuing general physiatry as a career.

What attracted you to general physiatry rather than a physiatric subspecialty?

I love the variety! Every day, I see patients with concussion, burn injury, recent polytrauma, stroke, amputation, critical illness myopathy, neuropathy, back pain, joint ailments, etc. Each case is so unique. I like having the first crack at management and procedures, but I’m also glad that I can refer the more complex patients to my specialized colleagues. Watching the daily improvement of the patients I get the privilege to treat is so rewarding.

Which factors did you find to be the most important in choosing your first general physiatry job?

I wanted a dynamic department with an excellent reputation that was growing and contributing to medical knowledge as well as the community. I envisioned working in a department that was well-integrated and respected by the surrounding health care system. I wanted a work environment that was supportive and collegial, where I could enjoy coming in every day. A degree of flexibility in order to balance my family’s schedule was also important to me.

What did you do early in your career that enabled you to define your patient population and recruit the types of patients that you were most interested in caring for?

Whenever possible, highlight your skillset. There are certain things I am not interested in doing — EMGs for example. I was able to discuss my preferences up front, then let my department chair know where I could contribute instead of doing EMGs. Efficient consults are within my skillset, but another colleague may not feel as comfortable in that role. In this way, you can further define your practice preferences.

In addition, don’t be afraid to market your skills to providers that could be referral sources. Showcase what you can do for their patients and reach out to them via the email or phone call to discuss specific cases. Close the loop. Word of good work spreads fast, so you can expect increased referrals if you provide excellent care and follow it up with feedback.

How do you maintain a balance between inpatient and outpatient medicine duties?

The secret is to be as efficient as possible so that the majority of your inpatient responsibilities and time-stamped documentation is completed prior to beginning outpatient clinic. Completing your outpatient notes during or just after clinic will reduce the amount of angst about closing your charts prior to restarting the next day. Your documentation will also be more accurate. Staying as close to caught up as possible is the key!

What do you like most about practicing as a general physiatrist?

As a general physiatrist, you get to define your own path. There is no patient population or practice environment that is out of your realm. You can choose how to evolve and grow over time.

What advice would you give to residents considering a general physiatry practice?

You absolutely are ready! It’s intimidating to think about being the most responsible provider (attending physician), but everything you have accomplished to this point has prepared you well. A strong residency program has provided you with the skills necessary to be an excellent general physiatrist. There is a learning curve, of course, but you never stop learning. Every patient you see is an opportunity to learn something, so take every day as a chance to enhance your knowledge, compassion, and skillset.

Marissa Pavlinich, MD is a PGY4 at the University of Pittsburgh Medical Center who is interested in interventional pain medicine.