04-08-2003, 03:09 PM
Ok, so PM&R sounds like a pretty awesome specialty: rewarding work helping people regain a decent standard of life, a pretty cush lifestyle, and plenty of time for a family life( vital to me)
The question I have is about what you -do- on a day to day basis. Do you just evaluate the patient and prescribe a plan of action and send them of to a pt or someone like that or do you actually get to work with the patients rehabilitating them on a regular one on one basis? I have done a bit of research online but i just cant seem to find out this information! Does it depend on hte physician how much of the actual rehabilitation work they actually do?
Any help would be great!!!
04-08-2003, 04:05 PM
The day-to-day practice of physiatry is largely dependent on the setting. If you're doing typical inpatient medical rehabilitation, then yes, the physiatrist functions more or less as the "captain of the ship." Patients admitted to inpatient medical rehabilitation units are often stable and over the acute phase of their illness or injury, but are far from medically well. In this setting, the rehab doctor basically manages and prevents any medical issues that might interfere with a patients recovery of function. They develop a rehabilitation plan---in conjunction with PT, OT, speech, neuropsych---and other allied health care practitioners, and make sure that the patient progressing adequately. Most rehab doctors are comfortable doing some bread-and-butter internal medicine work-ups other will just consult for any little issue.
In the outpatient/occupational medicine setting the physiatrist evaluates patients for injuries and functional impairments. This might involve a variety of diagnostic (and therapeutic) modalities. They performs EMGs, nerve conduction studies, and other electrodiagnostic tests. They determine what kind of work restrictions (if any) a patient might require. There is often significant medico-legal issues to contend with and many outpatient-oriented physiatrists find themselves doing expert witness work on disability-related cases.
Finally, there is the interventional pain/physiatry setting. Here, physiatrists develop a variety of rehabilitation plans for chronic/acute pain syndromes. Interventional physiatrists perform a variety of sophisticated procedures including spinal injections, intradiscal electrotherapy, kyphoplasty/vertebroplasty, selective nerve root blocks, etc. This is the newest (and best reimbursed) area of PM&R, but carries substantially more liability and requires fellowship level training and sub-specialty certification.
Here are some other links highlighting different areas of inpatient/outpatient PM&R:
Interventional Pain Fellowship (http://www.uphs.upenn.edu/rehabmed/educ/penn%20spine%20center.htm)
Michigan Sports and Spine (http://michigansportsandspine.com/staff.html)
Spine Program at University of Michigan (http://www.med.umich.edu/pmr/spine/fellows.htm)
Spine Center--Saint Mary's San Francisco (http://www.webbdesign.com/stmarys/index.html)
Spine Center---Good Shepherd Hospital (http://www.advocatehealth.com/gshp/services/mind/spine/specialists.html#schneider)
Private Practice Physiatry Group in San Diego (http://rehabmeddocs.com/index.html)
Private Practice Physiatry Group in Hawaii (http://www.rehabmedicine.org/index.html)
Spinal cord injury fellowship---Washington University (http://www.neuro.wustl.edu/sci/fellowsh.htm)
Multiple Sclerosis Fellowship (http://depts.washington.edu/rehab/fellowship/ms.html)