hey everyone,

so during my 8 weeks of surgery, where i'm at requires we do 2 weeks of exposure to some subspecialty-i've been doing ortho(i have no interest in ortho, but thought it would be useful since I'm strongly considering PM&R).. ok granted ortho folks do surgery but....

-during the time i've spent w/ortho docs and residents outside of the OR (i.e. clinic, office etc), i've seen them do a lot of post-op pre-op stuff, but also more general complaints, trigger point injections, refer people to pt etc etc.

-I'm beginning to wonder, if I go into musculoskeletal stuff via PM&R, what I'll have to offer that ortho guys don't typically do?

-their 5 yrs of training is a long time(granted, its more surgery oriented), I wonder if I will feel as competent as an ortho guy for outpatient non-surgical cases? or for helping w/rehab for post surgery cases? as useful? will I have something to offer (outpatients) that ortho doesn't?

-is there anything different about ortho training vs PMR that results in one field being more appropriate than another for certain types of musculoskeletal problems? obviously I'm talking generalizations here, how people approach problems varies from doc to doc w/in each field...

-im assuming no fellowships, just 4yrs PM&R and then outpatient musculoskeletal paractice...

if people considering/familiar with this path have some comments, would be appreciated(probably helpful to others after me as well)..it's kinda becoming unclear to me what the difference between ortho and PM&R would be in the outpatient musculoskeletal practice(with the exception of surgery), and if so, why someone would goto a rehab doc over an ortho doc...

i'm assuming PM&R folks would be better for treatment of non surgical, chronic type problems, but this is just an assumption. and i know nothing about training to support this..

take care, thanks for your time and help...
scm

Surgeons make money and usually feel the most gratified and useful in the OR, not the office. Physiatrists, being non-surgical specialists, work in the office. Most orthopods do not like seeing nonoperative musculoskeletal problems even though this comprises a significant portion of their practice. Ask a neurosurgeon or an orthopod how they feel about "low back pain" or "neck pain" without radiographic findings and watch their eyes go into rotatory nystagmus.

Being conservative care specialists, these problems are the bread and butter of outpatient physiatry. The surgeons are more than happy to "turf" these patients to their nonsurgical colleagues. We usually have one or two tricks up our sleeve that sometimes helps make patients feel better.