PT vs Sports Medicine Physician

[Buckeye243]

Hi everyone, I am currently finishing up my undergrad course work but am torn between going to physical therapy and medical school. I have googled the topic to death regarding a sports medicine physician versus a physical therapist within a sports medicine clinic but cannot really find a good answer. Can anyone explain the difference on here?

I really want to work with movement and dysfunction and get people moving and feeling healthy again but I also really enjoy a hollistic approach and would love to help people avoid major health problems from a whole body health perspective. Thanks in advance everyone!

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[goyo1010]

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[MinnDasota]

Completely different but both very important.

Sports PT: mostly specialized in sports rehab and performance enhancement (such as changing abnormal neuromuscular firing patterns during a movement). Treats physical problems arising from sport (but can overlap with orthopedics) through rehab of injuries (sprains and strains) and surgeries (ACL, arthroscopy) in prep to return to the playing field. Many PTs call themselves sports PTs, but ideally one should be board certified in sports (SCS) or an ATC but is not required. Sports PTs tend to work in high volume facilities treating multiple patients at a time (unfortunately). PTs will treat either manually (hands on through joint/spine mobilizations and soft tissue therapy) or through neuromuscular re-education and therapeutic exercise, with the occasional modality and taping.

Sports medicine MD: physician with extensive training in sports medicine through a residency or fellowship (can be almost any specialty within the MD). For the most part, they are orthopedic surgeons and physiatrists. They are ultimately the ones that oversees the treatments of the athletes. MDs have the ability to order radiographs whereas PTs (outside of the military) can't. Both can diagnose (ultimately, MDs make the final diagnosis), but PTs usually spend most of their time treating the patient and constantly reassessing outcomes of that treatment. Sports medicine MDs will treat with meds, injections, surgery, PRP, etc, or referral to PT.

And then there's the obvious: PTs are trained as generalists and schooling is much shorter. You can specialize through a PT sports residency or by working in a sports medicine clinic. Salary is much much less. Hours are much much better. Malpractice is much much less.

 

[rcheeley]

Here's the primary difference...

1) Do you want to do surgeries? If yes, then MD, if no, then PT.

If you aren't sure about surgeries...

2) Do you want to see a patient, have the primary concern of diagnosing the patient, and then sending them to an ATC, PT, or another MD specialist for treatment?

3) Or do you want to perform the treatment in terms of spending 1-on-1 time w/ the patient, assessing the patient in terms of mechanical dysfunction, and then correcting this to improve function?

Primarily, if your interest is Sports Medicine, and you're wanting to go to Medical School, then you're going to become an Orthopedic Surgeon and perform surgeries, that would be your specialty.

 

[DancerFutureDPT]

Primarily, if your interest is Sports Medicine, and you're wanting to go to Medical School, then you're going to become an Orthopedic Surgeon and perform surgeries, that would be your specialty.

Not necessarily....there is a sports medicine "specialty" within medicine where there is no surgery involved. Orthopedic surgeons tend to specialize within their field (i.e. yeah they can technically see any patient with an ortho injury, but 90% of their surgical cases are localized to one body part, i.e. knee, shoulder, etc...at least the ones I've interacted with). Sports medicine docs don't do surgery, but treat athletes and others with those types of injuries, but refer out for surgery. Many sports medicine docs in this case start in primary care for their residency, and then move into more sports medicine (so they too start as generalists, similar to a PT in that sense).

Sports med docs also will work for teams (i.e. "the team doctor"), where if a player gets injured they see the team physician, but that physician wouldn't do the surgery. But, these jobs are few and far between...just like trying to be the official PT for a professional team would be. Lots of people want the job, but not everyone gets it.

So if surgery isn't your thing, you can definitely still go to med school if you want to.

For more info: http://www.aoasm.org/faq.cfm#What is a sports

 

[TheOx777]

Not necessarily....there is a sports medicine "specialty" within medicine where there is no surgery involved. Orthopedic surgeons tend to specialize within their field (i.e. yeah they can technically see any patient with an ortho injury, but 90% of their surgical cases are localized to one body part, i.e. knee, shoulder, etc...at least the ones I've interacted with). Sports medicine docs don't do surgery, but treat athletes and others with those types of injuries, but refer out for surgery. Many sports medicine docs in this case start in primary care for their residency, and then move into more sports medicine (so they too start as generalists, similar to a PT in that sense).

Sports med docs also will work for teams (i.e. "the team doctor"), where if a player gets injured they see the team physician, but that physician wouldn't do the surgery. But, these jobs are few and far between...just like trying to be the official PT for a professional team would be. Lots of people want the job, but not everyone gets it.

So if surgery isn't your thing, you can definitely still go to med school if you want to.

For more info: http://www.aoasm.org/faq.cfm#What is a sports

Pretty much took the words right out of my mouth!

 

[atstudent]

When I was in college, our head team physician was a PMR physician. He worked for an Orthopedic group so he could easily refer patients to an orthopedic surgeon as needed. He also held the CSCS credential and worked regularly with the athletic trainers and athletic training students at the university.

 

[DancerFutureDPT]

ATStudent is right...PMR would be another route to go for the "sports medicine" approach to being a physician. PMR docs also work a lot with PTs (as far as our referral sources go).

 

[MinnDasota]

PMR=physiatrist. I had included that in my post previously. I get a ton of referrals from sports med physiatrists as well as orthopedic and pediatric sports med MDs.

 

[Buckeye4life]

Becoming a sports med physician will take you about 9-10 years after you start med school. You will do 4 years of med school, 3 years of either family medicine/internal medicine/pediatrics or 3-4 years of emergency medicine or 4 years of PM&R residency, then a 2 year sports medicine fellowship. Or you can try for a 5 year orthopedic surgery residency and then pursue a 1 year sports medicine and arthroscopy fellowship, however the fellowship is not ultimately needed to practice sports medicine. Just remember that if you go to med school, ur mind will more than likely keep switching from specialty to specialty depending on the rotation ur on, you will always feel like ur competing against others who want ur residency or fellowship and even though you can get any of the above mentioned residencies without much trouble (not ortho) except getting through school, there is no guarantee you will match into a fellowship. But if you plan well and work hard, there is no reason you shouldn't.

If you get into PT, you will know from day 1 that you will be able to practice in sports medicine, just maybe not ur first choice setting depending on the desireability of the location and practice. It will take you 3 years to graduate and be on ur own, and a few years of experience before you will be ready to take a specialty certification, which is not required for PT sports med, but will make you more marketable and distinguish you from ur peers.

The biggest difference between the two is that a sports med doc will be able to make a medical and biomechanical msk dx because of their training in medicine. You will also be afforded unlimited scope of practice for prescribing and ordering imaging and other tests. Income potential is a lot greater, but so are ur responsibilities and consequences if they are not met. PTs are great diagnosticians for msk problems and movement disorders, but they make a PT diagnosis based on the impairment level (i.e. pain, ROM) which will ultimately affect a persons functional abilities and which ultimately affect their functioning in the community, wheareas physicians are trained to make a medical diagnosis starting at the cellular level on up.

 

[TheOx777]

Becoming a sports med physician will take you about 9-10 years after you start med school. You will do 4 years of med school, 3 years of either family medicine/internal medicine/pediatrics or 3-4 years of emergency medicine or 4 years of PM&R residency, then a 2 year sports medicine fellowship. Or you can try for a 5 year orthopedic surgery residency and then pursue a 1 year sports medicine and arthroscopy fellowship, however the fellowship is not ultimately needed to practice sports medicine. Just remember that if you go to med school, ur mind will more than likely keep switching from specialty to specialty depending on the rotation ur on, you will always feel like ur competing against others who want ur residency or fellowship and even though you can get any of the above mentioned residencies without much trouble (not ortho) except getting through school, there is no guarantee you will match into a fellowship. But if you plan well and work hard, there is no reason you shouldn't.

If you get into PT, you will know from day 1 that you will be able to practice in sports medicine, just maybe not ur first choice setting depending on the desireability of the location and practice. It will take you 3 years to graduate and be on ur own, and a few years of experience before you will be ready to take a specialty certification, which is not required for PT sports med, but will make you more marketable and distinguish you from ur peers.

The biggest difference between the two is that a sports med doc will be able to make a medical and biomechanical msk dx because of their training in medicine. You will also be afforded unlimited scope of practice for prescribing and ordering imaging and other tests. Income potential is a lot greater, but so are ur responsibilities and consequences if they are not met. PTs are great diagnosticians for msk problems and movement disorders, but they make a PT diagnosis based on the impairment level (i.e. pain, ROM) which will ultimately affect a persons functional abilities and which ultimately affect their functioning in the community, wheareas physicians are trained to make a medical diagnosis starting at the cellular level on up.

I almost categorically agree with everything you have written in this post; however, why wouldn't a PT be able to diagnose the biomechanical aspects of a patient's conditions. Given the fact that biomechanics, is certainly a basic science heavily engrained in the classroom and clinical diagnoses classes of most(if not all) PT programs. Maybe you meant to say biochemistry? I imagine most PTs may not be considering how the Pentose Phosphate pathway or rate-limiting steps of the TCA cycle while treating a rotator cuff reconstruction. Hell, most MDs/DOs may not even think about, but I think you get my drift. Ultimately, I would argue that PTs are more than capable of biomechanical dx when treating patients. Thoughts?

 

[atstudent]

I almost categorically agree with everything you have written in this post; however, why wouldn't a PT be able to diagnose the biomechanical aspects of a patient's conditions. Given the fact that biomechanics, is certainly a basic science heavily engrained in the classroom and clinical diagnoses classes of most(if not all) PT programs. Maybe you meant to say biochemistry? I imagine most PTs may not be considering how the Pentose Phosphate pathway or rate-limiting steps of the TCA cycle while treating a rotator cuff reconstruction. Hell, most MDs/DOs may not even think about, but I think you get my drift. Ultimately, I would argue that PTs are more than capable of biomechanical dx when treating patients. Thoughts?

I would go a step further and say that many PTs are going to have a much better understanding of the biomechanics than most physicians.

 

[TheOx777]

I would go a step further and say that many PTs are going to have a much better understanding of the biomechanics than most physicians.

I have no evidence of this, but this was exactly what I was thinking. Biomechanics/ Human Kinematics is arguably the foundation of what sets PTs apart from every other health profession(save ATs, Chiros). Anatomy I would like to introduce you to my good pal Physics. You guys will have a great time together!

 

[Buckeye4life]

I almost categorically agree with everything you have written in this post; however, why wouldn't a PT be able to diagnose the biomechanical aspects of a patient's conditions. Given the fact that biomechanics, is certainly a basic science heavily engrained in the classroom and clinical diagnoses classes of most(if not all) PT programs. Maybe you meant to say biochemistry? I imagine most PTs may not be considering how the Pentose Phosphate pathway or rate-limiting steps of the TCA cycle while treating a rotator cuff reconstruction. Hell, most MDs/DOs may not even think about, but I think you get my drift. Ultimately, I would argue that PTs are more than capable of biomechanical dx when treating patients. Thoughts?

No, ur right. PTs do make a biomechanical evaluation, which is altered by physical impairments. I must have just written it wrong. I was trying to say physicians are able to make a medical and bio eval, whereas a PT cannot make a medical dx due to limitations in scope. As for PTs knowing how to make a better bio eval, I would say this is true for primary care docs, but not fellowship trained ones in sports med.

 

[fozzy40]

I think that another way of looking at this is breaking down what "Sports Medicine" actually means.

The term "sports medicine" is often used synonymously with "musculoskeletal injuries/issues" in the medical world. While alot of sports medicine is dealing with musculoskeletal injuries, there is a whole host of other issues that fall under the realm of "sports medicine" as a physician:
- concussion management
- return to play
- acute fracture management
- event coverage
- sports nutrition and supplementation
- sports psychology
- kinesiology
- biomechanics
- athletic issues specific to pediatrics and women
- exercise physiology
- prosthetics and orthotics
- exercise

I am obviously biased because I am a PM&R doc (AKA physiatrist) but I think we receive the best musculoskeletal training amongst the medical specialties. Orthopedic surgery is great at doing surgery. But in my interaction, I think we have a much better appreciation of functional anatomy and physical examination. Family medicine/sports medicine trained physicians are great. However, I just think that we have a lot more MSK exposure in residency and more tools at the end of the day.

Ultimately, it depends on what you want to do. PTs, OTs, Athletic Trainers, massage therapists, chiropractors all see athletic injuries and probably have the most "hands on" experience with patients. If you really like to work closely with athletes, probably one of these professions is your best bet.

I was actually pre-PT before going to medical school. While I still love physical therapy, I had a lot of questions about injuries, and treatment options that could only be answered by going to medical school.

We are all spokes in the wheel of sports medicine care you just have to pick where you fit best.

 

[TheOx777]

I think that another way of looking at this is breaking down what "Sports Medicine" actually means.

The term "sports medicine" is often used synonymously with "musculoskeletal injuries/issues" in the medical world. While alot of sports medicine is dealing with musculoskeletal injuries, there is a whole host of other issues that fall under the realm of "sports medicine" as a physician:
- concussion management
- return to play
- acute fracture management
- event coverage
- sports nutrition and supplementation
- sports psychology
- kinesiology
- biomechanics
- athletic issues specific to pediatrics and women
- exercise physiology
- prosthetics and orthotics
- exercise

I am obviously biased because I am a PM&R doc (AKA physiatrist) but I think we receive the best musculoskeletal training amongst the medical specialties. Orthopedic surgery is great at doing surgery. But in my interaction, I think we have a much better appreciation of functional anatomy and physical examination. Family medicine/sports medicine trained physicians are great. However, I just think that we have a lot more MSK exposure in residency and more tools at the end of the day.

Ultimately, it depends on what you want to do. PTs, OTs, Athletic Trainers, massage therapists, chiropractors all see athletic injuries and probably have the most "hands on" experience with patients. If you really like to work closely with athletes, probably one of these professions is your best bet.

I was actually pre-PT before going to medical school. While I still love physical therapy, I had a lot of questions about injuries, and treatment options that could only be answered by going to medical school.

We are all spokes in the wheel of sports medicine care you just have to pick where you fit best.

Fozzy,

You mentioned that you , "had a lot of questions about injuries, and treatment options that could only be answered by going to medical school." Could you expound on the specificity of some of the training you have received in medical school related to injuries and treatment options that would be outside of the scope of a PT's knowledge? Also, was the aforementioned reasons regarding injuries and treatment the sole reason for going to medical school instead of physical therapy school? If not, then could you elaborate on those specific reasons?

 

[fozzy40]

Fozzy,

You mentioned that you , "had a lot of questions about injuries, and treatment options that could only be answered by going to medical school." Could you expound on the specificity of some of the training you have received in medical school related to injuries and treatment options that would be outside of the scope of a PT's knowledge? Also, was the aforementioned reasons regarding injuries and treatment the sole reason for going to medical school instead of physical therapy school? If not, then could you elaborate on those specific reasons?

Some of the questions that I wanted to be answered:
- What is the pathophysiology of Parkinson's Disease?
- Why is it that patient's with Parkinson's have a shuffling gait?
- What is the brachial plexus?
- What are the indications/contraindications to a total hip replacement?
- Why is diabetes such a bad disease?

Some of the experiences I wanted:
- To do a full body dissection for anatomy.
- Deliver a baby.
- Learn to suture.

Ultimately, I figured that I wanted a medical knowledge background more than a movement and rehabilitation science base. I love physiatry because it is the only medical specialty that has an intimate relationship with movement and rehabilitation science.

 

[TheOx777]

Some of the questions that I wanted to be answered:
- What is the pathophysiology of Parkinson's Disease?
- Why is it that patient's with Parkinson's have a shuffling gait?
- What is the brachial plexus?
- What are the indications/contraindications to a total hip replacement?
- Why is diabetes such a bad disease?

Some of the experiences I wanted:
- To do a full body dissection for anatomy.
- Deliver a baby.
- Learn to suture.

Ultimately, I figured that I wanted a medical knowledge background more than a movement and rehabilitation science base. I love physiatry because it is the only medical specialty that has an intimate relationship with movement and rehabilitation science.

I certainly agree that physiatry and physical therapy are intimately tied as it relates to patient care(as well they should be). I am just not sure that a PT student/professional would not be able speak at great length about the first set of questions you mentioned. I would be concerned if they could not, honestly!The second set is certainly a different scope of practice(minus the dissections, which is different for each DPT program). I am going to qualify the aforementioned by saying that there is a great deal of variability in schooling/training/clinical rotation and instruction, so that will certainly have an effect on a person's base of knowledge.

For the record, my opinions are not to start some big "bruhaha" about a PT's vs. MD's knowledge. I just hope that ppl(especially fellow health care workers) are aware of the extensive knowledge PTs have about the human body, not just at the musculoskeletal or neuromuscular levels. Also, I really appreciate the fact that we can have inter-mingling on these forums without it being a huge deal!

 

[fahimaz7]

I would go a step further and say that many PTs are going to have a much better understanding of the biomechanics than most physicians.

I would agree. My wife is a DPT, and she knows more about the biomechanics than I do, or her orthopedic uncle does.

 

[fahimaz7]

I certainly agree that physiatry and physical therapy are intimately tied as it relates to patient care(as well they should be). I am just not sure that a PT student/professional would not be able speak at great length about the first set of questions you mentioned. I would be concerned if they could not, honestly!The second set is certainly a different scope of practice(minus the dissections, which is different for each DPT program). I am going to qualify the aforementioned by saying that there is a great deal of variability in schooling/training/clinical rotation and instruction, so that will certainly have an effect on a person's base of knowledge.

For the record, my opinions are not to start some big "bruhaha" about a PT's vs. MD's knowledge. I just hope that ppl(especially fellow health care workers) are aware of the extensive knowledge PTs have about the human body, not just at the musculoskeletal or neuromuscular levels. Also, I really appreciate the fact that we can have inter-mingling on these forums without it being a huge deal!

The training is very different, and your failure to acknowledge that is baffling. With that said, he offered some of the worst examples for "wanting to know the pathology" that I could have thought of. Also, I've watched my wife get her DPT, and can honestly say that we learn more diseases in a month than she learns in an entire academic year (she agrees). Is that a bad thing? No it's not... DPT's are trained to recognize major pathology (systemic) and be the masters of movement science. They can train after school if they want to specialize (wounds, vestibular, etc), but for the most part their training is completely focused on major pathology and not the intricacies that separate out diseases.

DPT's are trained to recognize "red flags" and refer them back to their primary care doctor for evaluation.

Like we've already established, the two programs are very different, and really deciding between them is an individual decision. My wife is absolutely brilliant (and almost went to medical school) and one of the happiest professionals that I've ever met. PT is a strong field, that is being staffed by very educated people, who are absolute specialists at what they do.

 

[fozzy40]

With that said, he offered some of the worst examples for "wanting to know the pathology" that I could have thought of.

Not sure if this was directed at me. If so, why are these bad examples?

 

[TheOx777]

The training is very different, and your failure to acknowledge that is baffling. With that said, he offered some of the worst examples for "wanting to know the pathology" that I could have thought of. Also, I've watched my wife get her DPT, and can honestly say that we learn more diseases in a month than she learns in an entire academic year (she agrees). Is that a bad thing? No it's not... DPT's are trained to recognize major pathology (systemic) and be the masters of movement science. They can train after school if they want to specialize (wounds, vestibular, etc), but for the most part their training is completely focused on major pathology and not the intricacies that separate out diseases.

DPT's are trained to recognize "red flags" and refer them back to their primary care doctor for evaluation.

Like we've already established, the two programs are very different, and really deciding between them is an individual decision. My wife is absolutely brilliant (and almost went to medical school) and one of the happiest professionals that I've ever met. PT is a strong field, that is being staffed by very educated people, who are absolute specialists at what they do.

There is honestly nothing in which one should be baffled about. There is no equivocation that a large part of physician training and physical therapy training is different. You have not nor will you ever hear me dispute that claim or sneakily make allusions to the contrary. That said, there is much analogous about some of the basic sciences (Anatomy, Physiology, Pathology, Histology(for some programs), and Pharmocology, Neuroscience) for example.

I never uttered a word about the depth and breadth of disease knowledge a PT may have(outside of musculoskeletal, neuromuscular), so it does not surprise me at all that you covered more diseases in Med School than your wife did in DPT school. On the other hand, it would surprise me if you spent more time inundated in biomechanics and movement science coursework than your wife. I was simply(and obviously doing a poor job) making the case that the knowledge one gains from a DPT program would answer many of the aforementioned questions posed by fozzy.

Final word: I would also be somewhat cautious as to generalize the scope of knowledge an individual receives in one DPT program to the next. There is coursework that is certainly fundamental to most(if not all) programs. However, beyond Anatomy, Physiology, Biomechanics, Pathology and/or pathophysiology there may be a great level of variability in what one may learn as it relates to pre-clinical education.

 

[fahimaz7]

Not sure if this was directed at me. If so, why are these bad examples?

B/c even people with a BS in science can answer most of the questions that you had. While DPT's may not know about sorbitol accumulation and diabetes, they are well versed in DM and definitely the specialists when it comes to brachial plexus injuries. For the most part, they are more trained in nerve innervation and pathology than the orthopedist is, which is quite funny if you think about it.

 

[fahimaz7]

There is honestly nothing in which one should be baffled about. There is no equivocation that a large part of physician training and physical therapy training is different. You have not nor will you ever hear me dispute that claim or sneakily make allusions to the contrary. That said, there is much analogous about some of the basic sciences (Anatomy, Physiology, Pathology, Histology(for some programs), and Pharmocology, Neuroscience) for example.

.

Analogous yes, but it's like comparing the training that a nurse gets to what a MD gets in those fields. All of the allied health fields gets an introduction to pathology, histology, pharmacology, and neuroscience... but I can tell you that they don't get anywhere near the level of depth or understanding that a medical student gets. On top of that, add 2 years of clinical training at the end of medical school and 3-7 years of residency in a particular field, and once can quickly see how in depth and specialized we get in a hurry.

At MCG, I think my wife had maybe a week on pharmacology, a few weeks on neuroscience (mostly large lesions and therapeutic approaches from a DPT perspective), and zero histology. Why would she ever have to be able to diagnose rheumatic diseases using histology, rhabdomyolysis, or parasitic infections in a muscle biopsy? It doesn't make any since to get in depth histology training in the allied health fields.

Even PA's and DNP's don't get the depth of training that MD's get.... Even in pharm, path, and neuroscience. Here at MCG, they don't get a single lecture on histology or histopathology. If you ask them the molecular defect of say hypertrophic cardiomyopathy, or what the fiber orientation is, they have no idea. Is that bad? No.. it's part of being a mid-level practitioner and the perk of not having to spend a decade getting trained.

 

[fozzy40]

B/c even people with a BS in science can answer most of the questions that you had. While DPT's may not know about sorbitol accumulation and diabetes, they are well versed in DM and definitely the specialists when it comes to brachial plexus injuries. For the most part, they are more trained in nerve innervation and pathology than the orthopedist is, which is quite funny if you think about it.

I wanted to learn more of the details of each of these "bad examples" such as pathophysiology, neuropharmacology, medical, and surgical options. To use one of your examples, is it routinely taught in DPT school:
-what medications are first line treatment for diabetes
-what are the common side effects of these medications
-long term risk for MI or CVA with DM
-management of pressure sores
-what receptor gabapentin acts on to help with diabetic peripheral neuropathy

This is what I personally wanted to learn. Do I expect DPTs to learn this type of information? No, because most of the focus is on how the disease effects movement. No one said that DPTs never hear of these diseases and they need to go to med school to learn about them. Of course this is taught to some degree but I wanted more details.

Most physicians want more emphasis on medical and surgical options for disease. DPTs probably want to focus on how these diseases affect their function so that they can design therapeutic exercise programs.

Like I said, we're all spokes in the same wheel you just have to pick what knowledge base you want of the wheel.

 

[fahimaz7]

I wanted to learn more of the details of each of these "bad examples" such as pathophysiology, neuropharmacology, medical, and surgical options. To use one of your examples, is it routinely taught in DPT school:
-what medications are first line treatment for diabetes
-what are the common side effects of these medications
-long term risk for MI or CVA with DM
-management of pressure sores
-what receptor gabapentin acts on to help with diabetic peripheral neuropathy

This is what I personally wanted to learn. Do I expect DPTs to learn this type of information? No, because most of the focus is on how the disease effects movement. No one said that DPTs never hear of these diseases and they need to go to med school to learn about them. Of course this is taught to some degree but I wanted more details.

Most physicians want more emphasis on medical and surgical options for disease. DPTs probably want to focus on how these diseases affect their function so that they can design therapeutic exercise programs.

Like I said, we're all spokes in the same wheel you just have to pick what knowledge base you want of the wheel.

I think my wife could answer all of the ones that you mentioned, except for the side effects one (unless we're purely talking about hypoglycemia). They are the people who are in charge of treating bed sores, wound healing, etc.. so they would be very familiar with that. Don't worry though, I would think the same thing about their training if I hadn't seen her go through the program.

The receptor thing with Gabapentin is actually quite controversial, since it doesn't act as a GABA analog as once thought. I don't think a lot of physicians actually know that it hits VG Ca channels and doesn't act as a GABA analog.

 

[fozzy40]

I think my wife could answer all of the ones that you mentioned, except for the side effects one (unless we're purely talking about hypoglycemia). They are the people who are in charge of treating bed sores, wound healing, etc.. so they would be very familiar with that. Don't worry though, I would think the same thing about their training if I hadn't seen her go through the program.

The receptor thing with Gabapentin is actually quite controversial, since it doesn't act as a GABA analog as once thought. I don't think a lot of physicians actually know that it hits VG Ca channels and doesn't act as a GABA analog.

Great! So was medical diagnosis and management the emphasis of her training? Did she also learn that gabapentin works on the alpha2g receptor to decrease presynaptic release of substance P and glutamate?

My point is that we all have a different skill set and its based on what knowledge base you want to acquire.

 

[fahimaz7]

Great! So was medical diagnosis and management the emphasis of her training? Did she also learn that gabapentin works on the alpha2g receptor to decrease presynaptic release of substance P and glutamate?

My point is that we all have a different skill set and its based on what knowledge base you want to acquire.

She does not. But, I bet you that 90% of practicing physicians don't as well. She does know about neurotransmitters and what substance P is though.



What you have done there is perfectly show the difference in training between mid-level practitioners and people who finish medical school. The basic science background that we have is what separates us from the rest of the health care providers, which may or may not have any real benefit to our patients in the long run (like the drug discussion that's going on here. Most prescribers don't know the exact pharmacological mechanisms for the drugs that they prescribe, and they really don't care either).

 

[TheOx777]

Analogous yes, but it's like comparing the training that a nurse gets to what a MD gets in those fields. All of the allied health fields gets an introduction to pathology, histology, pharmacology, and neuroscience... but I can tell you that they don't get anywhere near the level of depth or understanding that a medical student gets. On top of that, add 2 years of clinical training at the end of medical school and 3-7 years of residency in a particular field, and once can quickly see how in depth and specialized we get in a hurry.

At MCG, I think my wife had maybe a week on pharmacology, a few weeks on neuroscience (mostly large lesions and therapeutic approaches from a DPT perspective), and zero histology. Why would she ever have to be able to diagnose rheumatic diseases using histology, rhabdomyolysis, or parasitic infections in a muscle biopsy? It doesn't make any since to get in depth histology training in the allied health fields.

Even PA's and DNP's don't get the depth of training that MD's get.... Even in pharm, path, and neuroscience. Here at MCG, they don't get a single lecture on histology or histopathology. If you ask them the molecular defect of say hypertrophic cardiomyopathy, or what the fiber orientation is, they have no idea. Is that bad? No.. it's part of being a mid-level practitioner and the perk of not having to spend a decade getting trained.

I agree with much of what you said. "Mid level" training is typically not as in depth as a physician's training, and I truly believe that the residency aspect of physician training(additional 3-7 years) and don't forget post-residency fellowships for many specialties is what truly separates physicians apart from other practitioners. No argument there. I have family members who are physicians(Dermapath and Radiology who also has a Phd and is a professor at a major university in the south), so I am not inept when it comes to physician training. I consulted these ppl when deciding btwn my DPT vs. MD/DO. You are still alluding to a specific program(MCG), and I will tell you that at the program I will be attending this year we will spend an entire year on Pharmacology and Neuroscience. We will also spend an entire year on pathophysiology. I will not spend an entire year on histology yet receive an introduction to it, and intermittent histology/histopathology coursework. Other programs do spend an entire year on "histo" though. These are courses taught by physical therapist who also have PhDs in Pharmocology, Neuroscience, Physiology, Biomechanics, Anatomy, etc. These are also course that may be taught by MDs/DOs. So as I stated earlier, many things are program specific.

Will the application of these basic sciences be mainly pertinent in the DPT setting/scope of practice? Sure! That does not mean that a DPT could not have a convo with you or other physicians about more in depth issues related to basic science, just because it is legally outside of the scope of their practice. I have no intention of diagnosing Tay-Sachs or Li fraumeni syndrome or a squamous cell carcinoma while providing wound care for a patient. Doesn't mean that you and I couldn't talk about it if I did have the requisite knowledge. If I were a physician or a future physician like you will be, I would want the ENTIRE Team to be as knowledgeable as possible. I contend that it would only serve to augment patient care!

 

[fahimaz7]

TheOx... So you haven't even stepped foot into your first DPT class? I doubt you spent an entire year learning pharmacology and neuroscience, then another year learning pathophysiology that bears any resemblance to the pathophysiology that we have in medical school.

Pathophys for you guys is simplified and gross in nature, and is really nothing like what we get in medical school. Neither is pharm or neuro, as you will never be prescribing any of these medications, nor will you be a neurologist or neurosurgeon. Hate to break that to you, but that's just how it goes.

What school are you going to? If they teach the way you are making it sound, they will be leaving out A LOT of material that defines the scope of a DPT practice.

 

[fozzy40]

She does not. But, I bet you that 90% of practicing physicians don't as well. She does know about neurotransmitters and what substance P is though.



What you have done there is perfectly show the difference in training between mid-level practitioners and people who finish medical school. The basic science background that we have is what separates us from the rest of the health care providers, which may or may not have any real benefit to our patients in the long run (like the drug discussion that's going on here. Most prescribers don't know the exact pharmacological mechanisms for the drugs that they prescribe, and they really don't care either).

In my mind, it's not about just recognizing what diseases or medications are. It's also about how the individual wants to use that information and relate it to their scope of practice.

Getting back on track, to the OP, we are all health care professionals. Shadow a little bit of everybody and figure out what scope of practice interests you. As I said before, there are a lot of ways to get involved in sports medicine. You just need to figure out what route is best for you. Plus, I'm assuming that you are a traditional undergrad so there is plenty of time to figure out your career goals. You can always try one route and then decide to go down another.

Good luck to you!

 

[leannakin325]

Just wanted to say that I really enjoyed this discussion regarding the topic. All very great input from knowledgeable individuals! I am applying to dPT program this year and was always interested in sports medicine beyond the Athletic Trainer M.S., just was unsure about all the training/years/residency/scopes of practice. Thank you!