PM&R Scope of Practice Description

drusso said:

From time to time medical students ask about the scope of practice of a musculoskeletally-oriented physiatrist. This is a document prepared by AAPM&R for hospitals and HMO's describing the training and sope of practice of a physiatrist:


Musculoskeletal Scope of Practice


PASSOR (Physiatric Association of Sports, Spine, and Occupational Rehabilitation) has developed the document below to clearly describe what a musculoskeletal physiatrist can do. This document can be used to help obtain hospital privileges. It can be helpful when contracting with health care organizations. Additionally, it can be used for marketing and explaining to patients, providers, and third parties what a musculoskeletal physiatrist might do. The AAPM&R Board of Governors recently endorsed the document.


In the current medical environment, establishing parameters within which a specialist may practice is very important. The following document has been developed to define the appropriate practice for physicians who specialize in Physical Medicine and Rehabilitation (PM&R).

Using skills developed in ACGME-accredited training programs, PM&R specialists routinely perform inpatient and outpatient musculoskeletal and neuromuscular diagnoses and treatments that emphasize function and rehabilitation. Physical medicine and rehabilitation specialists treat patients of all ages afflicted with painful and function-limiting musculoskeletal disorders of the spine, peripheral joints, and soft tissues such as sprains/strains, disc herniations, rheumatologic conditions and athletic injuries. PM&R specialists also diagnose and treat degenerative, developmental, acquired, and traumatic neuromuscular conditions of the upper and lower limbs, spinal cord, and brain. It is this unique blend of orthopedic, neuromuscular, pain, and rehabilitation training and experience that makes the PM&R specialist an ideal primary or secondary care physician for patients with occupational or sports-related musculoskeletal or neuromuscular injuries. This multidisciplinary training also makes the PM&R physician the most qualified specialist to lead the team of medical specialists and rehabilitation therapists involved in a patient's rehabilitative care.

Physical medicine and rehabilitation specialists are specially trained to prescribe therapeutic exercise and other rehabilitation modalities. They are expert in the performance and interpretation of electrodiagnostic studies including electromyography, nerve conduction studies, and evoked potentials. PM&R specialists use routine laboratory and radiographic studies, but they are also trained in the interpretation of more sophisticated diagnostic studies that evaluate a patient's musculoskeletal and neuromuscular systems such as CT, myelography, bone scan, and MRI. Many physical medicine and rehabilitation specialists are skilled in manual medicine.

All physical medicine and rehabilitation residents are trained to perform injection techniques such as peripheral nerve blockade, trigger point injections, joint injections, and the injection of neurolytic agents and botulinum toxin. With specific training, many PM&R specialists routinely perform fluoroscopically directed spinal and large joint procedures such as interlaminar and transforaminal epidural injections, zygapophysial joint injections, radiofrequency denervation, sacroiliac joint intra-articular injections, sympathetic blockade, discography, and other advanced interventional pain management techniques.

The American Academy of Physical Medicine and Rehabilitation asserts that all physical medicine and rehabilitation specialists who have completed a physical medicine and rehabilitation residency have adequate training to practice in the following areas:

--Inpatient and outpatient musculoskeletal and neuromuscular diagnosis and rehabilitation;

--Electrodiagnostic medicine;

--Medical and rehabilitative pain management;

--Injury prevention and wellness;

--Non-surgical spine medicine; and

--Sports medicine including athletes with disabilities.

In addition, the Academy further asserts that many physical medicine and rehabilitation specialists have the appropriate training to practice in the following areas:

--Interventional diagnostic and therapeutic spinal procedures; and

--Interventional pain management.

In summary, physical medicine and rehabilitation is a diverse specialty allowing its members to seek and pursue special interests such as pain medicine, spine medicine, and sports medicine. Many PM&R specialists are integrally involved in university and private practice based spine centers, pain centers, and care of athletes from all levels of participation.

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