Is there any benefit for her to earn a MD and then pursue a career in PM&R (on top of her DPT)? Do programs exist where advanced standing in medical school can be granted to a DPT who wishes to continue onward with PM&R (similar to the oral/maxillofacial surgery residents that receive their dental degree then then complete 2 years of medical school to earn a MD prior to residency)?
Thanks for your help.
There is no program like that as far as I know. The PT training and MD/PM&R training is very different. There are no similarities in what a PT does vs physiatrist except we may treat the same types of patients.
In the outpatient MSK setting - Probably the closest comparison to what a physiatrist does is what an orthopedic surgeon does in clinic minus the surgery - so we do the initial assessment, H&P, order and do initial interpretation of imaging, write for medications, DME, interventions if appropriate, EMG if appropriate, and write the prescription for physical therapy. The PT then carries out the prescription. We see the patients as frequently as an orthopedic surgeon would (once for initial visit, then a few more times for follow up), PTs see them 2-3 times a week for however many weeks. Although some of us do give some intro level exercises, we leave it up to the PT to do most of the therapy.
In inpatient rehab - most of us function like an internist with a little more neuro/MSK background - so we admit the patient, do a H&P, write orders, round on patients every day and talk to families and patients. We have team meetings with PT, OT, SLP, nursing, social work, etc. to assess the progress and troubleshoot. If there is an acute issue, we can manage (run codes, transfer to acute care, etc.) then transfer. Some rehabs use consultants in other fields to manage specific issues and others don't. In my residency we had patients on dialysis, s/p transplant, LVAD patients, vent dependent spinal cord injury patients, etc. I dont' think a PT would be able to manage a vent or know what to do with abnormal labs.
DPTs are pushing for independent access to patients - and at the risk of offending some - I don't think that's bad IF they are willing to take the responsibility/risk. They're basically going to be like chiropractors. Patients will go directly to them, they will do an assessment and come up with some issues to work on, and take on the responsibility/malpractice risk of missing a cancer, fracture, or other medical issues. When physicians write the Rx for PT, the therapists trust that we already did the work up, ruled out red flag stuff, and will give them some medical parameters (cardiac precautions, etc.) to work within. When they treat patients independently, they don't have that luxury and they will need to deal with the consequences. If they feel ready to do that, more power to them. Same thing with chiros. I have caught vertebral compression fractures and cancer that they have missed. I had a patient with OPLL who was going to go to a chiro for initial care - I'm glad he didn't cuz he could've been paralyzed. I have had a PT do aggressive traction on a patient with severe RA (this was done prior to the patient coming to see me).
Bottomline there are "cowboys" in any field including medicine - and how much risk you are willing to take is up to the healthcare provider. I was taught by an attending to do the "yomama" sniff test. Would you want your mom (provided you like your mom) to be treated by that person? (like the people who go on about how NPs and PAs are MD/DO equivalent - would they want to go see a NP or PA if it was their health and life???)
my 2cents
