Advantage to having a D.C. degree?

[MDDC]

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I was curious as to whether being a chiropractor will be of benefit as I apply for a PM&R spot. I'm a US FMG and realize that this fact alone will be a hurdle, but I hope my chiropractic/rehab experience (practiced for a couple of years) and my extensive needle EMG/NCV knowledge (I have personally performed over 400 tests) will lighten the negative blow to my application. I would say that the rest of my application is simply average to good. I would sincerely appreciate any comments/opinions on the topic.

Thanks for your time...

 

[prefontaine]

It depends what kind of a spin you put on it. Most programs are looking for residents to train. If an applicant comes across like they are already at an attending level, why bother to train them. Practice being humble prior to the interviews.

I was curious as to whether being a chiropractor will be of benefit as I apply for a PM&R spot. I'm a US FMG and realize that this fact alone will be a hurdle, but I hope my chiropractic/rehab experience (practiced for a couple of years) and my extensive needle EMG/NCV knowledge (I have personally performed over 400 tests) will lighten the negative blow to my application. I would say that the rest of my application is simply average to good. I would sincerely appreciate any comments/opinions on the topic.

Thanks for your time...

 

[delicatefade]

I disagree - I've been told that my PT degree and experience in SCI/TBI rehab would do nothing but help.

 

[prefontaine]

Where does the OP ask about a PT degree?

Having known a number of former DCs that have applied for residencies, interviewed residency applicants, as well as sitting on a ranking committee, my experience is that a chiropractic degree may hurt an applicant as much as help.
Our program currently has a former DC in it and he wisely says little about his former profession.
There are physiatrists that are strongly opposed to DCs performing EMGs.
Too, the debates that go on behind the scenes can be quite different than the experience(s) of a student in the basic sciences being told their background can "do nothing but help." Certainly, a PT is more likely to be looked favorably upon than a DC.

I disagree - I've been told that my PT degree and experience in SCI/TBI rehab would do nothing but help.

 

[delicatefade]

I just don't think that he should downplay his experience is all.

 

[DOctorJay]

I think I'd focus more on the manual medicine skills, how you've seen that help patients, and how you'd be an asset to those around you by being able to teach techniques (but of course being modest about these skills at the same time).

-J

 

[rehab_sports_dr]

> I was curious as to whether being a chiropractor will be of benefit as I apply for a PM&R spot.

I am not sure whether it would help or hurt. I do think it is essential to who you are, however, so you must address your prior experience.

I think the big question for interviewers will be why you are seeking a change in careers. Are there specific skills and training that you feel were missing from your chiropractic training? Are you interested in expanding your clinical interests?

Undergoing addtional training is grueling, so I think many people will want to know why your are bothering. If you can make a case for why you want and need the training, then I think your prior experience will be viewed either neutrally or as a positive.

As for your experience in EMGs, I agree with prior posters to be careful how you frame your experience. Many physiatrists are skeptical about the quality of electrodiagnostic evaluations performed by chiropractors. So I would be cautious as to overselling your EMG experience. The last thing you would want is for a really good electrodiagnostician to pimp you during the interview to test the limits of your knowledge base. You could sell your experience, however, by saying that one of the reasons you are interested in physiatry is because you would to expand your electrodiagnostic knowledge base.

 

[delicatefade]

I think the big question for interviewers will be why you are seeking a change in careers. Are there specific skills and training that you feel were missing from your chiropractic training? Are you interested in expanding your clinical interests?

Isn't this kind of irrelevant once you are applying for residency??? I mean, all of us who changed careers got asked this question in our medical school interviews. Why would a program director ask you the same questions after you had just done 4 years of medical school??? I mean, of course we felt like specific skills and training were missing. Of course we were interested in expanding our clinical interests. Of course we wanted more than our professions could offer. That's why we went to medical school.

Just asking because I really don't know the answer. I didn't think I'd be asked those questions again because the answers seem obvious, but I could be wrong!

 

[rehab_sports_dr]

> Isn't this kind of irrelevant once you are applying for residency??? I mean, all of us who changed careers got asked this question in our medical school interviews. Why would a program director ask you the same questions after you had just done 4 years of medical school??? I mean, of course we felt like specific skills and training were missing. Of course we were interested in expanding our clinical interests. Of course we wanted more than our professions could offer. That's why we went to medical school.

> Just asking because I really don't know the answer. I didn't think I'd be asked those questions again because the answers seem obvious, but I could be wrong!

The answers are definitely NOT obvious, and I would be shocked if they didn't ask you on your interviews. I came from an atypical background (as a PhD researcher), and most programs asked me about my prior experience.

There is no getting around the fact that your experience as a chiropractor is a defining characteristic of you as a candidate, so I would expect to be asked.

Also, interviewers always want to know why EVERY candidate is specifically interested in PM+R, so even if you weren't a chiropractor, you should have a good answer for what you specifically you want to get out of residency training.

So let me ask you- why do you want to go into PM+R? What about PM+R interests you? How has your experience as a chiropractor shaped your opinion of PM+R? These are questiosn for which you need good answers.

 

[MSKMed]

Sorry to revive an old thread, but I thought I would add to the conversation as this topic will apply to me in the near future.

I think it depends on who you talk to. People are people immaterial of their level of education. They carry personal biases with them based on their experiences.

I will be attending a Carib med school this fall and am a chiropractor with 10 years of experience, mainly treating sports injuries and working with professional teams and athletes. I also have experience in medical-legal consulting and have made contacts with several physiatrists over the years that have encouraged me to pursue medical school, and have advised me that my education, training and experience will serve me well in my goal of pursuing a career in PM&R, as there is a certain degree of overlap between chiropractic and physiatry. Although the scope of chiropractic is significantly narrower than the broad scope of PM&R.

So don't be discourage. As posters above have mentioned, highlight your strengths, but in a positive and humble manner. You have to be teachable when pursuing residency training and keep an open mind with respect to the methods of treatment being administered by various health care professionals.

 

[lobelsteve]

Google Dan Wik. He did DC then PMR and has been a vocal advocate for the field.
Don't know where he is in practice at today, but he hailed from MN.

SML

 

[MSKMed]

Thanks Steve!

 

[PMR2008]

Thanks Steve!

lots of examples

http://www.spineone.com/perry-l-haney-spine-doctor-denver-chiropractor.html

http://www.paindoc.yourmd.com/index.cfm/fuseaction/site.physicians/action/dtl/phys/99849152.cfm

http://www.avvo.com/doctors/jeffery-fitzthum-2514767.html

and many more

 

[ghost dog]

I was curious as to whether being a chiropractor will be of benefit as I apply for a PM&R spot. I'm a US FMG and realize that this fact alone will be a hurdle, but I hope my chiropractic/rehab experience (practiced for a couple of years) and my extensive needle EMG/NCV knowledge (I have personally performed over 400 tests) will lighten the negative blow to my application. I would say that the rest of my application is simply average to good. I would sincerely appreciate any comments/opinions on the topic.

Thanks for your time...

Why even mention the EMG ?

This is a big risk. What PMR is going to have a benign view of this ??

I would focus more on the general experience as a DC when asked.

 

[MSKMed]

lots of examples

http://www.spineone.com/perry-l-haney-spine-doctor-denver-chiropractor.html

http://www.paindoc.yourmd.com/index.cfm/fuseaction/site.physicians/action/dtl/phys/99849152.cfm

http://www.avvo.com/doctors/jeffery-fitzthum-2514767.html

and many more

Thanks for the links!

 

[RUOkie]

lots of examples

http://www.spineone.com/perry-l-haney-spine-doctor-denver-chiropractor.html

and many more

He should never be used as a positive example for anybody. His practice is terrifying. He also has NEVER done any type of residency. (only a 1 yr internship)

 

[nvrsumr]

He should never be used as a positive example for anybody. His practice is terrifying. He also has NEVER done any type of residency. (only a 1 yr internship)

Ditto.

 

[PMR2008]

He should never be used as a positive example for anybody. His practice is terrifying. He also has NEVER done any type of residency. (only a 1 yr internship)

I have a friend who is currently working in Dr. Haney's practice. He has nothing but good things to say about him. I personally do not have an opinion on Dr. Haney's but I used the links for examples of MD DC's who practice PM&R.

 

[RUOkie]

I have a friend who is currently working in Dr. Haney's practice. He has nothing but good things to say about him. I personally do not have an opinion on Dr. Haney's but I used the links for examples of MD DC's who practice PM&R.

OK, maybe things have changed in the 10 yrs since I left Denver, but I took care of a few catastrophes from there. For somebody with no formal interventional training, he sure did a lot of crazy stuff.

 

[specepic]

I have a friend who is currently working in Dr. Haney's practice. He has nothing but good things to say about him. I personally do not have an opinion on Dr. Haney's but I used the links for examples of MD DC's who practice PM&R.

Assuming their own website is correct, Haney is doing interventional spine with only an internship. Anyone who sees anything acceptable about that may want to look into an MRI Brain in their future. I'm sure this guy is charasmatic and is a savvy businessman. Most chiros are more business focused than MDs/DOs, perhaps to a fault. Ever read a chiro journal...almost every ad is about how to squeeze more money out of pts and the practice. Never (or rare) seen that in the NEJM, etc. There are many good chiros, but also for many, they are sales people > physicians.

To answer the OP, this is what could drag down a chiro/MD applicant. You have to highlight your experience while subtly saying, "I'm not a snake oil salesman" too.

 

[MSKMed]

Assuming their own website is correct, Haney is doing interventional spine with only an internship. Anyone who sees anything acceptable about that may want to look into an MRI Brain in their future. I'm sure this guy is charasmatic and is a savvy businessman. Most chiros are more business focused than MDs/DOs, perhaps to a fault. Ever read a chiro journal...almost every ad is about how to squeeze more money out of pts and the practice. Never (or rare) seen that in the NEJM, etc. There are many good chiros, but also for many, they are sales people > physicians.

To answer the OP, this is what could drag down a chiro/MD applicant. You have to highlight your experience while subtly saying, "I'm not a snake oil salesman" too.

This "snake oil salesman" comment is a classic example of the personal bias that I was speaking to. As you mentioned there are many good chiros and many bad chiros, so I don't think there is any need to make such a "disclaimer". Moreover, being savvy in business should not be viewed as a negative either, unless of course the term "business savvy" is implied to mean unethical.

Here are a few links of some chiros working in hospital and university settings that should shed some light on the type work that chiros do in academic settings, as opposed to the strip mall chiros we often see or hear about doing "spinal screenings":

http://www.tgwhf.ca/mha/scientists_erwin.asp


http://www.stmichaelshospital.com/programs/chiropractic/index.php


http://www.mountsinai.on.ca/wellbeing/our-practitioners


http://www.winchesterhospitalchiro.com/


http://www.uhnresearch.ca/researchers/profile.php?lookup=833


http://www.uhnresearch.ca/researchers/profile.php?lookup=1225


http://www.uoguelph.ca/hhns/people/faculty/srbely.shtml


http://my.clevelandclinic.org/staff_directory/staff_display.aspx?doctorid=9419

 

[nvrsumr]

OK, maybe things have changed in the 10 yrs since I left Denver, but I took care of a few catastrophes from there. For somebody with no formal interventional training, he sure did a lot of crazy stuff.

No they havent except now has his MD employees do 5 level bilateral cervical facet injections on MRI negative whiplash cases in his ASC with propofol and a 10K bill instead of doing himself.

 

[PMR2008]

No they havent except now has his MD employees do 5 level bilateral cervical facet injections on MRI negative whiplash cases in his ASC with propofol and a 10K bill instead of doing himself.

interesting. Thanks for sharing.

 

[Fifty 3rds]

Because chiropractic shops are steeped in pseudoscience, I'd not mention it. (unless you somehow link your new found passion for real science to the disenchantment of your previous career choice)

For any posters lurking out there wondering the same thing in regards to their previous "science jobs", such as: naturopathic medicine degree, or their acai-berry suppository gig or their foray into metaphysical peyote and stinging nettles mani-pedis , I'd suggest you leave those life experiences in the waters where you underwent your scientific conversion.

 

[facetguy]

Because some chiropractic shops are steeped in pseudoscience, I'd not mention it. (unless you somehow link your new found passion for real science to the disenchantment of your previous career choice)
.

Fixed that for you.

And why must a DC be "disenchanted" in order to have a desire to pursue medicine?

 

[MSKMed]

Because chiropractic shops are steeped in pseudoscience, I'd not mention it. (unless you somehow link your new found passion for real science to the disenchantment of your previous career choice)

For any posters lurking out there wondering the same thing in regards to their previous "science jobs", such as: naturopathic medicine degree, or their acai-berry suppository gig or their foray into metaphysical peyote and stinging nettles mani-pedis , I'd suggest you leave those life experiences in the waters where you underwent your scientific conversion.

Let's stick to the topic at hand please. Your anecdotal bias is acknowledged, but the purpose of this thread was not to bash alternative health care professionals. It was to learn about PM&R attendings'/residents' views on DCs continuing their education to study medicine with the goal of pursuing a career in physiatry.

 

[specepic]

Let's stick to the topic at hand please. Your anecdotal bias is acknowledged, but the purpose of this thread was not to bash alternative health care professionals. It was to learn about PM&R attendings'/residents' views on DCs continuing their education to study medicine with the goal of pursuing a career in physiatry.

You have asked for input/advice, then when you did not like what was said, have proceeded to tell us how it really is. That approach in itself will not serve you well on the interview trail.

Some physiatrists will have no beef with chiros, but some will. Part of that may be bias/ignorance but some of that is the fault of chiropractors who practice outside the realm considered appropriate and these MDs/DOs have experience interacting with that element.

The best thing to highlight is MSK knowledge, imaging, anatomy, etc.; would avoid EMG (landmine there), and demonstrate humbleness, willing to learn/be trained, and an insight to discover what you do not know. There is no more dangerous a resident/physcian than one who does not know what they do not know. Don't be that doc.

 

[Jitter Bug]

OK try to think of it a different way. If you were going to interview for an executive job at Target corporation, you wouldn't enthusiastically rave about how much you appreciate the Walmart philosophy of retail management. And how your years being a great Walmart executive made you who you are today. You would piss everyone off speaking so highly of a rival. And to academic physicians, yes chiropracters are rivals. And all rivals think they are better than the other team (whether it's true or not doesn't matter)

Don't sell yourself as a DC. Sell yourself as a 4th year medical student because that is the only training that even makes you eligible to go on these interviews. While your degree as a DC makes for a "hmm interesting" sidenote it shouldn't be the focus of how you present yourself during residency interviews.

 

[MSKMed]

You have asked for input/advice, then when you did not like what was said, have proceeded to tell us how it really is. That approach in itself will not serve you well on the interview trail.

Some physiatrists will have no beef with chiros, but some will. Part of that may be bias/ignorance but some of that is the fault of chiropractors who practice outside the realm considered appropriate and these MDs/DOs have experience interacting with that element.

The best thing to highlight is MSK knowledge, imaging, anatomy, etc.; would avoid EMG (landmine there), and demonstrate humbleness, willing to learn/be trained, and an insight to discover what you do not know. There is no more dangerous a resident/physcian than one who does not know what they do not know. Don't be that doc.

I appreciate the comments made, and all points are well taken. As I do not fall into the category of chiros being portrayed on this thread, I felt it was important for me to impress upon the fact that not all chiros practice outside the profession's scope of practice, which is the conservative management of MSK conditions/injuries, similar to that of PTs. I think it is perfectly fine for me to make such statements. Moreover, it is my view, limited as it may be, that program directors would view a 4th year med student who previously practiced as a DC as just a 4th year student pursuing medicine as a second career. I mean the fact that someone goes through the rigors of med school, taking the boards etc... and undergoing electives in PM&R with a genuine interest in the field should (according to what I have read on SDN) satisfy the "fit" criteria that most programs are looking for, over the type of candidate that may pursue PM&R if he/she is unsuccessful at matching in an ortho program.

I feel that Jitter Bug's advice is probably the most practical, as one should sell him/herself primarily as a 4th year student interested in pursuing a career in physiatry, and not a DC wishing to go into physiatry.

 

[Taus]

I appreciate the comments made, and all points are well taken. As I do not fall into the category of chiros being portrayed on this thread, I felt it was important for me to impress upon the fact that not all chiros practice outside the profession's scope of practice, which is the conservative management of MSK conditions/injuries, similar to that of PTs. I think it is perfectly fine for me to make such statements. Moreover, it is my view, limited as it may be, that program directors would view a 4th year med student who previously practiced as a DC as just a 4th year student pursuing medicine as a second career. I mean the fact that someone goes through the rigors of med school, taking the boards etc... and undergoing electives in PM&R with a genuine interest in the field should (according to what I have read on SDN) satisfy the "fit" criteria that most programs are looking for, over the type of candidate that may pursue PM&R if he/she is unsuccessful at matching in an ortho program.

I feel that Jitter Bug's advice is probably the most practical, as one should sell him/herself primarily as a 4th year student interested in pursuing a career in physiatry, and not a DC wishing to go into physiatry.

Re scope of practice- I'd be shocked if you found any physiatrists or other physicians who would agree
that EMG/NCS were within chiro scope. I would absolutely not mention that.

 

[MSKMed]

Re scope of practice- I'd be shocked if you found any physiatrists or other physicians who would agree
that EMG/NCS were within chiro scope. I would absolutely not mention that.

Thanks Taus, I absolutely agree with you.

To clarify, I am not the one who posted performing EMG/NCV. That was the OP (MDDC). My experience lies strictly in the administration of manual therapies (joint mobilization/manipulation, manual myofascial release), physiotherapeutic modalities (i.e. IFC, US etc..), and exercise prescription, instruction and supervision. My undergraduate background is in kinesiology and I attained CSCS certification through the NSCA. Aside from my experience in treating athletes from weekend warriors to the pros, I have 6 years of medical-legal consulting experience and I managed a medical assessment center that commissioned IMEs, FCEs, Pre-Participation exams, In-Home Evaluations etc... for insurer, legal and corporate markets. I have also completed a Master of Health Administration degree.

 

[ghost dog]

Thanks Taus, I absolutely agree with you.

To clarify, I am not the one who posted performing EMG/NCV. That was the OP (MDDC). My experience lies strictly in the administration of manual therapies (joint mobilization/manipulation, manual myofascial release), physiotherapeutic modalities (i.e. IFC, US etc..), and exercise prescription, instruction and supervision. My undergraduate background is in kinesiology and I attained CSCS certification through the NSCA. Aside from my experience in treating athletes from weekend warriors to the pros, I have 6 years of medical-legal consulting experience and I managed a medical assessment center that commissioned IMEs, FCEs, Pre-Participation exams, In-Home Evaluations etc... for insurer, legal and corporate markets. I have also completed a Master of Health Administration degree.

Hmmm... I think the medical / legal stuff may almost be as contentious as the EMG area.

 

[MSKMed]

Hmmm... I think the medical / legal stuff may almost be as contentious as the EMG area.

How so?

I have academic training in insurance medicine and medico-legal expertise from a university's faculty of medicine and am often called upon in arbitrations to provide my opinion on various cases from my area of expertise. I also have extensive experience in performing IMEs and preparing med-legal reports.

I understand that many in the medical community are unaware of the knowledge that DCs possess because they only hear about the subluxation-based/philosophy-based practitioners, but there is a significant population of evidenced-based DCs that do great work in the clinics and hospitals where they work and are called upon to do med-legal work, perform FAEs and are involved in industrial rehabilitation.

 

[MSKMed]

Hmmm... I think the medical / legal stuff may almost be as contentious as the EMG area.

Moreover, I agree with your view on the Hon. Deb Matthews.

 

[PMR 4 MSK]

How so?

I have academic training in insurance medicine and medico-legal expertise from a university's faculty of medicine and am often called upon in arbitrations to provide my opinion on various cases from my area of expertise. I also have extensive experience in performing IMEs and preparing med-legal reports.

I understand that many in the medical community are unaware of the knowledge that DCs possess because they only hear about the subluxation-based/philosophy-based practitioners, but there is a significant population of evidenced-based DCs that do great work in the clinics and hospitals where they work and are called upon to do med-legal work, perform FAEs and are involved in industrial rehabilitation.

In med-legal work, as long as you do whatever the guy who pays your bills wants you to do, you are considered to be doing "great work" regardless of degree. That may or may not coincide with what is good for the patient.

 

[MSKMed]

In med-legal work, as long as you do whatever the guy who pays your bills wants you to do, you are considered to be doing "great work" regardless of degree. That may or may not coincide with what is good for the patient.

I acknowledge this sentiment as I do see this in the industry, but again, the theme of generalizing occurs on this forum a lot.

 

[ghost dog]

In med-legal work, as long as you do whatever the guy who pays your bills wants you to do, you are considered to be doing "great work" regardless of degree. That may or may not coincide with what is good for the patient.

Yes, and this is one of the issues I was referring to; doctors of chiropractic ( although physicians are absolutely guilty of this as well) have a reputation as a "gun for hire."

Unfortunately, I have seen the same chiropractic documentation written in regards to numerous patients, irrespective of their presentation.

On the flip side of this issue, I have also seen ridiculous statements that can't possibly be true in ( the well intentioned ? ) effort to advocate for a claimant.

An example: a younger claimant has a complaint of back pain radiating to both thighs. The chiropractors cites a " bilaterally positive straight leg raise test." This kind of crap pisses me off. No, this is not the case.

Is it possible ? Sure, this person could have cauda equina or other serious pathology ( anythings possible - hey, I could own a 24 karat gold toilet , and who are you to judge me ?!) . However, they would likely be presenting to the ER with the other relevant symptoms. Far, far ( far ! ) more likely, the examiner doesn't know what the heck they are talking about , and the patient in question has an exacerbation of back pain with hip flexion. I cannot count how many times I have read this in chiro reports - it grinds my gears.

 

[facetguy]

Yes, and this is one of the issues I was referring to; doctors of chiropractic ( although physicians are absolutely guilty of this as well) have a reputation as a "gun for hire."

Unfortunately, I have seen the same chiropractic documentation written in regards to numerous patients, irrespective of their presentation.

On the flip side of this issue, I have also seen ridiculous statements that can't possibly be true in ( the well intentioned ? ) effort to advocate for a claimant.

An example: a younger claimant has a complaint of back pain radiating to both thighs. The chiropractors cites a " bilaterally positive straight leg raise test." This kind of crap pisses me off. No, this is not the case.

Is it possible ? Sure, this person could have cauda equina or other serious pathology ( anythings possible - hey, I could own a 24 karat gold toilet , and who are you to judge me ?!) . However, they would likely be presenting to the ER with the other relevant symptoms. Far, far ( far ! ) more likely, the examiner doesn't know what the heck they are talking about , and the patient in question has an exacerbation of back pain with hip flexion. I cannot count how many times I have read this in chiro reports - it grinds my gears.

I'm glad you mentioned that underlined part because that's the truth. And dumb stuff shows up in MD reports as well; we've all seen them.

 

[RUOkie]

I'm glad you mentioned that underlined part because that's the truth. And dumb stuff shows up in MD reports as well; we've all seen them.

correct. I see this from FP's and from some of the unethical spine surgeons as well.

 

[MSKMed]

Yes, and this is one of the issues I was referring to; doctors of chiropractic ( although physicians are absolutely guilty of this as well) have a reputation as a "gun for hire."

Unfortunately, I have seen the same chiropractic documentation written in regards to numerous patients, irrespective of their presentation.

On the flip side of this issue, I have also seen ridiculous statements that can't possibly be true in ( the well intentioned ? ) effort to advocate for a claimant.

An example: a younger claimant has a complaint of back pain radiating to both thighs. The chiropractors cites a " bilaterally positive straight leg raise test." This kind of crap pisses me off. No, this is not the case.

Is it possible ? Sure, this person could have cauda equina or other serious pathology ( anythings possible - hey, I could own a 24 karat gold toilet , and who are you to judge me ?!) . However, they would likely be presenting to the ER with the other relevant symptoms. Far, far ( far ! ) more likely, the examiner doesn't know what the heck they are talking about , and the patient in question has an exacerbation of back pain with hip flexion. I cannot count how many times I have read this in chiro reports - it grinds my gears.

ghost dog, not sure if you practice in the GTA, but there are a few physiatrists in the area who do IME/med-legal work, and reading their reports makes one wonder how they obtained their medical degrees and completed their specialty training. This problem crosses over various specialties in the industry. And now with a ton of GPs doing this type of work, physical exam findings outside of ROM and palpation (if that) are non-existent.

 

[MSKMed]

In any event, it appears that the general consensus (on here) is that a bias exists against DCs who pursue medical school and wish to obtain a residency in PM&R. Will see how this plays out when my time comes to apply to residencies down the road.

I thank everyone for their thoughts and feedback.

 

[ghost dog]

ghost dog, not sure if you practice in the GTA, but there are a few physiatrists in the area who do IME/med-legal work, and reading their reports makes one wonder how they obtained their medical degrees and completed their specialty training. This problem crosses over various specialties in the industry. And now with a ton of GPs doing this type of work, physical exam findings outside of ROM and palpation (if that) are non-existent.

Suprisingly I haven't come across a heck of a lot of IME phys reports. The reports I have come across I have't had an issue with ; very good / non - biased stuff.