EMG Advice

[EMGinterest]

Hi everyone,

I'm an M3 trying to finalize my specialty choice. I'm down to PM&R and neurology, leaning toward PM&R (for reasons beyond this thread). One thing I'm currently interested in is EMGs. The problem I'm having is that both specialties perform them, and I haven't been able to figure out much about how the two differ. From what I can tell, PM&R gets more training in residency, but neurology has a fellowship. Beyond that, physicians I've talked to in both seem to believe their specialty is the best path, without offering specifics. I'm hoping to get some answers that will help me better understand the opportunities as a physiatrist.

- Are there differences between the types of EMGs the two specialties perform? I get the sense that neurology does EMGs focused on more complex/neurologic pathologies, but is there the possibility for a physiatrist to break into those areas if interested? The neurologist at my institution implied that all the myopathies, ALS rule out, myasthenia, etc. fall within the neurology realm. If that's the case, what do physiatrists see?
- Do PM&R residents ever go on to complete the neurology fellowship?
- Is it possible to perform enough EMGs to be the primary/only part of a physiatrist's practice? If not, what other focuses do these physiatrists have?
- What is the job market for someone interested in performing these procedures?

Thank you in advance for your answers. Choosing a specialty is a big decision and I want to make sure I'm make as informed of one as possible.

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[timisdaman]

1. Both specialties can do the same types of EMGs. However, at institutions where both specialties do EMGs, I would say it depends on what is being referred.

2. Yes, PM&R residents can do the EMG fellowships if they want.

3. Possible, but probably the best model is to have your own clinic, whether it is pain, sports, general or neuromuscular, so that you can do EMGs on your own patients. Some people will have a technician do the nerve conduction study while they see clinic patients, and the MD will do the actual EMG.

4. Job market is good. Almost every place that is hiring is looking for more people who do EMGs.

 

[Jitter Bug]

You can do any kind of EMG's you want, based on interest and skill level. I leave the blink studies and ALS evals to my colleague who is PM&R with a neurophysiology fellowship, because they have an interest in these patients and I don't.

Due to clinical interest, you will commonly see more PM&R docs doing radics, CTS, UMNE, peroneal neuropathy studies (because we typically tend to have more MSK clinics) and neuro doing more myopathy/NMJ disorder/ MND workups because more neurologists have these types of clinics.

PM&R can do a neurophysiology fellowship if interested.

Now that the bottom has dropped out of EMG reimbursement, there is far less competition to do them, so you should have no trouble picking them up for your practice.

If you want to compete in a saturated market for EMG business, it helps to get the ABEM certificate. It's a pain in the a** exam though.

 

[cowboydoc]

Great advice above. Most importantly, look at each specialty from the perspective of "is this something I would like to do if I did NO EMGs?" Chances are your interest will shift, and you don't want to end up without options. I know a couple docs with exclusively EMG practices, but don't see that commonly, and most wouldn't set up a practice like that after the pay cuts of 2012.

Training will vary greatly. I think PM&R still requires 200 during residency, don't think neurology has a specific requirement? I did nearly 400 in residency, other PM&R colleagues had to tag team studies to get "200."