Trends in the field will continue to favor sub-specialization in physiatry. PM&R base training will serve as a gateway to fields like musculoskeletal medicine.
PASSOR "re-integrates" into the Academy but maintains a vestigial a network of individuals who advise the field on Spine/MSK/Pain/Occ Med issues.
MSK ultrasound establishes itself as an important tool for physiatrists in diagnosing and treating MSK injuries. Basic MSK training requirements are incorporated into ACGME PM&R residency training competencies some time before the turn of the next century!
Stagnation in academic physiatry continues to weaken PM&R department chairs' institutional clout and reputations as junior physiatrists "abandon ship" and take positions in departments of anesthesiology, orthopedics, and neurological surgery. Progressive chairs who "see the handwriting on the wall" respond in innovative ways to promote faculty development. Traditionalists are left wringing their hands and wondering "what went wrong??..."
Hmmm...
The million dollar question.
Will musculoskeletal medicine become its own subspecialty, or will Physiatrists in general become the de-facto experts in MSK and non-operative spine care? Will neither one happen?
Right now, we say we are, but other physicians don't really think so and the general public still doesn't know what Physiatrists are or do. I'd say we're about half way there. Other docs know we do MSK/spine, but think that we take care of "easy" patients, are limited procedurally and don't really do anything that other docs can't do.
It seems the academy is going for the latter (all Physiatrists are experts in MSK) with the new AAPMR journal "Musculoskeletal and Rehabilitation Medicine", creating a spine track at the AAPMR conference, inviting Dr. Bogduk to speak, etc. Those are all good efforts and should increase the depth of the core PM&R knowledge base. But, ultimately, the most substantial change must occur at the residency level. The medical community and patients will never be convinced that we are
the MSK experts if you have a few very skilled practicioners/experts but your average physiatrist is so-so.
That means competencies is specific diagnoses/management and skill sets. Reading CT/MRI, complex spines, failed joint surgeries, basic needle skills, an even deeper knowledge of functional biomechanics and kinematics and ultrasound (if enough Physiatrists ever become experts).
Surverys about residency MSK training have been done, etc. I haven't seen any changes implemented yet. When it comes down to it, PDs and chairmen will just have to step up, make some affiliations, sacrifice some inpt coverage and let their residents get the training they need if this is to happen.
There's the rub.
