General Outpatient Physiatry?

[gimmedanews]

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So, just a few questions: I'm confused over some of the areas that PM&R covers.

I know that the field has inpatient and outpatient areas. I also know that several different sub-specialties exist (all of which require a fellowship), such as Sports and Spine and Pain. I also know that some people divide PM&R into 'interventional', which use more invasive procedures, with 'non-interventional', which tend to do simpler procedures and more conservative approaches, like PT.

Here's the question: how do these different distinctions 'match-up'? Are the non-interventionalists those docs who handle inpatients and don't do fellowships, while the interventionalists handle outpatients and do fellowships? Or do these distinctions not necessarily go hand-in-hand? Thus, would there be such thing as a non-interventional, general physiatrist who does not complete a fellowship, and handles outpatients?

Finally, if I were interested in this form of 'general-outpatient PM&R', is it true that only certain residencies would provide this experience for me, while others are more geared toward the inpatient side?

Thanks!

 

[PMR 4 MSK]

So, just a few questions: I'm confused over some of the areas that PM&R covers.

I know that the field has inpatient and outpatient areas. I also know that several different sub-specialties exist (all of which require a fellowship), such as Sports and Spine and Pain. I also know that some people divide PM&R into 'interventional', which use more invasive procedures, with 'non-interventional', which tend to do simpler procedures and more conservative approaches, like PT.

Here's the question: how do these different distinctions 'match-up'? Are the non-interventionalists those docs who handle inpatients and don't do fellowships, while the interventionalists handle outpatients and do fellowships? Or do these distinctions not necessarily go hand-in-hand? Thus, would there be such thing as a non-interventional, general physiatrist who does not complete a fellowship, and handles outpatients?

Finally, if I were interested in this form of 'general-outpatient PM&R', is it true that only certain residencies would provide this experience for me, while others are more geared toward the inpatient side?

Thanks!

Excellent questions.

Interventionalist vs non-interventionalist really only applies to the subspecialty of pain medicine within PM&R. Most Physiatrists who complete fellowships in pain or spine consider themselves an interventionalist as they are able to perform many injection-type procedures, more than the average non-fellowship-trained Physiatrist. They tend to practice with more of a interventional bias to their practice.

There are many Physiatrists who do fellowships in SCI, TPI, EMG, etc, who are not interventionalists.

Anyone should be able to leave any PM&R residency and feel competent to do inpt rehab as well as general outpt MSK. There are many non-interventional, non-fellowship-trained Physiatrists doing outpt MSK. Many do basic procedures like nerve and joint injections, trigger point injections, tendon and ligament injections and usually things like Botox for spasticity.

Depending on where they trained, they may or may not have sufficient exposure to epidurals and other basic spinal injections. Some programs now have such extensive exposure and hands-on experience with interventional procedures that it's graduating residents don't really need a fellowship (but politics of hospitals and priviledges may make a fellowship more desirable still).

So any aspect of inpt or outpt PM&R can be performed by anyone without a fellowship. The decision for a fellowship depends on how much training you got in your residency to do what you want to do in your career.

And yes, some residencies are geared more toward inpt than outpt. Choose wisely...

 

[Ludicolo]

Agree w/ above.

OP - it’s not as cut and dry as you think. There is tremendous overlap in what a “general” physiatrist covers compared to a “subspecialist”. A lot of generalists do a mix of inpatient and outpatient. Inpatient physiatry has its own associated fellowships (i.e. SCI, TBI), and there are outpatient, non-interventional fellowships available as well (i.e. EMG, neuromuscular).

There are lots of outpatient physiatrists whose practice is exactly what you describe – non-interventional, outpatient based, general MSK/neuromuscular. There are also non-fellowship trained physicians performing spinal procedures – where competency was gained during residency or during practice itself. The great debate round these parts is whether some of these outpatient subspecialties (sports, spine, msk) should even “require” a fellowship.

As far as PM&R residencies go, some are certainly more inpatient heavy than others. However all programs are required to provide a minimum of 12 months inpatient and 12 months outpatient, in addition to consult and EMG experience. The quality of these exposures however – will vary greatly from program to program.