History Lesson

[SportsMed09]

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AS an incoming resident and participant in the world of PM&R, I was hoping that contributors to this forum could answer some questions for me and the future generation of this specialty. Anyone who comes to this board will quickly get inundated with the vidbe that our field is underappreciated, antiquated, and behind the times.
I would like to ask if people who contribute here would be willing to share just how this came to be. What points in time, looking back, did physiatrists miss the boat? Specific conferences? Losing head to head against other specialty academies? And why is it, that with all this recognition and frustration, that there is this slow march towards the most basic element, recognition as a specialty? Is this mismanagement by past physiatrists?
No need to name names and get into trouble (unless you want to share). All I ask is that experienced physiatrists help shed some light on this, because identifying these things, can help in the future focus younger physiatrists to turn some of those things aounrd.

 

[Taus]

AS an incoming resident and participant in the world of PM&R, I was hoping that contributors to this forum could answer some questions for me and the future generation of this specialty. Anyone who comes to this board will quickly get inundated with the vidbe that our field is underappreciated, antiquated, and behind the times.
I would like to ask if people who contribute here would be willing to share just how this came to be. What points in time, looking back, did physiatrists miss the boat? Specific conferences? Losing head to head against other specialty academies? And why is it, that with all this recognition and frustration, that there is this slow march towards the most basic element, recognition as a specialty? Is this mismanagement by past physiatrists?
No need to name names and get into trouble (unless you want to share). All I ask is that experienced physiatrists help shed some light on this, because identifying these things, can help in the future focus younger physiatrists to turn some of those things aounrd.

fizz-eye-uh-what? psychiatrist? podiatrist?

oh my bad...I meant Fizz-ee-AT-trist 😉

 

[MSKalltheway]

fizz-eye-uh-what? psychiatrist? podiatrist?

oh my bad...I meant Fizz-ee-AT-trist 😉

You also forgot physiologist, lol

I heard one doc on the trail say "Whats the difference between a phys-eye-at-rist and a phys-ee-at-rist? They are the same except a phys-ee-at-rist is better!"

I'll only give my opinion on the joke after my rank list is submitted.

 

[Disciple]

AS an incoming resident and participant in the world of PM&R, I was hoping that contributors to this forum could answer some questions for me and the future generation of this specialty. Anyone who comes to this board will quickly get inundated with the vidbe that our field is underappreciated, antiquated, and behind the times.
I would like to ask if people who contribute here would be willing to share just how this came to be. What points in time, looking back, did physiatrists miss the boat? Specific conferences? Losing head to head against other specialty academies? And why is it, that with all this recognition and frustration, that there is this slow march towards the most basic element, recognition as a specialty? Is this mismanagement by past physiatrists?
No need to name names and get into trouble (unless you want to share). All I ask is that experienced physiatrists help shed some light on this, because identifying these things, can help in the future focus younger physiatrists to turn some of those things aounrd.

There are a few examples I can think of.

Failing to participate with the other specialties in establishing Sports Medicine in the 1990's (The specialty was anti-Musculoskeletal Medicine in the early 90's).

Allowing PM&R pain fellowships to fold without developing alternate pathways through our residency training, etc.

I think there is definitely more input from the specialties constituents than in the past, and communication is definitely better, but it all starts with the academic institutions. Even with the support of most, there are always going to be a requisite number of experienced Physiatrists, who can fillibuster proposed improvements in the specialty.

I don't think that this is unique to our specialty. What I do think, is that for us to remain relavent, we need to make sure our leadership, year after year, is strong and assertive.

 

[rysa4]

Many medical centers do not have any physiatrists, and the specialty is not part of many patients' health care lives, unless something like a TBI or SCI occurs; even then its more about the rehab center as opposed to the physiatrist.

Moreover, the type of practice an individual has in physiatry varies from doc to doc, so there is uncertainty in the medical community with regards to how to use the specialty since it is provider specific.

The field is young, with physicial medicine born in the midwest at the time of the polio epidemic, and rehabilitation medicine with its origins in the East coast as an inpatient specialty, prior to the two combining.

To put it another way, a nephrologist owns the kidney, a pulmonologist owns the lung; but what does the physiatrist own? Thus the challenge.

 

[PMR 4 MSK]

To put it another way, a nephrologist owns the kidney, a pulmonologist owns the lung; but what does the physiatrist own? Thus the challenge.

I'll take the muscles, tendons and ligaments. Neuro gets the nerves and ortho gets the bones and joints.

 

[rysa4]

I'll take the muscles, tendons and ligaments. Neuro gets the nerves and ortho gets the bones and joints.

exactly my point. You may take the muscles tendons and ligaments but nobody outside of the field would be able to put the name of the field together with that selection, whereas the rest of the specialties don't have this issue. It's just part of the challenge.

BTW- Some physiatrists take the nerves, bones, and joints too!

 

[Disciple]

To put it another way, a nephrologist owns the kidney, a pulmonologist owns the lung; but what does the physiatrist own? Thus the challenge.

I think most other physicians associate inpt/neuro rehab with Physiatrists, in part because other specialties don't want to deal with it. Is involvement of Physiatry required for CARF accreditation?

We can't own pain management or sports medicine. These are multidisciplinary.

I think we should attempt to own non-surgical musculoskeletal care.

We're well established in the Worker's Compensation system under this classification. Now, if we spread this to the academic institutions. It would take alot of effort, doable in my opinion.

 

[Disciple]

To put it another way, a nephrologist owns the kidney, a pulmonologist owns the lung; but what does the physiatrist own? Thus the challenge.

I think most other physicians associate inpt/neuro rehab with Physiatrists, in part because other specialties don't want to deal with it. Is involvement of Physiatry required for CARF accreditation?

We can't own pain management or sports medicine. These are multidisciplinary.

I think we should attempt to own non-surgical musculoskeletal care.

We're well established in the Worker's Compensation system under this classification. Now, if we spread this to the academic institutions. It would take alot of effort, doable in my opinion.

 

[rysa4]

I do not know what level of involvement of PMR docs is required, if any, for CARF accreditation. The organization does have a CD-ROM that goes through all of that.

My answer was really to the OP as to why the field is under-appreciated - it has a lack of association as to an exact nature of the field.

This is due to the breadth of the field, and its tough to be really good in PMR, because of the breadth. So PMR docs tailor their practices to a combination of market demand essentially in their job environment and desire of the individual doc. In the end, the key is for the recently minted PMR doc to choose wisely as to their job environment choice.

 

[MSKmonky]

NeuroMuscular Orthopedics and Rehabilitation

 

[Hemisphere]

fizz-eye-uh-what? psychiatrist? podiatrist?

oh my bad...I meant Fizz-ee-AT-trist 😉

I think it's time we stop joking... this joke is getting old... When someone asks me what I do, I say loud and clear. a PHYS-I atrist.

I don't like starting it off as fizz ee... that's a bubbly soft drink... I don't like it called rehab doctor... or rehab medicine... that's drug rehab...
yeah average people don't know what i'm saying when I say PHYS I atrist, but I like that. When people don't know they become curious... yeah they ask you did you say podiatrist... who cares!! then you have their attention. When I have that, I drill the PHYS into their head by saying a PHYS i atrist, a doctor of PHYSICAL function. A specialist in PHYSICAL MEDICINE AND REHABILITATION, and say it in a way that subtly makes it sound like "duh, OMG you don't know that?" THey instantly know it's not psychiatry. Those who are really interested might ask another question a physical therapist? NO, I prescribe medicines, a doctor, not a therapist. They instantly think, why haven't I heard of this before?? Because everyone keeps changing the name to avoid the questions rather than take the time to provide the public the answers.

And why haven't they?? We should all be calling ourselves the same thing. And then publicizing what we do better. I have referred to many friends of friends to see PHYS-iatrists for outpatient MSK conditions who never heard of us before. But then were thankful that they found out! Agreed we should try to own this area better in the public mind, especially before more PT's own it through direct access laws.

Depending on who i'm talking to, for example, a girl i'm trying to impress, I might glamorize it and say yeah we get paralyzed people to move around, we use robots, medicines, prescribe therapies, anything it takes. The neuro side does sound more glamorous, though. But, It never hurts to tell someone of the opposite sex that you are SPECIALIST of PHYSICAL function or PHYSICAL medicine either.

anyway, be proud, not fizzy, when representing, and consider someone asking for clarification and repeating yourself a victory, not a failure. It's a sign of interest. Didn't fizzy develop because people thought PHYS--I- atrist sounds too much like psychiatrist?

Let's get back to the PHYSical and not worry about being confused with psychiatrists. If you emphasize the PHYS and follow up any quizzical looks that you are specialist of physical medicine, there will be no confusion. Or just say off the bat "a PHYS-i atrist, a specialist of physical medicine and rehabilitation"

It's usually the more intelligent people who can't wrap there head around the fact that they haven't heard of a particular medical specialty who are in disbelief and ask psychiatrist, podiatrist, therapist, etc. stick to all the things they know... the more intelligent, the more questions.
The ones who work at burger king and don't care are like... yup, physiatrist... cool... cool... no further questions needed.

Although once you meet that intelligent person who knows what a physiatrist is, it's gratifying isn't it? makes you feel like the specialty is getting recognized... so all we need to do is create more of those people who have been educated...

And to those of you spine and pain peopel who think you are above this, you can't forget your roots. If you say you are a pain doctor or a "spine" doctor, or a brain injury doctor, then don't forget to follow it with I'm a pain specialist, and a PHYSiatrist. It will make you sound more special if you keep your roots not forget them...