Is It True Neurologists Don't Like Physical Medicine and Rehab?

[Llenroc]

One of my friends, whose Dad is a Neurologist, said that Neurologists don't like PM&R because they "stole" the EMG test, which used to be their big money maker.

I just started my Neurology rotation. The other day we went to see one of the patient's, and the heroic PM&R fellows were already in the patient's room. At this point, one of the interns (whose from Anesthesiology) said, "Look, it's their nemesis, PM&R!"

Unfortunately, I told the Neurology people that I was thinking about going into PM&R on the first day of the clerkship. Mistake?

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[Louisville04]

One of my friends, whose Dad is a Neurologist, said that Neurologists don't like PM&R because they "stole" the EMG test, QUOTE]

My understanding was PM&R started EMG's and Neurology "stole" them. I don't know why they are complaining...they do EEG's on new CVA patients here all the time...plus they can do spinal taps.

 

[Llenroc]

One of my friends, whose Dad is a Neurologist, said that Neurologists don't like PM&R because they "stole" the EMG test, QUOTE]

My understanding was PM&R started EMG's and Neurology "stole" them. I don't know why they are complaining...they do EEG's on new CVA patients here all the time...plus they can do spinal taps.

Hrmmm... Interesting.

 

[njdevil]

As far as EMG/NCS, my understanding is that when the technology 1st was developing, Neurology overall did not take much interest in it (of course a lot of the great research was done at both Neuro & PM&R). PM&R was the most involved clinically. Eventually, Neurology began doing the procedure as well when they realized how it was a good money generator. These days it is a modest generator of money and we as fields are both fighting to keep other midlevels away from doing the procedure.

As far as the deparments, Neuro and PM&R at Jefferson seem to compliment each other quite well. The departments consult each other for proper expertise. As PM&R residents, we rotate with the Neuro EMG Attending and fellow weekly for a two month rotation. The neuro-emg fellow also rotates with one of our EMGers. One of our attendings completed his residency in PM&R at Jefferson and did a Emg fellowship through the neuro department. Our Neurophys city-wide conference is taught by both disciplines for the EMG section.

 

[Disciple]

One of my friends, whose Dad is a Neurologist, said that Neurologists don't like PM&R because they "stole" the EMG test, which used to be their big money maker.

I just started my Neurology rotation. The other day we went to see one of the patient's, and the heroic PM&R fellows were already in the patient's room. At this point, one of the interns (whose from Anesthesiology) said, "Look, it's their nemesis, PM&R!"

I haven't seen a whole lot of that during residency and now out in the community. The institution where I did my residency had a pretty large Neuro department and they were very welcoming and treated me the same as they did their EMG fellows. The interactions I've had with Neurologists out in the community who do Occ Med/EMGs/pain has generally been very friendly and collegial (except during Utilization Review, but that's another story).

What I have seen more of is animosity between Pain Clinics and Spine Centers, more often in the academic setting.

 

[rehab_sports_dr]

When I was a medical student, I was at a medical school with a strong neuro department and an essentially non-existent PM+R department. When I told my attendings I was going into PM+R, I definitely got a bit of the "why would someone as bright as you waste your time in PM+R" comments.

That said, I don't feel like it's an especially antagonistic relationship. During my internship, I rotated a bunch with neurologists, and they seemed excited to teach me and aknowledged the value of our overlapping fields.

In the big picture, I think the fields get along pretty well, although I think some old school neurologists have some skepticism about the growth of PM+R and don't really get what we offer that they don't.

 

[jofutti]

I'm doing a sub-I in Neuro now, and my attending seems very supportive of my choice to go into PM&R.

 

[P Willi]

When I did a neuro rotation and told my attendings that I was going to apply to PM&R, they all were pretty excited. One even refered to it as the "cousin of neurology."

 

[Disciple]

Alot of Neurologists value what Physiatrists have to offer (treatment wise), as many of the diseases they diagnose are slowly progressive and uniformly fatal.

 

[lobelsteve]

I'm PMR-PM, my sister is Peds-Neuro.

It's a love-love relationship, and it is a free phone consult.

 

[Hemisphere]

actually I think neither field stole EMG from the other...
The original electromyographers evolved from physicians who
started studying electricity as a "cure all" zapping
patients for anything from chronic pain to "female troubles"
It was quite fashionable for a certain time and physicians wrote up
cases in the journal called The Journal of Electrotherapeutics.
They were neither physiatrists nor neurologists. If anything they
were closely aligned with radiologists!!

The journal at one time was called The Journal of Electrotherapeutics
and Radiology. These were doctors interested in physical modalities to treat patients. Especially electricity and roentgen rays. Yes even radiation was considered beneficial at one point.

Back to the point... tracing the lineage of the journals
The Archives of Physical Therapy, X-ray and Radium, was changed to Archives of Physical Therapy. In 1945 the journal became simply Archives of Physical Medicine. Later it became the Archives of Physical Medicine and Rehabilitation, a premiere journal in the field of rehabilitation.

SO what does this mean? In my opinion, PM&R can trace it's roots back to the original electrophysiologists!! The field eventually evolved into modern application of EMG and nerve conduction study.

Also, Look at the way the residency programs arrange education in EMG... PM&R docs are REQUIRED to do a couple hundred EMG's to graduate. Neurologists who want to do EMG's do an elective electrophysiology fellowship after they graduate.

In conclusion, electrotherapeutics was the origin, neither PM&R nor neurology at that time. Naturally, PM&R doctors, who evolved from interns treating patients with paraplegia and other disabilities mostly from wartime injuries, became fundamental to PM&R to help these patients. Their interest in physical modalities and similar mindset to their predecessors as well as the modern applications of nerve conduction to help diagnose functional impairments made EMG fundamental to the field of PM&R.

 

[Llenroc]

Some of the Neurologists that I was working for said that they are planning to do a Musculoskeletal Fellowship, which basically involves EMG training.

In that case, what's the point? Why not just do a residency in Physical Medicine and Rehab?

That said, at my institution it seems that the Neurologists do most of the EMG procedures, even though there is a large PM&R department.

 

[Disciple]

Are you sure they didn't mean "Neuromuscular Fellowship"?

i.e. ALS, FSH, AMAN, Myotonic Dystrophy, etc.

 

[DistantMets]

There's been nothing but a good relationship with neuro at my hospital here in Columbus. The main neuro practice here has a physiatrist that does pain, spine, and emg in their office, and a few of the neurologists also do emg. In the hospital, the inpatient neuro service is far, far too busy to do emgs so they consult PM&R. We brought PM&R on board quite a bit for emgs, general pmr consults, etc and there were several, "hey, what do you think about that one guy?" converations. My program at VCU does emg and neuromuscular clinic with neuro too and we can do their neuromuscular fellowship. I haven't heard anything bad about their interaction. That said, PM&R is a relatively small field, and other physicians get crappy exposure to it. PM&R docs need be thorough and really add something to the patient's care whether it's in the hospital or the outpatient world. If you're content being the "dispo doc", write generic therapy orders, or do crappy emgs etc., then you're probably not going to be thought of very highly. If you're the first physiatrist a doc has met, you may taint opinions of the field in general for them. So...you get the stroke patient in an AFO and get them dispo'ed to acute rehab (easy enough), but you also notice the early pressure ulcer everyone has missed, treat the greater troch bursitis that's actually the reason the patient's agitated and getting hit with zyprexa, and pick up the thenar atrophy (? CTS) in the good hand that might make a cane hard to use and you're leaving an impression. Basically, know a hell of a lot of neuro, ortho/sports med, rheum, pain mgt etc, in addition to your general PM&R training--you'll impress people and they'll seek you out. Oh, and don't throw neuro BS re-consults from acute rehab .