Is PM&R Teetering on the Precipice of a Dark Age?

[researchdoc]

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I read this article out of the main PM&R journal, Archives of Physical Medicine and Rehabilitation, March 2006 (Volume 87, No 3). It is written by the president of the AAPM&R Bruce Gans, M.D., titled, Is PM&R Teetering on the Precipice of a Dark Age? This article is making me think twice about entering the field of PM&R. Is there anyone out there that can shed a little light on the future of the field? Thanks

Is PM&R Teetering on the Precipice of a Dark Age?.
Archives of Physical Medicine and Rehabilitation, Volume 87, Issue 3, Pages 315-316
B. Gans

 

[ihaveaquestion]

excerpt from abstract:

"Today, we are on the brink of the most serious challenges ever to face the specialty. In this address, I review briefly the history of the field, show evidence of our successes, identify the many overwhelming challenges we now face, and forecast a potential doom for our field."

😱 😱 😱

 

[Hard24Get]

excerpt from abstract:

"Today, we are on the brink of the most serious challenges ever to face the specialty. In this address, I review briefly the history of the field, show evidence of our successes, identify the many overwhelming challenges we now face, and forecast a potential doom for our field."

😱 😱 😱

But the end of the abstract says, "In the end, I offer specific strategies and tactics that the field should follow to guide us to a bright and reinvigorated future."

So if everyone listens to him, PM&R will be fine. That said, I'm going into neuro and was just being nosy 😀 Good luck guys!

 

[researchdoc]

But the end of the abstract says, "In the end, I offer specific strategies and tactics that the field should follow to guide us to a bright and reinvigorated future."

So if everyone listens to him, PM&R will be fine. That said, I'm going into neuro and was just being nosy 😀 Good luck guys!

Thanks for the optimism. But I would like to hear from a PM&R doc or resident that has read the whole article. There are a lot of issues that the field seems to be facing which will bring down reimbursements or the need for most (not all) of our work. I've also spoke to 2 docs (in California) that said their practice is on a downward trend for reimbursements because of the insurance issue. Is that unique to California? How is the field doing in other states? How is the job market in other states for PM&R? Do you have to live in big cities to get a sufficient population to support a practice? Sorry about all the questions, just trying to figure things out.

 

[myrandom2003]

how would I be able to get access to this article online (without paying of course)??

 

[Disciple]

Thanks for the optimism. But I would like to hear from a PM&R doc or resident that has read the whole article. There are a lot of issues that the field seems to be facing which will bring down reimbursements or the need for most (not all) of our work. I've also spoke to 2 docs (in California) that said their practice is on a downward trend for reimbursements because of the insurance issue. Is that unique to California? How is the field doing in other states? How is the job market in other states for PM&R? Do you have to live in big cities to get a sufficient population to support a practice? Sorry about all the questions, just trying to figure things out.

I just read the article. I wouldn't worry excessively about these issues. His concerns, while very real, are not unique to PM&R. Medicare cuts, decreased patient access to services and a need for evidence based guidelines threaten most other fields as well. This article is more of a "call-to-arms" type statement that I'm sure many other specialties are also putting out in their journals.

Anyway, development of evidence based guildlines for inpt rehab placement is not necessarily a bad thing. Anyone who has gone through PM&R residency has had many pts on their "acute" service who probably did not belong there, while other "appropriate" pts wasted away in nursing homes. If you are trying to run a "for-profit" rehab unit by keeping beds filled, it's clear how some of these issues may be a threat. As for California, they just underwent workers comp reform in 2005 which is probably bringing many practicioners million dollar annual incomes back down to earth with the rest of the country.

 

[axm397]

I skimmed the article and it really needs a lot of background. The article is basically a political opinion piece by the Academy president to energize the membership, talk about some of the changes to come within the Academy, and lay down Dr. Gans' vision on the future of the Academy (AAPMR) and the field of PM&R.

I just went to the Resident Physician Council meeting and I can tell you that the Academy is going through a major rennovation at this time. Some of the reasons for the improvements/changes are outlined in Dr. Gans' article.

I don't think the article is spelling out the end of the field of PM&R, it may be an indication of changes to come. 1/2 of the article is devoted to the successes we have had as a field and Dr. Gans warns us not to become complacent. He wants more research to support what we do as physiatrist, to nurture the international rehab community, and for the Academy to become more current. He even alludes to the idea of a new journal put out by the Academy in the address.

So for people reading this thread, I would not take this article to mean that the dark ages are coming for the field of PM&R. That language is simply a dramatic way of grabbing people's attention. As Dr. Gans himself says in his address "But, we can avoid this impending doom, and transform this potential Dark Age into a new Golden Era for PM&R...." At which time he spells out his plans for the future of the Academy.

 

[axm397]

Thanks for the optimism. But I would like to hear from a PM&R doc or resident that has read the whole article. There are a lot of issues that the field seems to be facing which will bring down reimbursements or the need for most (not all) of our work. I've also spoke to 2 docs (in California) that said their practice is on a downward trend for reimbursements because of the insurance issue. Is that unique to California? How is the field doing in other states? How is the job market in other states for PM&R? Do you have to live in big cities to get a sufficient population to support a practice? Sorry about all the questions, just trying to figure things out.

Specifically in response to your other questions, California is a notoriously difficult state for physicians because of the prevalence of a certain HMO organization. I know that in speaking with the senior graduating residents, they have had NO problems finding jobs in any area of the country. The highest paying jobs are NOT in big cities, as there is usually a bigger concentration of physiatrists in big cities. There's a variety of different types of jobs and you would have to be a bit more specific about the type of jobs you are looking into for that question to be answered adequately. (i.e. inpatient rehab, medical director of a specific rehab unit, academic/private practice, out patient, MSK, pain, EMG, consults, Pediatrics, SCI, TBI, stroke, Ortho etc.) for example, for Ortho, there are definitely more hip and knee replacement patient going home and NOT going to acute inpatient rehab - some what because of the 75% rule.

 

[Disciple]

I just went to the Resident Physician Council meeting and I can tell you that the Academy is going through a major rennovation at this time.

Would any of these changes be related in any way to the dissolution of PASSOR?

 

[Disciple]

So, I got some promotional mailing from Kessler the other day. Dr. Gans has a short write-up in it which is basically the same as his Archives editorial. In both pieces, he is concerned that many Physiatrists now choosing outpt musculoskeletal careers is a factor that is hurting our inpt tradition.

If more of our leaders share this view, I certainly hope this does not cause further division between musculoskeletal and inpt Physiatrists.

 

[jsaul]

lets not overreact here...

the field is strong and will continue to be. I have been in private practice now for 2 years and I am not worried.

like others have said, that article is a call to arms sort of thing. Nothing more nothing less. This sort of thing is happening in many specialities--- rads, er, anesth, etc...

 

[axm397]

Would any of these changes be related in any way to the dissolution of PASSOR?

They're not calling is "dissolution of PASSOR" but reintegrating PASSOR into the Academy. Basically, since the majority of physiatrist members of the Academy practice at least some component of MSK medicine, and there is more interest in MSK among the residents, they felt that PASSOR could integrate into the Academy and serve the needs of more physiatrists. What that means for dues and the specific structure, I don't know. I do know that they will be looking into producing more educational products and trying to meet the needs of the Academy membership better.

 

[Ligament]

The sentiment of most of my co-residents is that inpatient rehab is dying a slow death.

 

[chauffeur]

The sentiment of most of my co-residents is that inpatient rehab is dying a slow death.

While the current state of healthcare puts all specialties in a unique situation, I can’t recall any medical specialty that has completely dissolved in the past. If anything will happen, the specialty will divide into inpatient (primarily more internal medicine based) and out-patient (MSK, pain).

Don’t approximately 80% of PMnR residents finishing residency work a primarily out-patient setting? Don't quote me, but I've heard this several times.

As an incoming PGY2, I’ve never met a resident who wanted to practice solely general inpatient medicine. I know several who would like to work in SCI, Peds, and TBI. However, only in academic centers can one work in only those fields and make a living, right?

Can we take a poll? Who on this board has a strong desire to work in a general rehab floor in major hospital, free standing rehab center?

 

[Gauss]

I'm doing the bare minimum inpatient with no desire to practice inpatient in the future.
I foresee major medicare cuts looming for inpatient rehab.
And Gans is just blowing smoke - New Prez trying to rile everyone up and make a name for himself.

 

[Disciple]

They're not calling is "dissolution of PASSOR" but reintegrating PASSOR into the Academy. Basically, since the majority of physiatrist members of the Academy practice at least some component of MSK medicine, and there is more interest in MSK among the residents, they felt that PASSOR could integrate into the Academy and serve the needs of more physiatrists.

Yeah, I know what we're told, but I can't help wondering if they feel they have enough representation on the board and within the AAPMR to fully push their own agenda.

BTW, I'm a spine/MSK guy so I'm not necessarily fighting this.

 

[Disciple]

I foresee major medicare cuts looming for inpatient rehab.
And Gans is just blowing smoke - New Prez trying to rile everyone up and make a name for himself.

Dr. Gans is not the president currently, but I would say he is probably "old school".

There is a paradigm shift occuring.