Midlevel Encroachment

[622601]

All this nonsense of midlevels pushing for independent practice, a proposed PA name change, everybody who graduates high school getting to wear a long white coat, etc., has me worried about midlevels encroaching further and further and further, and eventually into PMR territory. Is this a ridiculous notion, or something actually possible in our field? I've already seen a report of a PT doing an EMG on someone, and there was apparently no thought process to it...just needling essentially every muscle in the arms and legs. The whole thing makes me worried about my future job prospects, salary, etc. Anyone else?

---

Members don't see this ad.

 

[lobelsteve]

Nope, just you.

 

[j4pac]

All this nonsense of midlevels pushing for independent practice, a proposed PA name change, everybody who graduates high school getting to wear a long white coat, etc., has me worried about midlevels encroaching further and further and further, and eventually into PMR territory. Is this a ridiculous notion, or something actually possible in our field? I've already seen a report of a PT doing an EMG on someone, and there was apparently no thought process to it...just needling essentially every muscle in the arms and legs. The whole thing makes me worried about my future job prospects, salary, etc. Anyone else?

That’s just nuts. I could see mid-levels having a role ..but performing and interpreting EMGs? Get out of here

 

[Thumpar]

My completely uninformed opinion is that PM&R does a good job of encroaching horizontally: they can do some neurology procedures, they can do some anesthesiology procedures, and the new "interventional orthopedics" field looks like it's aiming to take work from orthopedic surgeons.

My impression is that this field is expanding its scope a lot. Maybe the PM&R leadership is doing a good job in advocating for the field? I don't know enough to say anything with confidence.

 

[DMBandFan86]

wheres this report of PT's doing EMG's? Was it a research study? Was it physician supervised?

I can't imagine any PT's buying their own EMG machine and then talking patient's into doing the test with them instead of a residency-trained physician. I'm not really sure what your worried about: no surgeon is going to take an EMG study and interpretation from a PT anyways. Insurance also probably wouldn't pay for it. EMG reimbursement is not all that great so undercutting physicians wouldn't even be worth the effort.

Maybe PT's were doing nerve conductions? which can pretty much be done by anyone trained. But you really need a physician to do the EMG and interpret the entire exam.

If you're worried about too many people wearing white coats then you could start wearing a different color. I've seen one doctor wear a blue lab coat because he didn't like all the social workers, etc wearing white. I though he was crazy.

My opinion of NP's is that they are mostly very helpful. There are some that probably go above their scope of practice, but mostly they help take the volume down so physicians can work with more complex cases. The ones that seem to bother most physicians seem to be in primary care. In PM&R, its great having an NP doing IPR or SNF follow up visits. PA's, on the other hand, make me nervous. I would 10 times rather work with an NP than a PA.

I think you should be more upset with medical schools increasing enrollment and over expanding. Eventually that is going to catch up and hurt physician salary and job prospects.

 

[lobelsteve]

PT's, Chiros, Edx Neurophysiologists all do EMG/NCV. It is state dependent who gets allowed to do what.

 

[MD87]

A few years back, my now mother-in-law had an EMG/NCS performed by her PCP. She called me and said "the doctor said that based on the EMG I have chronic nerve damage. Who do I go for to get an actual diagnosis?" I asked what her symptoms were - she told me she had pain radiating from her back down her leg to her big toe with numbness and tingling. That doctor's office was then raided earlier this year for narcotic-related things... NOT for performing EMG/NCS without having any idea what he was doing. It's not just midlevels. Charlatans come in many forms. It's a mess.

 

[puahate]

Scary times. I think the profession just created a self tickling bomb years ago. This mid level crap we created will blow up in physicians face

 

[jesspt]

wheres this report of PT's doing EMG's? Was it a research study? Was it physician supervised?

I can't imagine any PT's buying their own EMG machine and then talking patient's into doing the test with them instead of a residency-trained physician. I'm not really sure what your worried about: no surgeon is going to take an EMG study and interpretation from a PT anyways. Insurance also probably wouldn't pay for it. EMG reimbursement is not all that great so undercutting physicians wouldn't even be worth the effort.

Maybe PT's were doing nerve conductions? which can pretty much be done by anyone trained. But you really need a physician to do the EMG and interpret the entire exam.

If you're worried about too many people wearing white coats then you could start wearing a different color. I've seen one doctor wear a blue lab coat because he didn't like all the social workers, etc wearing white. I though he was crazy.

My opinion of NP's is that they are mostly very helpful. There are some that probably go above their scope of practice, but mostly they help take the volume down so physicians can work with more complex cases. The ones that seem to bother most physicians seem to be in primary care. In PM&R, its great having an NP doing IPR or SNF follow up visits. PA's, on the other hand, make me nervous. I would 10 times rather work with an NP than a PA.

I think you should be more upset with medical schools increasing enrollment and over expanding. Eventually that is going to catch up and hurt physician salary and job prospects.

There are a few PTs who do EMGs/ NCVs, but not many. My understanding is that it most commonly occurs in the military setting, but I could be wrong. It is an area where a PT can, through examination, obtain board certification through the American Board of Physical Therapist Specialties (a branch of our professional organization, the APTA).

 

[cluelessme7]

From what I have heard from colleagues having done PT as well as PM&R residency, this encroachment possibility is quite a non-issue. It is not akin to say the CRNA versus Anesthesiologist conflict, where there is a clear overlap in roles. The relationship between PT and PM&R is instead mutual as each needs the other to function most efficiently. Private or group PT practices are quite lucrative on their own, and I have not met any PT that wishes to do what PM&R does (a lot of PT's are also not even fully aware of what PM&R actually does--each functions as separate consult service that interact with the same patient population).

 

[Shufflin]

Not only PTs, but many MDs are not fully aware of what PM&R actually does.

 

[Fiveoboy11]

Not only PTs, but many MDs are not fully aware of what PM&R actually does.

Nobody is fully aware of what anyone does outside of their own profession or specialty

 

[Stagg737]

Nobody is fully aware of what anyone does outside of their own profession or specialty

True, but many physicians can't even begin to tell you what PM&R docs do. I'd guess most are completely unaware that they even perform EMGs. I'll admit I had no idea what they did and thought they did a lot of what PTs did before my PM&R rotation and I'd probably still think that if I hadn't had that rotation.

 

[Shufflin]

Nobody is fully aware of what anyone does outside of their own profession or specialty

Good point. However, some specialties lend themselves much more readily to an intuitive understanding of what is at least treated than others. Neurosurgery, for example, to the lay public is about going into the damn head and taking out a tumor. Or cardiology, hard to miss the gist there.

 

[Fiveoboy11]

True, but many physicians can't even begin to tell you what PM&R docs do. I'd guess most are completely unaware that they even perform EMGs. I'll admit I had no idea what they did and thought they did a lot of what PTs did before my PM&R rotation and I'd probably still think that if I hadn't had that rotation.

That's probably for the best IMO. There's great harm from my experiences as a PT in people thinking they know what they don't know.

 

[W19]

I still don't know what PM&R docs do... I have only come in contact once with PM&R doc so far.