pardon me for being naive. Can you explain how these PAs are keeping the practices alive. I haven't graduated medical school yet, but have a unquenching thirst to learn about the practice of medicine (instead of just the science). In my naive way of thinking, I still see PTs and others doing similar work to what PMRs do (I know that PMRs can manage the medical side of the patient as well). I also see Orthopods and others doing similar procedures or seeing similar types of patients than PMRs do. I am very inexperienced in this area, so all I can do is ask questions. It just seems like such a saturated area to me.
It has to do with the general financing and reimbursement for health care services. Basically, non-procedurally oriented physiatrists work primarily off of Evaluation and Management (E&M) professional codes. If you're a surgeon or other kind of proceduralist, the evaluation and management of a patient is typically "bundled" into the global fee for a procedure's CPT (current procedural terminology) code. Thus, your economic incentive to manage non-operative medical issues is exceedingly low...
Initial evaluation, consults, and hospital admissions are reimbursed more highly because of the higher complexity inherent in the delivery of these services. Subsequent visits (either outpatient, inpatient, or consult) are reimbursed far more meagerly because these services usually entail assessing and monitoring response to treatment. Thus, in any busy practice, the goal is to keep physicians engaged in more complex service delivery (new evals and procedures) and mid-levels engaged in the more routine service delivery (follow-ups). Under some circumstances, midlevels can "tee-up" new evals, but the reimbursement for delivery of this service will be at a lower level.
This is the reason why you hear primary care physicians (whose job it is to provide longitudinal and preventive care) complain that they're getting short-changed for their services under the current system of health care financing...once their practice panels "fill-up," all they have are subsequent visit E&M codes to charge unless they do procedures. Health care executives who employ salaried physicians and other health care providers in group practices exploit the E&M service gap by employing mid-levels for primary care (Why pay a primary physician $150K when you can pay a PA $80K and collect essentially the same revenue for their service?). Similarly, you're seeing more mid-levels on surgical and medical consult services for the same reason. Keep the MD/DO's engaged in high end service delivery (either new consults, procedures, or in the OR) and have mid-levels do the more routine follow-up. In academic settings, the incentives are different because resident house-staff are always the cheapest labor available. Why pay a PA $80K when you can pay a resident $40K and have complete and unfettered control over them??
PT's don't directly compete with physiatrists for service delivery, but they do compete in some states with physiatrists for patient access to therapy services. Physiatrists don't personally administer therapy for patients (except those who use manual medicine and there are special CPT codes and modifers for that). Hence, you'll hear PT's advocate for "direct access," and physiatrists advocate for medically-supervised therapy. It's a story as old as time...
Does that help??
. But it's really difficult to protect any one specialty's turf these days. Very often neorology and gas, asp those with pain training do the same work as PM&R. I wonder if that area is saturated?
