Physiatrist vs. Physical Therapist

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BigBucksPTA

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Can someone tell me what the differences are? Any danger of turf infringement?
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BigBucksPTA said:
Can someone tell me what the differences are? Any danger of turf infringement?
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Main difference is a physiatrist is a physician (MD or DO) who practices physical medicine and rehabilitation.
 
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I was tempted to say, the main difference is that one is a real doctor. :laugh: But I thought it was too mean to say. :)
 
6 replies, and not even one of substance to what was a perfectly legitimate question. Instead, your petty focus was to attack my credentials and prior posts.

If you have trouble defining your own profession, then I pity you defining anything to your patients at all. But then of course, you probably let PTs do all that anyways.
 
the focus was to point out that you probably already know the answer to your question
 
axm397 said:
looks close to trolling to me:

http://forums.studentdoctor.net/showthread.php?p=4892080#post4892080

http://forums.studentdoctor.net/showthread.php?p=4900325#post4900325

it's weird because he says he is a PTA yet he claims to have a DPT. hmmm
http://forums.studentdoctor.net/showthread.php?p=4855071#post4855071

I don't think this even warrants a discussion.
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Doesn't look close to trolling at all. This is obvious trolling. My favorite post is this one:

BigBucksPTA said:
Even though I'm not an allopath, nor pre-allopath - but instead I am a physical therapy doctor who went to physical therapy medical school - I support the 2 round system.
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?????:confused: wtf is physical therapy medical school?
 
p9142 said:
Doesn't look close to trolling at all. This is obvious trolling. My favorite post is this one:



?????:confused: wtf is physical therapy medical school?
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Very nice job on extracting some key quotes from my prior postings.

In fact, you're so good at it - that you should probably write a book about it, since you obviously (a) have the inclination (b) have the time (c) lack any creativity or originality of thought.

Strange....though you have the time to sort through all of my prior posts and pull out quotes (LOSER), you have no altruism or beneficence when it comes to answering honest queries. You should be kicked out of medical school or stripped of your degree, since you obviously lied when you took your oath. I suggest you pursue a career in ridiculing other people, since you're so good at it.
 
DOctorJay said:
the focus was to point out that you probably already know the answer to your question
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Thanks, but you can take your patronizing attitude and shove it up your rear end. I don't need you telling me what I know and don't know. Either answer the question, or refrain from insulting posts.
 
Taurus said:
I was tempted to say, the main difference is that one is a real doctor. :laugh: But I thought it was too mean to say. :)
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You call yourself a "real doctor"?? WTF is that supposed to mean - do you even know what it means to be a doctor? Its not for petty-minded mean-spirited people like you - and if you happened to lie your way into medical school, then I pity you.
 
Taurus said:
I was tempted to say, the main difference is that one is a real doctor. :laugh: But I thought it was too mean to say. :)
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What's mean about it? :confused: It's fact. Are physical therapists in your area walking around in white coats that they say Dr. ____ on them?
 
let's try to keep it civil... no shoving anything up anywhere!

Here's a link to the answer to the question what is a physiatrist?
http://www.aapmr.org/condtreat/what.htm

If you want a real answer here you go:

Physiatrist = a physician who has gone through 4 years of medical school, 4 years of residency +/- fellowship who specializes in the field of physical medicine and rehabilitation. Physical therapy is just one of many methods we prescribe to help patients optimize their function. We do NOT actually perform the physical therapy and although some of us teach our patients some very rudimentary home exercises until they get into see a physical therapist, we still leave the actual therapy regimen up to the therapist(s). Some physiatrists have studied different types of therapy and most of us write more than a generic "eval and treat" type prescription. We also do a medical assessment of the patient BEFORE referring them to therapy to rule out any contraindications, and to aide the therapist in coming up with a good therapeutic plan.

Physical Therapist = a professional in physical therapy who has up to a doctoral degree in physical therapy who provides physical therapy services to patients. They do a musculoskeletal assessment, and can work within their paradigm to come up with the pathologies that may be causing the patient's dysfunction, and prescribes home exercise programs, does manual therapy, and applies modalities to help improve patient function. They also do a functional assessment and may also help with assistive technologies.

The reason why the world you envision,
BigBucksPTA said:
I also view a future world where physical therapists refer patients to physicians, not vice versa, and physicians call up PTs to give them status reports.
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would be very dangerous to patients is because physical therapists only have a very rudimentary background in medical pathologies and pharmacology. They also do not know how to interpret lab and radiology tests and they cannot diagnose a medical condition. They may be familiar with some of the more common diagnoses but knowing the names of conditions that have already been diagnosed is very different from being able to interpret all the data to diagnose and treat a medical condition.

I as a physiatrist would never dare to provide physical therapy services myself to patients (at least not a comprehensive program), so I don't think therapists should dare provide medical services to patients. The PM&R model of teamwork is a good thing as we recognize each other's expertise and limitations.

Unfortunately, when you don't have a history of posting in this forum and the first post you make is provocative, it is difficult to take you seriously. But, giving you the benefit of doubt, here's my honest answer.
 
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axm397 said:
let's try to keep it civil... no shoving anything up anywhere!

Here's a link to the answer to the question what is a physiatrist?
http://www.aapmr.org/condtreat/what.htm

If you want a real answer here you go:

Physiatrist = a physician who has gone through 4 years of medical school, 4 years of residency +/- fellowship who specializes in the field of physical medicine and rehabilitation. Physical therapy is just one of many methods we prescribe to help patients optimize their function. We do NOT actually perform the physical therapy and although some of us teach our patients some very rudimentary home exercises until they get into see a physical therapist, we still leave the actual therapy regimen up to the therapist(s). Some physiatrists have studied different types of therapy and most of us write more than a generic "eval and treat" type prescription. We also do a medical assessment of the patient BEFORE referring them to therapy to rule out any contraindications, and to aide the therapist in coming up with a good therapeutic plan.

Physical Therapist = a professional in physical therapy who has up to a doctoral degree in physical therapy who provides physical therapy services to patients. They do a musculoskeletal assessment, and can work within their paradigm to come up with the pathologies that may be causing the patient's dysfunction, and prescribes home exercise programs, does manual therapy, and applies modalities to help improve patient function. They also do a functional assessment and may also help with assistive technologies.

The reason why the world you envision,

would be very dangerous to patients is because physical therapists do not have any background in medical pathologies and pharmacology. They also do not know how to interpret lab and radiology tests and they cannot diagnose a medical condition. They may be familiar with some of the more common diagnoses but knowing the names of conditions that have already been diagnosed is very different from being able to interpret all the data to diagnose and treat a medical condition.

I as a physiatrist would never dare to provide physical therapy services myself to patients (at least not a comprehensive program), so I don't think therapists should dare provide medical services to patients. The PM&R model of teamwork is a good thing as we recognize each other's expertise and limitations.

Unfortunately, when you don't have a history of posting in this forum and the first post you make is provocative, it is difficult to take you seriously. But, giving you the benefit of doubt, here's my honest answer.
Click to expand...

Thank you - thats what I was looking for. Would have been nice if it'd happened earlier, but better late than never.
 
just curious... i dont understand the jargon.

Trolling?
 
axm397 said:
physical therapists do not have any background in medical pathologies and pharmacology.
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I agree with your post - the above statement is a little misleading, however. PT's do take pathology and pharmacology courses. It's not anything remotely resembling a medical school path or pharm course. But they do take them so that PT's are familiar with the basic pathology of common diseases of various organ systems that will impact the conditions they will treat. They are also exposed to pharmacology so that during an evaluation, they can review the patient's meds and have an understanding of the indications and major side effects, again both of which can impact a patient's rehab.
 
delicatefade said:
I agree with your post - the above statement is a little misleading, however. PT's do take pathology and pharmacology courses. It's not anything remotely resembling a medical school path or pharm course. But they do take them so that PT's are familiar with the basic pathology of common diseases of various organ systems that will impact the conditions they will treat. They are also exposed to pharmacology so that during an evaluation, they can review the patient's meds and have an understanding of the indications and major side effects, again both of which can impact a patient's rehab.
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I edited my post. I meant that they dont' have nearly the background in pathology and pharmacology needed to actually diagnose and treat MEDICAL conditions. (I understand that PTs diagnose and treat within their own paradigm) Is that better??

I think those of you who have actually gone from being a therapist to a physiatrist will know best what the distinctions are.:thumbup:
 
BigBucksPTA said:
6 replies, and not even one of substance to what was a perfectly legitimate question. Instead, your petty focus was to attack my credentials and prior posts.

If you have trouble defining your own profession, then I pity you defining anything to your patients at all. But then of course, you probably let PTs do all that anyways.
Click to expand...


I will reply. I am a DPT and what Keau said is correct. physiatrists are real doctors. I am an expert at movement dysfunction, and pretty good at clinical diagnostic testing. I am good at getting to the root of a musculoskeletal problem when it is mechanical. I know a little about some things medical (enough to refer) and a little about OT and a little about Speech. PM and R docs know more about the three rehab types than other doctors and are coordinators of the care provided by the three. I would venture to say that they don't know as much about PT as a PT does, etc . . . but DO know how to medically manage the rehab patient.
Some are experts in movement disorders, some come from athletic training backgrounds or PT backgrounds or OT or SLP.

I also can't believe that a PTA doesn't know the difference.
 
Out of the small sample size of friends who were previously physical therapists (n=3) then went on to become physicians, all have stated that they thought they knew something about physiology and pathology prior to becoming physicians, but came to realize their knowledge base was quite limited.

I can't speak for myself, since i have never been to PT school.

In response to what exactly a physiatrist is, the definition above is quite adequate.
 
p9142 said:
Doesn't look close to trolling at all. This is obvious trolling. My favorite post is this one:



?????:confused: wtf is physical therapy medical school?
Click to expand...

Frankly I doubt he/she even went to PT school. I have never heard the phrase "physical therapy medical school". idiot.
 
It's usually not the original post that gets BigBucksPTA into trouble, but it's her subsequent responses that do. She gets so defensive and starts attacking people. It cracks me up. :laugh:
 
truthseeker said:
Frankly I doubt he/she even went to PT school. I have never heard the phrase "physical therapy medical school". idiot.
Click to expand...

Just because you haven't heard the phrase before, does that make me an idiot?

You obviously think you have a vocabulary that exceeds mine. My contention is that your vocabulary doesn't even exceed your IQ, judging by the way you insult other people.

I've already got the answer I want, so can you please stfu - and focus on other things? You clearly have way too much time on your hands - go sweep some roads if you do, coz at least that way you'll be useful to society.

IDIOT.
 
BigBucksPTA said:
My contention is that your vocabulary doesn't even exceed your IQ, judging by the way you insult other people.
Click to expand...

That....makes no sense.

My contention is that your oranges do not even exceed your apples.

You cant compare two different quantities like that.

My car is faster than your shirt.

I've already got the answer I want
Click to expand...

So why are you still here?
 
RogueNine said:
That....makes no sense.

My contention is that your oranges do not even exceed your apples.

You cant compare two different quantities like that.

My car is faster than your shirt.



So why are you still here?
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Thanks for your astute observations. Hope I didn't make your sole neuron creak too much.

Nice to meet you btw, its always nice to meet someone whose first comment goes "why are you still here". Your upbringing and manners are exemplary. Full kudos to Momma and Poppa Rogue (8?)
 
why dont you clear this up and explain what physical therapy medical school is?
 
alright, I am a medical student researching which medical specialty I may be interested in... reading all the info I can etc... and while once in a great while someone has some good info... everybody uses the forum to whine and try to compete with others. Medicine is about working together. Nobody is "better" than anyone else, period. One pm&r physician will not have the same skills as another pm&r physician, just as one pt will not have the same skills as another pt. We are all individuals looking to help other individuals... don't slam someone else for their decisions, support them.
Also, it doesn't matter if you have an extensive vocabulary, because 90% of your patients wont understand anyway.
To those of you who have really tried to keep your postings constructive and positive, you're practicing medicine already... to those who call names and single out others, you've got much to learn.
Maybe everyone should put their real names on their posts so they don't have such a sense of invincibility... it's that sense of invincibility that sends a great percentage of physicians each year into drug/alcohol abuse counseling and gets licenses revoked.
Be the physician you'd like to send your family to.
Now I'm done...........
To those hoping to reply and get an aggressive response, I'll demonstrate how to show constraint.
Thanks again to those who use the forum for informational purposes!
 
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proudoms said:
alright, I am a medical student researching which medical specialty I may be interested in... reading all the info I can etc... and while once in a great while someone has some good info... everybody uses the forum to whine and try to compete with others. Medicine is about working together. Nobody is "better" than anyone else, period. One pm&r physician will not have the same skills as another pm&r physician, just as one pt will not have the same skills as another pt. We are all individuals looking to help other individuals... don't slam someone else for their decisions, support them.
Also, it doesn't matter if you have an extensive vocabulary, because 90% of your patients wont understand anyway.
To those of you who have really tried to keep your postings constructive and positive, you're practicing medicine already... to those who call names and single out others, you've got much to learn.
Maybe everyone should put their real names on their posts so they don't have such a sense of invincibility... it's that sense of invincibility that sends a great percentage of physicians each year into drug/alcohol abuse counseling and gets licenses revoked.
Be the physician you'd like to send your family to.
Now I'm done...........
To those hoping to reply and get an aggressive response, I'll demonstrate how to show constraint.
Thanks again to those who use the forum for informational purposes!
Click to expand...

You are demonstrating REstraint, not CONstraint

And the guy we are all deriding ISN'T a physician, which is the basic point of WHY he is being universally reviled ... he claims to have gone to "physicial therapy medical school" but then won't own up to the fact that there is no such thing
 
BigBucksPTA said:
Thanks for your astute observations. Hope I didn't make your sole neuron creak too much.
Click to expand...

Ur dumbz! lolz!

its always nice to meet someone whose first comment goes "why are you still here".
Click to expand...

That was actually my last comment.

Your upbringing and manners are exemplary.
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Heh, a troll lecturing on manners.
 
Interventionist said:
You are demonstrating REstraint, not CONstraint

And the guy we are all deriding ISN'T a physician, which is the basic point of WHY he is being universally reviled ... he claims to have gone to "physicial therapy medical school" but then won't own up to the fact that there is no such thing
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Wow thats brilliant.
 
Man.

The quality of trolling on SDN sure has gone down over the years.

Makes my eye teary for the days of SquatNSqueeze and the like. :(
 
I know that the original post was somewhat ridiculous, but I can see where he/she was coming from. Sometimes the skills that I've seen a Physiatrist use are no different from a physical therapist (not including the medications obviously). It was kind of disheartening to see and it made me ponder what is so special about the field. Don't some of you find it a bit boring as well?
 
Of all of the adjectives to describe rehab, boring would certainly not be one I would use. For me as a rehab resident, it provides a constant challenge. It is a very diverse field, and one that provides the physician to be as broad or as narrow as he or she wants. Prosthetics & orthotics, musculoskeletal medicine & physical modalities are just a small fraction of what we do.

A bit off topic here, but perhaps slightly relevant: We had dinner a few nights ago with a neuropsychology student on our TBI unit. I asked her how she felt about prescription rights for clinical psychologists, and of course, she felt that a simple thing like depression should be something for which a psychologists should be allowed to prescribe medications. My response... certainly neuropsychologists know much about neurotransmission, probably more than most physiatrists, and perhaps more than many TBI physicians. However... there is no such thing as a pure "brain" receptor, and if you have not been trained in other body systems, how can you predict & treat possible side effects?

In my experience as a resident, I generally let the therapists do whatever they feel is best... they have the experience, and day-to-day interactions with the patients. But the times I have exercised my "veto" option have generally been when the PT or OT has proceeded to "think" like a therapist, and neglected some other body system at work.
 
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I didnt' mean to sound negative before. I'm still not clear on what a physiatrist does I suppose. What I basically saw, was a PMR doc walk in, take a really long history, and then tell the PT what he thought would be the best rehab strategy and thats it. Is there more to it? I saw this for 2 weeks and I was discouraged. From all I've read in this forum, my actual Rehab experience seemed more like a Diet version of a Medicine elective. I implore everyone to please convince me otherwise, because I'm really curious.
 
peduncle said:
I didnt' mean to sound negative before. I'm still not clear on what a physiatrist does I suppose. What I basically saw, was a PMR doc walk in, take a really long history, and then tell the PT what he thought would be the best rehab strategy and thats it. Is there more to it? I saw this for 2 weeks and I was discouraged. From all I've read in this forum, my actual Rehab experience seemed more like a Diet version of a Medicine elective. I implore everyone to please convince me otherwise, because I'm really curious.
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Was that an inpatient doc or outpatient doc? What kind of patients was that doc seeing? pain? MSK? sports? TBI? SCI?

PM&R is a really broad field and there's a great variety in the types of work a PM&R doc can do. On the inpt side, we manage the patients' medical issues - i.e. spasticity, pain, autonomic dysreflexia, infections, etc.etc. and we help make sure the patients can take advantage of therapy. We also know how to talk the lingo of therapists and we understand the pattern of recovery of function in common diagnoses. (ASIA exam for spinal cord, stroke recovery and location of lesion, dysphagia and aphasia eval, etc. etc.)

On the outpt side, we see all the pts we see in inpt (SCI, TBI, stroke, amputees, etc.) but we manage their rehab related issues as outpatients. We look at their dispo issues, their medications, spasticity, pain, etc.. We are in contact w outpt therapists to follow the pts' progress in therapy. Some physiatrists specialize in MSK/Sports where we see athletes and "weekend athletes" with sports related injuries (ankle, knee, elbow, shoulder, etc.) and ppl with back, neck etc. pain. Some are more pain management (chronic or acute pain) and others are more sports/MSK. Some even specialize in occ med, IMEs, workers comp, etc. We also can perform EMG/NCS to help diagnose conditions such as peripheral neuropathy, carpal tunnel syndrome, and more rarely, ALS and other neuro disorders.

All physiatrists should know how to perform a good MSK and neuro exam in addition to the standard physical exams (heart, lung, etc.) We also know how to assess spasticity and some even do intrathecal baclofen trials. We do procedures like epidural injections, peripheral injections, EMG guided botox injections, and more advanced procedures like stims and pumps with extra training. We are familiar with prosthetics and orthotics and we also manage medications to help manage pain, spasticity, etc. We also use neurostimulants in the right context.

It's really hard to describe in a nut shell what exactly we do because we do so much and the spectrum is broad.
 
peduncle said:
I implore everyone to please convince me otherwise, because I'm really curious.
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No one can, will, or should convince you into PM&R. If you felt that your experience in PM&R was less than optimal(and you truly have an interest in PM&R), I encourage you to rotate on another elective with a different PM&R physician, perhaps at a different facility.
 
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Acute care consultation generally does not involve "doing" a whole lot... if most of the services are doing what they're supposed to do, the rehab consultant's primary focus should generally be "where does this patient need to go, and what needs to be done to get them there?"

There are times when physiatrists as consultants do end up doing quite a bit. Examples include TBI & SCI rehab, which each present their own challenges not usually faced by other specialities: Neurogenic bowel & bladder, autonomic dysreflexia, coma stim, supine hypertension/upright hypotension, detrussor-sphincter dyssynnergia, wound care for insensate areas, cognitive rehab.... as well as providing for the patient & families an outlook for the future. Will a T4 Paraplegic female be able to have children? Is this agitation going to subside? What is the prognosis for a complete SCIWORA? What can we expect for improvement after Transverse Myelitis? Can I return to living by myself now that my cancer is widely metastatic?

An additional issue that we have at our program is intrathecal Baclofen pumps. Neurologists don't do pumps here, so any emergency related to a pump requires a PM&R consult. Additionally, if a service requires obtaining a CSF sample for further studies in someone with a pump, we quickly get on board so they don't screw it up.

This is all done at the Acute Care facility. Once they get to rehab, that's when the real fun starts. :D
 
Because PMR has a lot of overlap with other fields (Ortho, Neuro, etc..), doesn't that make for a non-ideal situation. Most physicians know more about Ortho, Neuro, or Rheum than PMR. Why would they decide to refer patients to PMR over these other fields??
 
Lack of referrals doesn't really seem to be a problem. There is plenty of work to go around. There are a shortage of physicians in every field.

The one patient I had as an intern who needed an EMG/NCS was at the VA. I tried to get him an appt with neuro, but they were booked up for awhile, so i thought, well, no one thinks to refer to pm&r. Turns out the pm&r clinic was booked out much further than the neuro.

There are definitely overlaps in several areas, but there are distinctions between neurology and neuro-rehab, between ortho surgery & non-surgical MSK.

And PM&R is surely not "diet medicine"
 
"Sports and Spine" and "Pain Medicine" have many overlaps as far as procedures... no?
 
haha, I recently asked a similar question to a resident. I'll let the residents/attendings out there answer that one.

So I've been conducting PMR research for a year already and during my time I've spend a day here and there shadowing docs to get more exposure. I looked into possibly shadowing some docs down at the Sports and Spine Center but found them all to be Chiropractors. Is there big competition between Sports and Spine physicians (PMR trained) and chiropractors for business? Can a PMR trained physician make a decent living nowadays just doing Sports and Spine Medicine?
 
and then I also read in a different forum about CRNA's in Louisiana doing pain procedures... it seems like there is so much competition in the fields of pain and sports/spine. should this be something to be worried about? I only ask because I"m applying for PMR this september.. sorry if these topics were already discussed before.
 
Well what can I say. PTs want to be doctors and do what doctors do. Dear Bucks PT don't you see how futile this all is. They are giving out transitional DPT degrees to PTs over the internet without attending any courses.

PT's have direct access to patients in over forty states yet in the majority of cases the insurance co. still wants a PT script from an MD or DO. Maybe in a hundred years a patient will go to his DPT first when he has back pain but nowadays he will either see an MD or even a Chiro first.

Good luck.
 
truthseeker said:
Frankly I doubt he/she even went to PT school. I have never heard the phrase "physical therapy medical school". idiot.
Click to expand...

Well, I don't blame you for not knowing about it, but ease up on the chap.
There, indeed, is a PT Medical Schooling, PT's are now being pushed to get their doctor of PT degree's, it's a 4 year medical program.

A good buddy of mine decided to consider becoming a physician after the industry began to make the shift.
 
please post a link where we can all review the nature of this "PT Medical School"
 
lovepark said:
Well, I don't blame you for not knowing about it, but ease up on the chap.
There, indeed, is a PT Medical Schooling, PT's are now being pushed to get their doctor of PT degree's, it's a 4 year medical program.

A good buddy of mine decided to consider becoming a physician after the industry began to make the shift.
Click to expand...

There is no such thing - prove me wrong by providing us with a link
 
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