Please help!!!

[DPT21]

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I am currently at Kinesiology Major at Temple University in Philadelphia Pennsylvania. I was originally interested in Physical Therapy as a career but having been introduced to PM&R I have shifted my focus. I have done a lot of research but I haven't found any concrete comparisons between Physical Therapy and PM&R. I am currently am certified massage therapist. I enjoy "getting my hand's dirty" by working with the anatomy directly and helping people restore optimal function. It seems like PM&R is somewhat of a hands off field and I am wondering if a career in PM&R will be rewarding. My questions are as follows...

1. Do Physiatrist treat the patient directly or is most of the treatment provided by other healthcare professionals?

2. Being only 21 yrs old, I wont be out of medical school until I am 30. Is the future of PM&R solid? Currently, all Physical Therapist are required to obtain a Doctorate. Will this affect the "authority" so to speak that the Physiatrist has over Physical Therapist?

I would appreciate any information that could help me make my decision!

BCS

 

[SSdoc33]

I am currently at Kinesiology Major at Temple University in Philadelphia Pennsylvania. I was originally interested in Physical Therapy as a career but having been introduced to PM&R I have shifted my focus. I have done a lot of research but I haven't found any concrete comparisons between Physical Therapy and PM&R. I am currently am certified massage therapist. I enjoy "getting my hand's dirty" by working with the anatomy directly and helping people restore optimal function. It seems like PM&R is somewhat of a hands off field and I am wondering if a career in PM&R will be rewarding. My questions are as follows...

1. Do Physiatrist treat the patient directly or is most of the treatment provided by other healthcare professionals?

2. Being only 21 yrs old, I wont be out of medical school until I am 30. Is the future of PM&R solid? Currently, all Physical Therapist are required to obtain a Doctorate. Will this affect the "authority" so to speak that the Physiatrist has over Physical Therapist?

I would appreciate any information that could help me make my decision!

BCS

i cant (wont) answer all of your questions, but ill try to help.

future is PMR is fine. future of medicine here in the US? dont know about that, but PMR outlook is fine when compared to other specialties.

physiatrists generally direct a team or initiate a care plan. there are certainly hands-on opportunities, but they are generally with interventional pain procedures, electrodiagnostic testing, or musculoskeletal ultrasound.

one area which sounds like it might be right up your alley is osteopathy. look into it. manual therapy is taught in "DO" medical schools as well as allopathic ("MD") training. you'd be able to use your hands and perform manipulations/manual therapy while also having the cache of being a physiatrist. btw, im using the term "cache" very loosely.

 

[PMR 4 MSK]

Many people don't really know what the difference is between a physical therapist and a physiatrist. Basically, we diagnose and set forth a treatment plan. Therapists help us implement the part of that plan that includes PT (or OT, or speech path, or similar).

Most physiatrists do not do hands-on therapy, but very few doctors do, unless you count surgeons. We use our hands to examine the patients, and to give injections and EMGs like SSdoc says. Most do not do stretching, strengthening, ultrasound (therapeutic - many physiatrists are using US for diagnostic purposes), TENS application, etc. We write a script for therapy to do that and go on to the next patient.

Any physiatrist can do this stuff, but most will find it not as financially feasible to do so.

 

[DistantMets]

Since you are directing therapy as a physiatrist, we're one of the few specialities that actually reads PT notes. I think one of the biggest things you learn in this field is to evaluate whether the therapy is adequate. ie good one on one session with an experienced PT in low back pain or stroke rehab vs 45 minutes of hot packs and e-stim with a PT assistant and a quick "remember those exercises I showed you" and out the door.

 

[ampaphb]

DPT is making reference to direct access.

This is more of a political agenda on the part of the PT community than related to patient care.

That being said, if the South Carolina experience is any indicator, therapists continue to work for groups, albeit under the guise of leasing arrangements, and most patients still seem to prefer to have their care directed by physicians, rather than DPTs, who have an inherent conflict of interest.

 

[Karaoke]

To the O.P. --

1. Most therapy is delivered by other healthcare professionals, not by us.
2. The future of PM&R is in flux, just as with many other specialties. Just ask a
GP about primary care NPs, or an anesthesiologist about nurse anesthetists, or
an obstetrician about midwives and doulas (I can spell that word), or an
ophthalmologist about optometrists. We are in no more danger of losing our
turf war with DPTs than those specialties are of losing theirs. Everyone wants
to be the boss if they can, and everyone wants as a big a piece of the pie as
they can get. The bigger threat to PM&R is the government, and that's just like
every other medical specialty.

Physiatrists examine patients, diagnose problems, plan out treatment, and
write prescriptions. Then we follow up to make sure orders were executed
properly, to see how the response to treatment was, and to revise the plan of
treatment as needed. We're the brains of the whole operation.

The "hands on" part of our job comes during the examination of the patient,
with EMGs, and for certain various injections. If you're an osteopath, you
may also do some manual therapies (of which I am woefully ignorant).
Otherwise, it's largely a thinking job, like most non-surgical specialties.

The difference between a physiatrist and a physical therapist is that the
physiatrist writes the prescription and the therapist executes (in an ideal
world) what was ordered. A prescription for therapy is just like a prescription
for medication. When you write for a med, you don't dispense the med, the
pharmacist does that. You don't administer the med, the nurse does that.
We don't deliver the therapy, the PT does that.