Speaking of which, did anyone happen to read Dr. Cifu's "From the President Column" in the April issue of the AAPMR's newsletter (The Physiatrist) called Academics in the 21st Century: Can We Bridge the Private Practice Divide?
In this piece, Dr. Cifu describes how alot of PM&R research is is conducted by private practicioners or "adjunct" faculty, or even full academic faculty who do mostly clinical work, and whether or not this type of Academia is good for the specialty and causes the field to be dismissed by other specialties.
Anybody have any viewpoints on this?
Gee, Disciple, glad you asked...
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I enjoyed the editorial, but I think that Dr. Cifu might have better subtitled it "Asleep at the wheel 1980 to present: How physiatry almost drove itself off the cliff." Bridging the *CULTURAL* divide between academic and community-based physiatrists will require more than just good-will and rhetorical pleas for common ground. It will actually require changing the culture of the specialty.
I argue that since residency training programs and academic physiatry departments are essentially physiatry's version of the "Hollywood Culture-making Machine" in our specialty, this where the bulk of the work will need to occur. So, one may ask, does the leadership in academic physiatry *really* want to change? Do they *want* a bridge to their community-based breathren or are they happy on their own island...are their actions congruent with their words? Afterall, it is revealing that this editorial did not appear in the AAP newsletter.
Come sit on my knee and let me tell you a little story...I interviewed at a very prestigious residency program in a city with a very prestigious group of private-practice/academically-oriented physiatrists practicing nearby who were doing very important research while also in the midst of running their own very profitable business. When I inquired of the university physiatrists how might I, as a resident in their program, network or rotate with this group of "community-based" practitioners, I was met with stern-faces, furrowed-brows, and even a daunting finger-wave. One university physiatrist remarked, "you want nothing to do with them; they are loose cannons."
You must be thinking that this happened circa 1992 or 1998 in the midst of all the tremendous and divisive upheaval that has resulted in the need for our specialty's mythical bridge? No. It was 2002...
So, there is a lot of warm and fuzzy enthusiasm lately about the reintegration of PASSOR
which I agree is sorely needed, but I think also some vigorous revisionist history writing is in progress too about "how things came to be the way they are." Some people are getting writer's cramp re-telling the tale of how physiatry became one happy family. Another version of the tale of "how things became the way they are" is recounted in Richard Materson's leading chapter in Slipman et al "Interventional Spine: An Algorithmic Approach." It's a good read. Almost as good as Dr. Cifu's editorial...
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Remember, the founding members of PASSOR (who comprise a large proportion of this coveted group of "academically-oriented/private practice" physiatric demographic who I suppose will be the keystones and cable of Dr. Cifu's bridge) were not uniformly regarded as forward thinking visionaries when they sought to create their "organization within an organization." In fact, in the eyes of many they were seen as renegades, bandits, and even common ****** who were hell-bent on ripping heart and soul out of the specialty and prostituting it on every street corner across the land.
I fear that this "bridge" that physiatry would like to build between its academic and "community-based" practitioners is in reality more of a Bridge to Terabithia---an imaginary place where the practice of academic physiatry and community physiatry converge...If we listen quietly we can hear the hum of harmony...
There are good models to explore. Medical oncology has actually done a very good job of linking its academic oncology departments and community oncology practices. Virtually every medium to large size community-based oncology group participates in industry-sponsored cancer clinical trials. Note that the "driver" here is industry not "good-will."
Anesthesiology and Emergency Medicine with its large national networks of practice management companies and group practices are now competing in markets for contracts at academic centers! So, potentially, you'll have "private practice" attendings working and teaching side-by-side with university physicians at academic health centers...imagine a similar arrangement at *your* physiatry residency program...
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I think that a first step to bridging the cultural divide, will be to eliminate the "blood-lines" in the specialty by uniformly raising the specialty's training standards. Similarly, the content of a physiatry residency program should reflect the knowledge base and
skills actually required to excel in either academic practice OR community-based private practice. There is still too much regional variation in where you train in this specialty and this creates abundant misperceptions in the minds of some about your qualifications: Is he a Baylor guy, an RIC gal, a Seattle Grad, a Mayo dude? For anyone who has been around the specialty for a while, these monikers bring certain images to mind...
So, if we are to have a bridge in the specialty, there needs to be a reason for people to cross it. In other words, there needs to be real opportunities to draw people across it. The current state of affairs is such that perceived hurdles and compensation are better outside the academic community in our specialty than inside of it. In recent conversations with recent graduates, it is still the case that most physiatry department chairpersons have a limited understanding of the resources, support, and infrastructure that an interventional MSK physiatrist needs to excel in an academic practice. The academic culture hasn't caught up with private practice culture yet.
So, I'm all for bridges. Let's just not make toll bridges or bridges guarded by angry trolls...
