Primary Care?

[DPPM]

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I know physical medicine is a specialty, but is it possible to practice in primary care as well with just a specialty in physical medicine? I know that physiatrists get experience in internal medicine in residency. Is it necessary to double board in internal medicine if you want to practice in primary care as well? Thanks in advance.

 

[doc05]

you'd be foolish to practice primary care if you're a rehab doc:
(1) it's not what you're trained to do
(2) worse lifestyle
(3) less money

 

[bbbmd]

you'd be foolish to practice primary care if you're a rehab doc:
(1) it's not what you're trained to do
(2) worse lifestyle
(3) less money

Some physiatrists do act as primary care physicians for the disabled. You will see this in many VA hospitals where PM&R docs provide primary care to SCI patients. PM&R as primary care docs for people with disabilities was a hot issue a few years ago, but it seemed to have died down. I don't know any recent developments.

 

[chauffeur]

from speaking to residents and physicians who plan on going into private practice as a general physiatrist, a big concern is how will you get referrals. a large percentage of the medical field does not know exactly what a physiatrist does. i imagine that a family physician could refer a patient to an orthopod or neurologist instead of a physiatrist.

i've heard about physiatrists visiting primary care centers/practices/clinics to solicit their services and education local physicians about the services they can provide a patient population.

that being said, i think might be smart to provide some type of general medical care to your patients to build a patient pool at first and then, once you are very busy, you can start being more particular about what you do.
this is probably not the best way to utilize your skills as a physiatrist at first, but it will keep you in business. it also depends on what type of practice you are in, who you are affiliated with, and in what part of the country.

 

[paz5559]

from speaking to residents and physicians who plan on going into private practice as a general physiatrist, a big concern is how will you get referrals. a large percentage of the medical field does not know exactly what a physiatrist does. i imagine that a family physician could refer a patient to an orthopod or neurologist instead of a physiatrist.

i've heard about physiatrists visiting primary care centers/practices/clinics to solicit their services and education local physicians about the services they can provide a patient population.

that being said, i think might be smart to provide some type of general medical care to your patients to build a patient pool at first and then, once you are very busy, you can start being more particular about what you do.
this is probably not the best way to utilize your skills as a physiatrist at first, but it will keep you in business. it also depends on what type of practice you are in, who you are affiliated with, and in what part of the country.

1) if your referral sources are PCP's, and then you encroach on their turf, how likely do you think they will be to refer patients to you in future?

2) if something goes wrong, and you hold yourself out to be any manner of FP/GP/PCP, IM doc, you will be held to the standard of an ordinary and reasonable FP/IM doc in court, not that of a phyiatrist practicing a little internal medicine on the side.

We are specialists. Would you go to your local orthopod to address your primary care needs? There is enough confusion about what we do without muddying the waters further, IMHO.

Unless you are double-boarded, I think it is a bad idea (but then again, I also think it is a bad idea to do fluoroscopically-guided ESIs and other spinal interventions without being fellowship-trained, so I clearly have a particular viewpoint on the broader subject of practicing without what I consider to be adequate training)

 

[bbbmd]

1) if your referral sources are PCP's, and then you encroach on their turf, how likely do you think they will be to refer patients to you in future?

2) if something goes wrong, and you hold yourself out to be any manner of FP/GP/PCP, IM doc, you will be held to the standard of an ordinary and reasonable FP/IM doc in court, not that of a phyiatrist practicing a little internal medicine on the side.

We are specialists. Would you go to your local orthopod to address your primary care needs? There is enough confusion about what we do without muddying the waters further, IMHO.

Unless you are double-boarded, I think it is a bad idea (but then again, I also think it is a bad idea to do fluoroscopically-guided ESIs and other spinal interventions without being fellowship-trained, so I clearly have a particular viewpoint on the broader subject of practicing without what I consider to be adequate training)

I dont know of any Physiatrists doing primary care outside of the VA system. If you did a prelim medicine year, you would probably be competent at basic primary care management. I would probably treat those basic things (coughs, colds), after all I am a physician, but I would also set boundries and refer out if I needed to. Know your limitations and focus on your expertise as a specialist.

I do think that we are better at many primary care issues with regard to TBI, SCI and catastrophic injury because the medicine and family practice docs are just not trained in it. (ie. dx and management of dysreflexia, recognizing medical complications in TBI early on, bowel, bladder and skin issues, as well as the myriad of musculoskeletal and pain complaints of our patient population). This is where we should focus our attention, rather than treating a person's chronic HTN, cholesterol or DM problems (leave that up to the medicine doc). I agree we need to educate the other physicians (starting at the resident and even med student level) to get business and referrals, but I wouldnt advertise that I would treat a disabled person's DM, HTN, CHF or Renal Failure! Thats the whole reason why I didnt choose to go into internal medicine in the first place.

We have such a broad specialty and the luxury to pick and choose what we want to do. Again, set your limitations at an appropriate comfort level and you will be happy. Moreover, you will not be doing any disservice to your patients by not refering them for appropriate care.

 

[DPPM]

Thanks for the replies. I guess what I was really wondering about (which some of you touched on), is how feasible is it for a physiatrist to start his/her own practice? Is it uncommon for those who haven't double boarded?