Q: rehab hospital, inpt attending. internist or physiatrist?

[oreosandsake]

Just wondering how this is since my experiences are limited to two rehabilitation hospitals.

Rancho Los Amigos and RIC


At Rancho, the inpt rehab attendings were mostly internists.
(roughly 4:1 ratio of internists to physiatrists)

At RIC, they were probably all physiatrists.
(I didn't go and investigate, so i could be wrong)

what is it like at other rehab hospitals?

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[Taus]

Were the internists consulting on patients who were also under the care of Physiatrists? Or were they actually running the show and performing all the usual duties of a Physiatrist?

I'd find it hard to believe it was the latter on a TBI/SCI/CVA/etc service. I guess I could see it being more realistic w/ primarily LTAC patients or mostly medical "deconditioning" in acute inpatient rehab, but not the other major dx's found in specialized rehab hospitals.

That being said, w/ the majority of grads trending towards outpatient MSK/EMG/Pain/Sports work, it makes it less surprising.

 

[oreosandsake]

Were the internists consulting on patients who were also under the care of Physiatrists? Or were they actually running the show and performing all the usual duties of a Physiatrist?

I'd find it hard to believe it was the latter on a TBI/SCI/CVA/etc service. I guess I could see it being more realistic w/ primarly LTAC patients or just mostly medical "deconditioning" in acute inpatient rehab, but not the other major dx's found in specialized rehab hospitals.

That being said, w/ the majority of grads trending towards outpatient MSK/EMG/Pain/Sports work, it makes less surprising.

I had a feeling this question would be raised.

the internists were "running the show"

the month I was there on the stroke floor, I was following a physiatrist. the other attending on the stroke floor was a neurologist. but my friend who was one floor up, on SCI, her attending was a cardiologist. http://www.rancho.org/md_wang.htm (awesome guy, loved to teach. His wife is an attending on a different floor - mostly stroke as well. she is an internist as well)

TBI is run by a physiatrist.

the other services were called "geriatrics" or "neurology" but they were all essentially stroke. we saw some guillian barre, west nile encephalopathy, and other pathology - not sure if they qualify as things dx'd in rehab hospitals.

I'm pretty sure all the internist run services had team meetings, and met with families, and visited their patients during PT just like mine.

so, is it just rancho?

I ask since maybe this is part of the reason why I hear sour statements about the job market. 😕

 

[Dr Manhattan]

The only doctors at RIC as physiatrists. Thats it, and thats all!

 

[axm397]

actually we have neurologists, rheumatologists, and orthopedic surgeons who come and hold clinic jointly with us. we also have double and triple boarded docs. we also have two geriatricians at RIC. One of the TBI attendings is a neurologist. we also have two chiropractors.

 

[Shalom77]

so, is it just rancho?

I ask since maybe this is part of the reason why I hear sour statements about the job market. 😕

Our rehab unit is only run by physiatrists.

But I would question the assumption that having internist attendings run a rehab unit is a negative sign about the PM&R job market. It could just as well be a good sign about the job market i.e. it could indicate a shortage of inpatient PM&R docs thus forcing hospitals to rely on internists. And if hiring internal medicine trained docs - it would make sense to hire someone who has worked as a medical consultant to a rehab unit over an internist who has no rehab experience. Isn't there a trend for physiatrists to be more interested in outpatient practices: pain/sports/msk than inpatient rehab which could lead to a relative shortage of inpatient PM&R docs (and a corresponding good job market for those interested in inpatient) ?

On the other hand it could be something idiosyncratic to Rancho (which I don't know much about). I know UCLA has a neurorehabilitation program and fellowship (open to both neurologists & physiatrists) run through the neurology department with a major focus in stroke/cerebrovascular disease. It wouldn't be surprising if as a result there are more neurologists running neurorehab units in the surrounding area. Also at UCLA - PM&R is a division within the Department of Medicine.

edit in although looking it seems Rancho is more connected with USC where it is affiliated with the Dept. of Medicine - in any case, regardless of the reasons for the training background of their attendings - I don't think it really says anything negative about the PM&R job market.

 

[RUOkie]

Many, inpatient rehab programs that are run by for profit companies intentionally do NOT hire physiatrists to be their medical directors. The reason for this is that most PM&R docs actually know what they are doing, and will not bow down in front of the program directors (ie taking advantage of the pps system). This type of situation is becoming rampant in community hospitals, and is only being marginally addressed by our academy.

Many physiatrists are turning towards outpatient/consultative based practices even for stroke/amputee etc. (ie non musculoskeletal).

If your only love is inpatient rehab, I would stick with TBI/SCI or with an academic program. It is very tough out there in the community hospitals. (by the way, most IM/ortho/neurology/neurosurgery specialists out there WANT our help and our expertise. The issue is the hospital adminstrators)