peduncle said:
I have gotten interested in PMR little by little but I"m a little unsure of the future of it. I know it is hard to predict any field's future, but do you see PMR going strong. This is a very vague question, I know. For example, you'd definitely see a solid foundation for Gastroenterology in the future, but do you see the same solid and continuing foundation for PMR??? once again.. still a vague question. Answer however you'd like.
I suppose that there are a couple of different ways to come at your question...
Are you aware of any medical specialties that have completely died or gone away?
There used to be a medical specialty just devoted to diagnosing syphilis---syphilisology---but penicillin really put an end to it. Realistically, I guess it just morphed into Infectious Diseases. So, from a historical perspective history is on PM&R's side. The historical trend has been toward expanding specialties, not condensing them.
Will there continue to be a need/demand for physiatrists in the coming decades?
Some of the best, albeit most cynical advice, I ever got about picking a specialty was to pick a field with lots of conditions that no one will ever cure. So, unless we figure out how to completely prevent disability or fully recover from neurological injuries (vis-a-vis stem cells or something like that), then I think the need for physiatrists will always exist.
Will physiatry be able to secure its own enviable niche in health care safe from competitors?
There are at least two views on this question: 1) Physiatrists do nothing that other specialists don't do equally well; or 2) Physiatrists do everything that no other specialty does well at all.
Neurologists can do EMGs; orthopods and family physicians can do sports medicine; rheumatologists claim to be the premier non-operative musculoskeletal specialist; anesthesiologists do pain medicine; and a kind-hearted geriatrician could probably run a rehab unit quite well. Taken in isolation things look really bleak for physiatry...
But, most patients don't have *one* single problem. Patients have musculoskeletal (CMC arthritis) and neuromuscular (carpal tunnel syndrome) problems in coexistance. Patients have disabilities (spinal cord injury) and chronic pain. Patients have acute neurological events (strokes), chronic health issues (COPD, DM, HTN, etc), on top of progressive functional decline (dementia). Sports injuries come from *and* promote poor technique.
So, it's the "putting it all together" where physiatry thrives. It's Humpty-Dumpty medicine. As long as Egg-heads keep falling from tall walls we should be fine.
