The Future of PM&R

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donkeykong1

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With the current demeaning outlook set forth for primary care physicians by healthcare reform, with Nurses, PA, NP and foreign graduates set to take an expanded role, will the PM&R specialty take a back seat to Physical Therapists and Chiropractics who can somewhat assist in rehab medicine.

What will happen to PM&R physicians?

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DOs will not let chiropractors take over their practices. PTs can't prescribe. You will need a physician, such as a PMR, to oversee these people if prescriptions are going to be used.

Don't worry, the career is going nowhere.
 
DOs will not let chiropractors take over their practices. PTs can't prescribe. You will need a physician, such as a PMR, to oversee these people if prescriptions are going to be used.

Don't worry, the career is going nowhere.

Kinda putting the poor guy down aren't we? :laugh:
 
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Who knows!?

I'm hoping things will be different in 8 years.....hopefully for the better.
 
Pm&R is awesome. It really offers a chance to bring OMM into a practice and practice a lot of preventative medicine. I think it's a good place to be in 8-10 years.
 
If you honestly think that my points have no substance please see what the aapm&r says:

"The future of physical medicine and rehabilitation may seem uncertain as subspecialization, the loss of traditional rehabilitation roles, and the growth of outpatient physiatry all torment us daily. It is natural to fear that physiatry will become displaced in the new millennium."

Its not like I'm putting the specialty down or anything, I respect such physicians greatly and indeed as jaggerplate noted there are a large number of positive medical attributes within the specialty. Although i am still young, in general, I must question the direction of specialties which I have a profound interest; for reasons of financial security, and career containment.
 
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as the OP is it possible to recommend that this thread be copied into the PM&R sub forum. for better results ofcourse.
 
Just start a duplicate thread there.
 
Just start a duplicate thread there.

It's actually against the Terms of Service, to which you agreed when joining, to post the same thing in multiple places (cross posting). It's much more difficult for conversations to be followed if they're going on in multiple places.

However, OP, I can move this thread if you'd like. Just PM me. :)
 
It's actually against the Terms of Service, to which you agreed when joining, to post the same thing in multiple places (cross posting). It's much more difficult for conversations to be followed if they're going on in multiple places.

However, OP, I can move this thread if you'd like. Just PM me. :)
Ah. My mistake. Thanks for the correction.
 
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thanks jagger, will do. I see from your previous posts that you also have an interest in PM&R.
 
If you honestly think that my points have no substance please see what the aapm&r says:

"The future of physical medicine and rehabilitation may seem uncertain as subspecialization, the loss of traditional rehabilitation roles, and the growth of outpatient physiatry all torment us daily. It is natural to fear that physiatry will become displaced in the new millennium."

Its not like I'm putting the specialty down or anything, I respect such physicians greatly and indeed as jaggerplate noted there are a large number of positive medical attributes within the specialty. Although i am still young, in general, I must question the direction of specialties which I have a profound interest; for reasons of financial security, and career containment.

So here's the quote put in proper context : http://www.aapmr.org/member/data_bagnall.htm This was written by Dr. Bagnall, the chair of the membership committee to try to get more physiatrists involved with Academy activities. I don't think he was trying to insinuate that the future of our field is bleak.

"The future of physical medicine and rehabilitation may seem uncertain as subspecialization, the loss of traditional rehabilitation roles, and the growth of outpatient physiatry all torment us daily. It is natural to fear that physiatry will become displaced in the new millennium.

In truth, the outlook is quite positive. There is more than hope to cling to, there is common ground. The Academy is one of our unifying forces, and its leadership is finding news ways to help us not only read the future for our specialty, but prepare for it as well..."
 
In my opinion-- The field of PM&R is in the process of redefining itself. Historically, the "base" was inpatient/outpatient rehabilitation. Now, a great majoritiy of physicians are primarily interested in MSK medicine. In the outpatient arena, we will not suffer. Our specialty is uniquely positioned to be the leaders in musculoskeletal medicine. By taking a mechanics based approach towards MSK problems, we help people more that "sports FP" or even by ortho. My biggest referral sources are neurosurg, ortho, and sports FP. They send me the difficult patients.

I hope that the loss of PASSOR does not cause that to suffer. But I suspect that by rolling PASSOR into the overall fold of AAPMR, the voice of musculoskeletal medicine will just be heard by a wider audience.

Finally, there is already a big decline in inpatient rehab being provided by PM&R. Companies like RehabCare who "own" a lot of rehab units in community hospitals prefer NOT to hire PM&R as medical directors. The physiatrists are too outspoken to cowtow to the program directors, and thereby the units don't make quite as much money.
 
After a thorough Hx and Px, I make a diagnosis and a treatment plan. Any PT or chiro can do this also.

Here's what I do as a Physiatrist, that no Physical Therapist or Chiropractor can do:

Where appropriate, I prescribe medications certified by the FDA as relatively safe and effective. I monitor the effects and adjust as neccesary. I don't prescribe things that say "This product is not intended to diagnose, treat, cure, or prevent any disease."

I do needle EMG's to validate the surface NCS I do. I don't use pre-made arrays such as NC-STAT and other designed to fleece patients and insurance companies. Ok, some chiros can do needle EMGs with specialized training, but I have yet to see one who really knew what they were doing.

I inject medications into specific areas of the body to diagnose and treat diseases and disorders. I know how to perform the procedures safely and effectively, and more importantly, I know when to do them.

Should I choose to do so, I could obtain more training and do even more advanced procedures, such as implanting pain and spasticity pumps, and spinal cord stimulators.

I do all of this with the advanced training of a PM&R to treat the whole patient, not just a body part, with therapies based more on science than anything.

Lastly, when people find out I am a doctor and ask what kind of doctor I am, they don't say "oh" in a disappointed fashion when they find out I'm an MD. :smuggrin:
 
It may be naive to say this, but the difference would be that we have 5 years of pure medical training (med school + intern year). that's before the 3 minimum years where PM&R learning is done. Back pain is more than MSK causes (prostate cancer mets). Neurologic problems can be caused by more than purely spine problems (side effect of meds like Lasix, Lyme's disease). Just because you become a physiatrist doesn't mean you have to forget all that studying you put in for Step 1 and your intern year reading!
 
It may be naive to say this, but the difference would be that we have 5 years of pure medical training (med school + intern year). that's before the 3 minimum years where PM&R learning is done. Back pain is more than MSK causes (prostate cancer mets). Neurologic problems can be caused by more than purely spine problems (side effect of meds like Lasix, Lyme's disease). Just because you become a physiatrist doesn't mean you have to forget all that studying you put in for Step 1 and your intern year reading!
I completely understand your point. My intention was not to bring up the obvious difference between related PM&R professions. It just seems that patients have more options when it comes to rehab or pain medicine these days, and perhaps one day the focus of PM&R physicians should be more MSK related.

Also, how does the referral process work for PM&R. Where does most of the patient base come from?
 
I completely understand your point. My intention was not to bring up the obvious difference between related PM&R professions. It just seems that patients have more options when it comes to rehab or pain medicine these days, and perhaps one day the focus of PM&R physicians should be more MSK related.

Also, how does the referral process work for PM&R. Where does most of the patient base come from?

Depends on what you do. Many PM&R docs are heavily PCP dependent, others more ortho and neurosurg. Some do better with self-referrals.
 
Part of the problem with the "new" American health care system,is that no-one (including our President) has any idea what it will look like. IMHO, I do not think we will be hit too hard, but maybe we will. Maybe there will be complete socialized medicine, and we can all be cared for by nurses:scared:. Or, maybe our rates will go up (the RVUs for EMG/NCS are set to increase in the current House bill!). All we can do at this point is talk to our congressmen/women and our Senators. I am lucky because I personally know both. I KNOW that my representatives are keeping my interests at the forefront.

Oh, and pray:luck::xf::D
 
Part of the problem with the "new" American health care system,is that no-one (including our President) has any idea what it will look like. IMHO, I do not think we will be hit too hard, but maybe we will. Maybe there will be complete socialized medicine, and we can all be cared for by nurses:scared:. Or, maybe our rates will go up (the RVUs for EMG/NCS are set to increase in the current House bill!). All we can do at this point is talk to our congressmen/women and our Senators. I am lucky because I personally know both. I KNOW that my representatives are keeping my interests at the forefront.

Oh, and pray:luck::xf::D
kudos to you RUOkie. I agree, we must always hope and pray.
 
Being that pmr is filled with manual labor, just out of curiosity PMR 4 MSK, how hard in your opinion, will PM&R physician salaries compared to other specialty salaries be hit by the inevitable "new" American health care system.

Two thoughts on that, in opposition with each other:

1) PM&R will become essential to the system to co-manage complex and/or aging pts with primary care and other specialties due to our unique training. We tend to work well as an aument to other health professionals and our work tends to cost insurance less for good outcomes (or so we like to think)

2) PM&R will suffer greatly as medicine falls deeper into the Evidence-Based Medicine approach to cost containment. EBM can be used to develop guides, standards, etc, but we've failed to do adequate research to prove what we do works, or what the best treatments are for various conditions. The pain managment portion of our field is starting to feel this pinch.
 
So here's the quote put in proper context : http://www.aapmr.org/member/data_bagnall.htm This was written by Dr. Bagnall, the chair of the membership committee to try to get more physiatrists involved with Academy activities. I don't think he was trying to insinuate that the future of our field is bleak.

"The future of physical medicine and rehabilitation may seem uncertain as subspecialization, the loss of traditional rehabilitation roles, and the growth of outpatient physiatry all torment us daily. It is natural to fear that physiatry will become displaced in the new millennium."


But, you wonder who he's trying to pander to here.

I am not "tormented" by the growth of outpatient Physiatry.

I and, most Physiatrists I know, are actually happy about it. Same with subspecialization, to a certain degree.
 
I think that given the well-documented problems residents have obtaining competencies in basic skills, I don't know what other options exist beside sub-specialization.

Proposing to restructure the 36 months that residents spend in core residency training in order to ensure that residents are ready for hospital credentialing as a bonafide MSK physiatrist after graduation is the "third rail" of organized physiatry politics.

Right now, I don't think that most of our programs are delivering the kind of expertise to health consumers, patients, and employers in their new graduates that our field purports.
 
I think that given the well-documented problems residents have obtaining competencies in basic skills, I don't know what other options exist beside sub-specialization.

Proposing to restructure the 36 months that residents spend in core residency training in order to ensure that residents are ready for hospital credentialing as a bonafide MSK physiatrist after graduation is the "third rail" of organized physiatry politics.

Right now, I don't think that most of our programs are delivering the kind of expertise to health consumers, patients, and employers in their new graduates that our field purports.


Eureka. I have been thinking about the quality of training during internship but especially in residency. While I think its the single biggest problem in our field a lot of people don't even think it exists.
 
Eureka. I have been thinking about the quality of training during internship but especially in residency. While I think its the single biggest problem in our field a lot of people don't even think it exists.


Jeez, once you get out in the real world, it is obvious that this problem exists. The people from the "top and upper middle" tier programs are fine. From some of the small ones, further training is usually needed.
 
Proposing to restructure the 36 months that residents spend in core residency training in order to ensure that residents are ready for hospital credentialing as a bonafide MSK physiatrist after graduation is the "third rail" of organized physiatry politics.


Exactly.

How did you like those responses to your proposal on the list serve?:laugh:

At least it's on the table for discussion now.

I do kind of like the listserves. They're kind of like town hall meetings. It lets the academy leadership know when a significant number of members are pissed about something.
 
Exactly.

How did you like those responses to your proposal on the list serve?:laugh:

At least it's on the table for discussion now.

I do kind of like the listserves. They're kind of like town hall meetings. It lets the academy leadership know when a significant number of members are pissed about something.


I guess I'm an igonorant old man, but how do you get on the listserves? I looked on the AAPMR website, but could not find it?
 
^^^
Thanks, I just updated my practice profile!
 
Get ready for a full mailbox!
 
LOL
I already get 70-80 emails/day. what's another 50 or 60!
 
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