Thoughts on the future of PM&R/Physiatry

[PMR2008]

---

Members don't see this ad.

Just as a quick background. I am about to hit 10 years since graduation from residency. My initial interest in PM&R was as a first year osteopathic med student. The interest only increased with exposure, electives and meeting other Physiatrist. I love the field and could not have asked for a better field than Physiatry since it fits my interests and desire for work life balance. I have a mixed practice with outpatient regen/interventional pain, inpatient coverage, subacute, med legal and admin. I regularly talk to policy makers, have been involved with CMS, AMA, AAPM&R and various payors and stakeholders. I was concerned about the future of PM&R as a med student and resident because there was always someone out there who would be pessimistic about our future. Since I have been asked this multiple times privately I wanted to write a post for other students and residents to reference and to start a discussion.

1) The US population is aging - "Today, there are more than 46 million older adults age 65 and older living in the U.S.; by 2050, that number is expected to grow to almost 90 million" Those are facts. With increased age comes functional impairment. The older population continues to desire a higher quality of living and a subset wants to stay active.
2) There is a shift to value added medicine. Physiatry is historically low cost medium value. Unfortunately the leadership never focused on collecting data on value of Physiatry until recently. Payors, stakeholders, CEO's are looking for value. We have a lot of competition from therapists, mid level creep, other specialties but in the industry most people know that Physiatry offers something that others can not.
As a group we are being approached by insurance companies, ACOs, bundled plans and large therapy groups to have us involved. This will continue in the future.
3) Expansion of regen med. We are only in the startup phase. lots of unknown, limited research and sporadic adoption. PM&R will be an active participant in the adoption for the next decade.
4) Adaptability - As a specialty we have multiple skills. We play well with teams and can be leaders when needed. I discourage students and residents to limit yourself to only sports/spine/pain/TBI etc. Early career and mid career changes can happen to anyone. Learn everything and if needed be ready to adapt. Step up to the plate and get involved in leadership as early as possible.

The only reason IMO the field will not succeeded is if we continue to complain about midlevel creep/Chiros/therapist and not have a seat at the table.

 

[Mitch Connor]

Just as a quick background. I am about to hit 10 years since graduation from residency. My initial interest in PM&R was as a first year osteopathic med student. The interest only increased with exposure, electives and meeting other Physiatrist. I love the field and could not have asked for a better field than Physiatry since it fits my interests and desire for work life balance. I have a mixed practice with outpatient regen/interventional pain, inpatient coverage, subacute, med legal and admin. I regularly talk to policy makers, have been involved with CMS, AMA, AAPM&R and various payors and stakeholders. I was concerned about the future of PM&R as a med student and resident because there was always someone out there who would be pessimistic about our future. Since I have been asked this multiple times privately I wanted to write a post for other students and residents to reference and to start a discussion.

1) The US population is aging - "Today, there are more than 46 million older adults age 65 and older living in the U.S.; by 2050, that number is expected to grow to almost 90 million" Those are facts. With increased age comes functional impairment. The older population continues to desire a higher quality of living and a subset wants to stay active.
2) There is a shift to value added medicine. Physiatry is historically low cost medium value. Unfortunately the leadership never focused on collecting data on value of Physiatry until recently. Payors, stakeholders, CEO's are looking for value. We have a lot of competition from therapists, mid level creep, other specialties but in the industry most people know that Physiatry offers something that others can not.
As a group we are being approached by insurance companies, ACOs, bundled plans and large therapy groups to have us involved. This will continue in the future.
3) Expansion of regen med. We are only in the startup phase. lots of unknown, limited research and sporadic adoption. PM&R will be an active participant in the adoption for the next decade.
4) Adaptability - As a specialty we have multiple skills. We play well with teams and can be leaders when needed. I discourage students and residents to limit yourself to only sports/spine/pain/TBI etc. Early career and mid career changes can happen to anyone. Learn everything and if needed be ready to adapt. Step up to the plate and get involved in leadership as early as possible.

The only reason IMO the field will not succeeded is if we continue to complain about midlevel creep/Chiros/therapist and not have a seat at the table.

I'm glad I came across this thread and hope more is posted on the subject. I am an OMS1 and PM&R is among my interests. Personally, I haven't talked to many people about the field and the one I have is an ER doc. Great guy, but didn't have much good to say about it so I do my best not to take it as gospel. As a DO student PM&R seems to be a natural fit with OMM and the focus on MSK etc.

Can you expand on some of the things you are doing or seeing with regenerative medicine?

What additional advice would advice would you give to anyone naive to the field? What do you think makes a good physiatrist? What do you think program directors look for in potential residents? A little off topic, but it's a start.

 

[drusso]

I'm glad I came across this thread and hope more is posted on the subject. I am an OMS1 and PM&R is among my interests. Personally, I haven't talked to many people about the field and the one I have is an ER doc. Great guy, but didn't have much good to say about it so I do my best not to take it as gospel. As a DO student PM&R seems to be a natural fit with OMM and the focus on MSK etc.

Can you expand on some of the things you are doing or seeing with regenerative medicine?

What additional advice would advice would you give to anyone naive to the field? What do you think makes a good physiatrist? What do you think program directors look for in potential residents? A little off topic, but it's a start.

Ask the ER what he thinks of physiatrists when he's trying to dispo his patients to a SNF or LTAC.

 

[PMR2008]

I'm glad I came across this thread and hope more is posted on the subject. I am an OMS1 and PM&R is among my interests. Personally, I haven't talked to many people about the field and the one I have is an ER doc. Great guy, but didn't have much good to say about it so I do my best not to take it as gospel. As a DO student PM&R seems to be a natural fit with OMM and the focus on MSK etc.

Can you expand on some of the things you are doing or seeing with regenerative medicine?

What additional advice would advice would you give to anyone naive to the field? What do you think makes a good physiatrist? What do you think program directors look for in potential residents? A little off topic, but it's a start.

Regen medicine is broad. I treat all sorts of MSK/Neuro injuries with Prolotherapy and PRP. Not a believer in stem cell therapy being much better than PRP at this point.

Spend time with a few Physiatrist. Create an interest group at your school unless you already have one, volunteer at the special Olympics and adaptive sports etc. Search SDN for other advice. Join the AAPM&R and find a mentor.

 

[PMR2008]

Why demand for physician leaders is growing - Becker's Hospital Review | Healthcare News & Analysis

As a practicing OB-GYN in the 1980s, Lawrence Antonucci, MD, didn't necessarily aspire to become CEO of a health system.

www.beckershospitalreview.com

As a practicing OB-GYN in the 1980s, Lawrence Antonucci, MD, didn't necessarily aspire to become CEO of a health system.

He said that was not a common career path for physicians at the time, except at top-performing organizations such as Cleveland Clinic and Rochester, Minn.-based Mayo Clinic, which have always been led by physicians. But Dr. Antonucci said he has increasingly seen more physicians in these leadership roles.

"I think it became apparent that over time physicians with the right training and experience could learn a lot about hospital operations and bring with them that clinical experience and that front-line experience," said Dr. Antonucci, who has served as president and CEO of Fort Myers, Fla.-based Lee Health since June 2017.

Increased interest in physician leaders

Over the last two or three years alone, global executive search firm WittKieffer has seen an estimated 20 percent increase in hospitals and health systems wanting physicians included as candidates in their CEO searches.

Linda Komnick, managing partner and practice leader in the physician integration and leadership division at the firm, attributes this trend in part to healthcare's shift from volume-based care, which focuses on the number of patients seen, to value-based care, which focuses on care quality. WittKieffer conducts more than 400 healthcare executive searches annually, and about 15 percent of those are CEO searches. In the vast majority of CEO slates, hospitals and health systems are looking for physician leaders who've had experience in improving quality through managed care and population health. Ms. Komnick said that wasn't the case 15 years ago, when a physician would go to managed care, then face difficulty getting into health system leadership operations.

Additionally, she's seen younger physicians increasingly seek MBAs and master's degrees in population health management to prepare for potential hospital and health system leadership roles. And she's seen quality committees of hospital and health system boards become even more important to organizations.

"This is an exciting time for physician leaders. There is a wealth of opportunity out there," she said. "How do these people move up? You see people starting on committees, medical staff, [and] moving into more leadership roles such as CMO, chief physician executive, [then] taking on operational responsibilities, getting that seat at the table, involved in leading clinical strategy."

Saul Weingart, MD, PhD, president of Providence-based Rhode Island Hospital and its Hasbro Children's Hospital, said increased employment of physicians by hospitals is another factor in the increase in physicians as hospital and health system leaders. Hospitals employed 44 percent of physicians in January 2018, up from 43 percent in January 2017 and 26 percent in July 2012, according to a study from the nonprofit Physicians Advocacy Institute and Avalere, published in 2019. From July 2012 to January 2018, the number of hospital-acquired physician practices also grew from 35,700 to 80,000, the study found.

"When I started practicing years ago, physicians wanted to be left alone to do their job, and their ideal circumstances was where they had relatively few administrative burdens and could see patients," said Dr. Weingart. "But over time, increasingly folks have become employed, and instead of being solo operators and entrepreneurs, they've become part of corporate enterprises. And I think there's a sense among many clinicians that it's helpful to understand the administrative challenges of the organization so you can play a role in overseeing and directing your own work."

Still, he acknowledged that not all physicians see hospital and health system leadership as an interesting career opportunity, and that there are multiple pathways that can be taken by physicians who desire these positions.

Leadership paths for two physicians

Dr. Weingart's career started on the quality side of the industry, in research, and gradually moved to administrative roles. He said he started as a primary care physician in an academic setting and did research on quality and patient safety.

"A lot of the quality improvement projects I did turned out to be important clinically because they improved patient experience or patient flow, or reduced medical errors and harm, so I was gradually able to take on more leadership roles in the quality area," said Dr. Weingart.

He served as vice president for quality and patient safety at Dana-Farber Cancer Institute in Boston, then as CMO and senior vice president of medical affairs at Boston-based Tufts Medical Center and Tufts Children's Hospital. He also was professor of medicine, public health and community medicine at Tufts University's medical school. He began his current role as president in February.

For Dr. Antonucci, with Lee Health, the path toward leadership began as a practicing OB-GYN, then led to him co-founding Physicians Primary Care, a large multispecialty physician practice in Florida's Lee County, in 1983. He became chief administrative officer of Lee Health's Cape Coral (Fla.) Hospital in 2007. He was appointed COO of hospital services for Lee Health two years later and took responsibility for physician services in early 2010. He was then named COO of Lee Health in 2011 before taking on his current role in 2017.

Expectations of physician leaders

No matter what path physicians take, once they get to the leadership role, such as CEO, there are certain expectations in today's healthcare environment.

For example, Dr. Antonucci said one of the biggest challenges for physician leaders, especially those just beginning their leadership role, can be learning to work as a team member.

"In a clinical scenario, you're as a physician, you're the one with the answers, you have the solutions, you make the diagnosis, you prescribe the treatments," he explained. "In healthcare leadership, you've got experts in human resources, you've got experts in IT, in other areas, and you have to tap into them and recognize you don't have all the answers. Your job as a physician leader is to ask the right question so those answers can come forward."

He said he believes it's important for physician leaders to acknowledge members of the leadership team who are not physicians are critical because they bring expertise to the table physicians don't have.

"It works best when everyone is transparent about what they know, what they don't know, and can come to decisions collaboratively through open and transparent discussion," said Dr. Antonucci.

Dr. Weingart agreed. He said physician leaders should have the ability to create and communicate a vision for the organization and feel comfortable managing people who are outside the physician's domain expertise.