Turf War Question From a Psychiatry Resident

[PsychMD2100]

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Greetings Physiatrists,

I normally post over on the Psychiatry forum. I am a Psychiatry resident and we've been having discussions about how some Clinical Psychologists (PhDs) and Licensed Clinical Social Workers (LCSWs) have impacted our practice. In some severely underserved jurisdictions (ie New Mexico), Clinical Psychologists have been granted the ability to prescribe psych meds. LCSWs are now doing psychotherapy since managed care has pushed Psychiatrists into doing the things that make them unique, eg ECT, involuntary commitment, and psych meds.

I'm posting similar questions in other forums, but I wanted to ask them here:

How have your turf wars with other fields changed the way you practice? Are there concrete examples of how they have undermined your practice (ie decreased salary, decreased patient volume)? I've heard about Doctors of Physical Therapy; are they a factor?

 

[PT2MD]

I'm a PT working on getting into medical school so take my post for what it's worth. I've never felt any friction between PM&R doctors and our field. The DPT is an over-marketed credential to potential PT's who would like a broader scope. There will be no teeth to having a DPT until there are drastic changes in curriculum and state law, both of which will meet with tremendous opposition (rightly so) from the medical profession and respective lobbies. I'm not sure if that helps, but from the PT perspective, we have much more turf battles with the chiropractic profession and licensed athletic trainers.

 

[njdevil]

Good luck with the application process PT2MD.

 

[anboptop]

How have your turf wars with other fields changed the way you practice? Are there concrete examples of how they have undermined your practice (ie decreased salary, decreased patient volume)? I've heard about Doctors of Physical Therapy; are they a factor?

On an inpatient unit (where I have the most experience), the physiatrists and the therapists do extremely different things and both are necessary. While I understand the theory behind it, I am not trained to do any of the things that the therapists do.... nor is there time to do it in the course of my job. Without the therapists, there would be no rehab unit. And the therapists are not trained to manage the things I do, such as BP, anti-coagulation, other medical issues.

 

[Therapist4Chnge]

I'm posting similar questions in other forums, but I wanted to ask them here:

Just an FYI....

Cross posting similar threads in multiple forums is not allowed.

-t

 

[ampaphb]

Just an FYI....

Cross posting similar threads in multiple forums is not allowed.

-t

Says who? Whether it violates an arcane SDN rule or not, it is commonplace, so don't sweat it. Lot's of topics are interdiciplinary, and the more voices you can get on a subject, the better, IMHO.

 

[axm397]

When PsychMD2100 first posted, I checked to make sure his/her other posts were not too similar to this one. It looked like the posts were all very specific to whatever forum he/she posted in - ex. opthalmology vs optometry, and anesthesiologists vs CRNAs. So it seemed fine.

 

[PT2MD]

Good luck with the application process PT2MD.

Thanks. I appreciate the kind words.

 

[rehab_sports_dr]

I cannot speak on a personal level, but many more senior attendings have expressed concerned that when physical therapists (PTs) have direct access to patients without physician referrals (and equally importantly, when insurance companies are willing to reimburse for said services), that it may be detrimental to the field of PM+R.

I am too early in my career to comment more substantively.

We certainly overlap in our clinical interests with many other fields, both within medicine (rheum, neuro, ortho, psych, etc), but also with ancillary health care professionals (clinical psychologists, PT, OT, SLP, chiropractors, etc).

Like most physicians, I think a general concern is that if other professions are going to market themselves as our equivalents in terms of skill set, they should have a similar level of responsibility and liability. It is not clear, however, that this has been the case.