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And is the pay comparable?
What's the difference between a PMR sports med doc and family med sports med doc?
- Thread starter executivewaffle
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Really depends. I am PM&R sports and work with FM, ER and Ortho sports docs. We practice a little differently, which may just be difference in training (academic vs community). A lot of it depends on where you train for residency and fellowship, with your comfort level with different pathology. I see everyting the FM/ER docs see but also do EMGs and some interventional spine, genicular RFA, botox, etc. Because of those procedures I probably make a little more than them but have more headaches than them. 
If I decided to drop spine and EMG then we really wouldn't have a different practice at all.
If I decided to drop spine and EMG then we really wouldn't have a different practice at all.
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It really depends. Everyone has their own way of practicing after fellowship. I've seen PMR/sports docs do a mix and still do inpatient stuff. Others work in an ortho clinic as the non-operative person and procedure jockey. I'm FM/sports. Our PM&R sports person does more procedures than I do, like nerve blocks/hydrodissections and fluoroscopy, but I do more fracture care. Most bread and butter sports medicine we both do. I do more game coverage however, and manage more PCP related things with my athletes, esp the collegiate ones. I also do inpatient FM service with the residents so I tend to do more FM stuff, but I still mainly practice in an orthopedics clinic. Basically, I do 90% sports, 10% FM (including inpatient).
Cross posted in the PM&R thread:
There is a lot of overlap in the treatment of MSK conditions. In general, physiatrists just out of training are likely to be more advanced than primary care docs due to extensive MSK training in residency. But over time primary care sports docs' MSK skills do equal out with the exception of the spine. Physiatrists are usually superior in managing spine conditions in general and spine conditions in athlete. Sports physiatrists can carve out a nice niche in the spinal care of athletes, especially if they do interventions. Primary care sports docs are superior in the primary care management of athletes.
At the highest level of sports coverage, physiatrists in general are at a disadvantage. This is due to many teams and organizations having an orthopaedic surgeon to cover orthopaedic injuries and then someone to care primarily for medical needs of the athletes (ie primary care sports). Of course, there is not always a 100% clear separation of roles as orthopaedic surgeons often have to address medical issues and primary care docs have to address orthopaedic issues. That being said, there are some physiatrists who are team docs in the top leagues in the US. I would say though, that this set up/bias is most prevalent at the major professional level and major D1 level. Beyond that (smaller D1 schools, Olympic sports, combat sports, etc) there is not as much of a bias. There are several physiatrists that are team doctors in high level athletics (for example, the chief medical officer for the USOPC is a physiatrist).
Academically there is near 100% overlap in leadership capabilities. Both can be active faculty in sports fellowship programs. There are PM&R trained docs who are PDs of primary care sports programs. I'm not aware of any primary care docs that are PDs of PM&R based programs though.
Pay wise, physiatrists is general will make more. But this is primarily due to physiatrists being more procedure heavy than primary care sports docs. One thing trainees fail to realize this is that in general, institutions, groups, insurances don't pay physicians different rates for doing the same thing. That is, you just don't show up and say "I'm a physiatrist, pay me more." In general, you are paid for what you do. A primary care doc sports specialist and a sports physiatrist with the same exact patient mix will get paid the same because they would bill the same CPT codes. There may be some subtilities in base pay and incentive/bonus plan with some groups, but in the end it mostly evens out. Ceiling wise, physiatrists have very high pay ceilings because of the ability to bill for higher value CPT codes than primary care sports docs, but this would likely entail having to be very heavily procedure based while leaving less room for true sports medicine care.
care.
There is a lot of overlap in the treatment of MSK conditions. In general, physiatrists just out of training are likely to be more advanced than primary care docs due to extensive MSK training in residency. But over time primary care sports docs' MSK skills do equal out with the exception of the spine. Physiatrists are usually superior in managing spine conditions in general and spine conditions in athlete. Sports physiatrists can carve out a nice niche in the spinal care of athletes, especially if they do interventions. Primary care sports docs are superior in the primary care management of athletes.
At the highest level of sports coverage, physiatrists in general are at a disadvantage. This is due to many teams and organizations having an orthopaedic surgeon to cover orthopaedic injuries and then someone to care primarily for medical needs of the athletes (ie primary care sports). Of course, there is not always a 100% clear separation of roles as orthopaedic surgeons often have to address medical issues and primary care docs have to address orthopaedic issues. That being said, there are some physiatrists who are team docs in the top leagues in the US. I would say though, that this set up/bias is most prevalent at the major professional level and major D1 level. Beyond that (smaller D1 schools, Olympic sports, combat sports, etc) there is not as much of a bias. There are several physiatrists that are team doctors in high level athletics (for example, the chief medical officer for the USOPC is a physiatrist).
Academically there is near 100% overlap in leadership capabilities. Both can be active faculty in sports fellowship programs. There are PM&R trained docs who are PDs of primary care sports programs. I'm not aware of any primary care docs that are PDs of PM&R based programs though.
Pay wise, physiatrists is general will make more. But this is primarily due to physiatrists being more procedure heavy than primary care sports docs. One thing trainees fail to realize this is that in general, institutions, groups, insurances don't pay physicians different rates for doing the same thing. That is, you just don't show up and say "I'm a physiatrist, pay me more." In general, you are paid for what you do. A primary care doc sports specialist and a sports physiatrist with the same exact patient mix will get paid the same because they would bill the same CPT codes. There may be some subtilities in base pay and incentive/bonus plan with some groups, but in the end it mostly evens out. Ceiling wise, physiatrists have very high pay ceilings because of the ability to bill for higher value CPT codes than primary care sports docs, but this would likely entail having to be very heavily procedure based while leaving less room for true sports medicine care.
care.
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Can FM Sports med docs do spine facet joint injections under US guidance, if they are comfortable and well trained? And is the reimbursement different for one procedure if practicing as PCP vs Sports med taxonomy code?
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Insurance doesn't pay for facet injections unless under fluoroscopic guidance. If done under fluoro if you got the training to do so than the cpt code should reimburse the same regardless of training.
I occasionally will do under u/s in a pinch but just bill as a TPI, as I will injection some lido in the paraspinal muscles as well.
I occasionally will do under u/s in a pinch but just bill as a TPI, as I will injection some lido in the paraspinal muscles as well.
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I did a fellowship where we were trained to do ESIs and facet joint injections but maybe got to do 5 LESIs on my own and 2 or the CESIs during my time with the interventional pain attending. Observed a lot more but….definitely am not enough of a cowboy to say I’m comfortable doing them in my practice. Plus I hate chronic back pain, it’s great to turf that all off to the PM&R crowd imo
