I've been doing research regarding the differences between the roles of Physiatry and Physical Therapy as well. Research continues so bear with me. I still have much more to do.
I'm curious to why a physiatrist would employ a PA/NP over a PT/OT. It seems to me that if rehabilitation is the goal in mind, that a rehabilitation specialists would be called upon to work with a patient. How do you use PAs/NPs in your practice? What is the role of PTs and OTs in the process? I'd like to hear more about the "baby sitting" concept. My guess it's the PAs/NPs that are the "babysitters." What is there role in your clinic? What are the tasks that they do on a daily basis?
Thank you for your insight.
PT and OT have the specific role of implimenting a treatment plan with a patient as prescribed by a physician, in this case, a physiatrist. They work hands-on with the patient in the gym, from 1 - 5 days/week, doing modalities such as ultrasound, other heat, cold, massage, tissue mobilization, therapeutic exercise and patient education. They are given a narrow scope of practice, further defined for each patient by the physician - i.e. exactly what they want the PT or OT to do with the patient.
An NP or PA works with the doctor in the clinic, seeing and assessing patients medically, with duties defined b/w the two of them. Each doctor decides how much autonomy they will allow their PA/NP. Some utilize them to do follow-up appointments, might see the doctor one visit, the PA the next, or maybe the doctor does the consult, the PA does most of the follow-ups. Other PA/NPs see the patient on their own, without the doctor ever seeing the patient, give their own diagnosis and impliment their own treatment plan, under the theoretical supervision of a doctor. I personally disagree with the use of Midlevels in that regard and believe it to beyond their scope of practice outside of primary care.
Doctors, as well as NPs and PAs see a patient, take a history, do a physical exam, make a diagnosis and offer treatment options, including medications, PT/OT, injections, surgery and similar. PTs and OTs can impliment the treatment plan portion as ordered by the doc, PA or NP, within their narrow scope of practice. They may not make diagnoses, order tests like MRI or labs, may not do injections or do surgical procedures. PAs and NPs can do all of that under the supervision of a physician.
Essentially, a PA or NP is a "physician extender" allowing the phsysician to see more patients, or concentrate on the more complicated patients, while PT and OT are the people who work hands-on with the patient implimenting the PT/oT script.
However, in Physiatry, the use of PAs and NPs is uncommon, if not rare. Very few PAs and NPs have enough musculoskeletal training to make them a financial benefit to the phsyician or organization. The rest would require prolonged training to be efficient. In my book, a PA or NP has the skill equivalent of an intern or resident depending on experience and training. With supervision, they can do well in subspecialties, given proper guidelines and training. No one comes out of PA school with the musculoskeletal skills of even a 1st year physiatry resident. Their training is aimed at primary care - coughs, colds, HTN, etc.
In my clinic, most of the orthopods have a PA who assists them in surgery and clinic, as well as rounds at the hosptial, and even hospital consults. Our rheumatologists have a PA who works fairly independently, seeing her own pts, most simple RA, gout and osteopoprosis. We have 2 podiatrists who do not have PAs, but do get podiatry residents fairly regularly. Myself (physiatry) and a FP sports med guy are the only ones at my clinic who do not utilize mid-levels or residents, and he is starting to participate in the local medical school and residency programs. They may start a sports med fellowship b/w him and the orthos.
I used to use an NP in a pain clinic, but she proved not financially beneficial. She worked slowly, could not write for opioids, and felt she had to discuss every single case with me. That and most every single patient whined "Don't I get to see the doctor today?" (Yeah, you need to see the doc to renew the meds you've been on for 3 years now...). I currently cannot see an NP or PA helping me right now. I do a lot of EMGs, which they would not be able to help with, injections under fluoro they could not do, and only about 1/3 of my time in clinic. Most of my clinic patients are short-term (I don't see many chronic patients for monthly visits) or intermittentent/episodic. I don't believe there to be an NP or PA with the skills to improve my clinic.
