You're going to be a what?

[2nd year]

Just curious as to what people already in the field think the future entails. Everytime I mention physiatry to people as a possibility after med school, they usually require an explanation as to what PM&R is. The fact that I have to explain it doesn't bother me, but I'm afraid that it is very concerning regarding the future of this field. Perception is reality and it doesn't seem to me that the perception of PM&R within the medical profession or amongst the public is very positive. I'm interested in working in a sports medicine/spine type of environment and thus would be highly dependent on referrals by other physicians and word of mouth in the community. Why should I be convinced that physiatry is the best route to pursue this? Why not IM/EM/FM to sports med? I understand that those alternatives may not set me up to deal with the spine as much, but then again, if so many physicians and the public are unaware of the work physiatrists do in this field, does it really matter? I once asked a family doc if he ever referred ortho/spine patients to physiatrists and it seemed as though it never even occurred to him. I guess in general it seems as though the field is very broad and thus has done a poor job overall of maketing itself within the medical community and to the public. Any thoughts on the strengths and weakenesses of the future of PM&R would be appreciated. I'm trying to be a realist as I understand how easy it is to initially see the field through rose-colored glasses once you commit to it, i.e. residents, etc.. Thanks for any input.

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[Mountain D.O.]

Just curious as to what people already in the field think the future entails. Everytime I mention physiatry to people as a possibility after med school, they usually require an explanation as to what PM&R is. The fact that I have to explain it doesn't bother me, but I'm afraid that it is very concerning regarding the future of this field. Perception is reality and it doesn't seem to me that the perception of PM&R within the medical profession or amongst the public is very positive. I'm interested in working in a sports medicine/spine type of environment and thus would be highly dependent on referrals by other physicians and word of mouth in the community. Why should I be convinced that physiatry is the best route to pursue this? Why not IM/EM/FM to sports med? I understand that those alternatives may not set me up to deal with the spine as much, but then again, if so many physicians and the public are unaware of the work physiatrists do in this field, does it really matter? I once asked a family doc if he ever referred ortho/spine patients to physiatrists and it seemed as though it never even occurred to him. I guess in general it seems as though the field is very broad and thus has done a poor job overall of maketing itself within the medical community and to the public. Any thoughts on the strengths and weakenesses of the future of PM&R would be appreciated. I'm trying to be a realist as I understand how easy it is to initially see the field through rose-colored glasses once you commit to it, i.e. residents, etc.. Thanks for any input.

I wouldn't worry about it. I will be a D.O. physiatrist, this is a double hit. So...you're going to be a physical therapist and not a doctor? That's what my mom asks me even after I've explained it fifteen times. You only need a few people in your community to know what you do. Get out and introduce yourself to the potential referring physicians and your set, if there is a market. Which there should be if you're good.

 

[cyanocobalamin]

One of my attendings joked that physiatrists aren't seen as real doctors. But the patients keep on coming like the deluge. And electrodiagnostics/NCS/EMG are neat to me (though maybe not to everyone else) and limited to PM&R and neurology. Just do what you think will best satisfy you. My impression is that the changing demographics of America coupled with the very low number of PM&R training slots will mean that you will have something to do in the future, a better bet than say CT surgery..

 

[melancholy]

As a 4th year interested in PM&R, I have very limited exposure to the field, but from what I gather, the field of physiatrist is still relatively new, but growing with increasing interest. Sometimes it is difficult to get a good sense of the job market outside the academic world especially when rotating at academic institutions, but it is good that you are bringing up these questions that others might be asking as well. It does seem like residents tend to learn more about the job market than most attendings because some will end up in private practice after completion of their residencies.

Presenting physiatry with a focus on a coordinated, interdisciplinary approach towards helping patients become more functional and indepedent tends to make more sense to patients and outsiders. Giving examples of people that were in rehabilitation settings such as Christopher Reeve, Luther Vandross, Aaron Ralston (rock climber who had his right arm amputated), many military personnel who have returned to the states with TBI/SCI/amputations, etc. is another effective way of demonstrating what a variety of patients physiatrists work with.

Since you mentioned your interests in sports medicine, you can easily look anywhere from local all the way to national and international teams (i.e. Olympics, Paraolympics) that have physiatrists as team doctors. I have a feeling the incidence of recognizing what a PM&R doc does is greater in the sports medicine realm.

As far as educating other physicians on rehabilitation, I do not have any experience with this and I'll defer to the residents and other senior folks here for that information.

Just curious as to what people already in the field think the future entails. Everytime I mention physiatry to people as a possibility after med school, they usually require an explanation as to what PM&R is. The fact that I have to explain it doesn't bother me, but I'm afraid that it is very concerning regarding the future of this field. Perception is reality and it doesn't seem to me that the perception of PM&R within the medical profession or amongst the public is very positive. I'm interested in working in a sports medicine/spine type of environment and thus would be highly dependent on referrals by other physicians and word of mouth in the community. Why should I be convinced that physiatry is the best route to pursue this? Why not IM/EM/FM to sports med? I understand that those alternatives may not set me up to deal with the spine as much, but then again, if so many physicians and the public are unaware of the work physiatrists do in this field, does it really matter? I once asked a family doc if he ever referred ortho/spine patients to physiatrists and it seemed as though it never even occurred to him. I guess in general it seems as though the field is very broad and thus has done a poor job overall of maketing itself within the medical community and to the public. Any thoughts on the strengths and weakenesses of the future of PM&R would be appreciated. I'm trying to be a realist as I understand how easy it is to initially see the field through rose-colored glasses once you commit to it, i.e. residents, etc.. Thanks for any input.

 

[cbc]

I dont see the confusion, cant you just introduce to your patients as, "Hi, I'm a rehab doctor, Dr Blank, and will be aiding you on your recovery." Or better yet, say "Hi, I'm a doctor who specializes in rehab." Any layman should understand that.

 

[bbbmd]

I dont see the confusion, cant you just introduce to your patients as, "Hi, I'm a rehab doctor, Dr Blank, and will be aiding you on your recovery." Or better yet, say "Hi, I'm a doctor who specializes in rehab." Any layman should understand that.

You'd think that there wouldnt be so much confusion, but there is. It seems easier to tell the patient's what you do than the other doctors that have had no exposure to PM&R in their training.

For the patients I spell it out. I am a "Physical Medicine and Rehabilitation specialist", I am also called a "Physiatrist". I am going to try and improve your FUNCTION so you can go "back home" (go back to work, play in a game, so that your family can take care of you better...) I never shorten my name to "rehab doc", "spinal cord doc", "pain doc" because then no one will ever know what PM&R or Physiatry is! Patients seem to really understand this and really appreciate everything we do (more than the surgeons, internists and so on). Many of them even say... "Finally, a doctor that understands me" (especially those with catastrophic injuries like SCI).

For other docs who did not do a PM&R rotation or those that did residency training or medical school where there was no PM&R department other than a P.T., it is more difficult. Many of them think we just do "dispo". Many times this is what we are consulted for. I usually take that opportunity to answer their question, "No/or Yes, appropriate for acute rehab" and/or "will benefit from..... (EMG, Modalities, Meds, Specific therapies, positioning, other consults, timed voids, treating a UTI, etc)". We have so much to offer that many docs do not know about! I think it is important that we go out there and tell them what we do. We can do this by teaching other residents (some of which tell me "I wish I had learned about PM&R when I was a student, I may have chosen to do that"), teaching nurses that work in other units (a source of referral... "Dr. Cardiologist, don't you think a PM&R consulted is needed?"), and going out into the private world and do lectures about the service that you can provide!

I think that the Academy has been doing a good job advertising our specialty in the last few years. It shows by the increased popularity among med students. At my program there is always several medical students that rotate with us!!! It is important that we do our part and continue to educate the public and the medical world about who we are and what we can provide. Our specialty is still young and continues to evolve, but with the aging population and more people surviving catastrophic injuries, we FUNCTION doctors will ALWAYS have a job!

 

[drusso]

Agree with bbbmd. I introduce myself as a "physical medicine and rehabilitation doctor" or sometimes if I'm in the hospital a "rehabiltation medicine doctor." Patients figure it out...

 

[Disciple]

For other docs who did not do a PM&R rotation or those that did residency training or medical school where there was no PM&R department other than a P.T., it is more difficult. Many of them think we just do "dispo". Many times this is what we are consulted for. I usually take that opportunity to answer their question, "No/or Yes, appropriate for acute rehab" and/or "will benefit from..... (EMG, Modalities, Meds, Specific therapies, positioning, other consults, timed voids, treating a UTI, etc)". We have so much to offer that many docs do not know about! I think it is important that we go out there and tell them what we do. We can do this by teaching other residents (some of which tell me "I wish I had learned about PM&R when I was a student, I may have chosen to do that"), teaching nurses that work in other units (a source of referral... "Dr. Cardiologist, don't you think a PM&R consulted is needed?"), and going out into the private world and do lectures about the service that you can provide!

This is absolutely true at my institution as well, and most likely the majority of PM&R programs around the country. To rant a bit, there is nothing more annoying than to go see a consult, have a long talk with the patient, do a thorough eval and then pop open the chart to write, only to see that the Geriatrics service has already been by and accepted the patient for transfer to the skilled nursing unit. Suggestions made are generally ignored except for the "acute rehab yes or no" assessment/plan at the bottom of the consult. Why does this happen?, because consulting services often call 2-3 consults simultaneously to "dispo" their patients. Many services really have no clue what we as a specialty do.

In regards to educating other physicians on our specialty. I think the academy is putting forth a concerted effort to see this happen. At my program I will be putting on a grand rounds or at least a noon lecture for the IM or FP residents this year on what a physiatrist "is", "does" and "can offer other specialties". I would encourage residents at other programs to do the same. After all, this is where the PCPs of tommorow are learning their referral patterns and preferences.