Default will OTs/PTs, and other midlevels ever supplant the role of a physiatrist

[Guest copacetic]

Im not really all the knowledgeable of PM&R so forgive in advance for any ignorance that i may display. In my explorations of the various medical specialties, i have noticed that there seems to be a trend for midlevels to gain more and more medicinal (diagnostic/procedural/theraperutic/prescriptive etc) powers.

 

It seems to me (objectively speaking) that PM&R is in a unique and perhaps unenviable position whereby PTs and OTs could easily do without the services that a physiatrist provides. In essence, physiatrists seem to be around to rubber stamp alot of what PTs and OTs do. if this is indeed true, it is not unreasonable that in the future OTs and PTs in a gambit to exercise their growing leverage, and expand their medical powers and autonomy would argue that they dont need physiatrists as overseers. this would inevitably be the first step in doing away with physiatrists all together.

 

just how relevant are physiatrists (dont take this perosonally, im not derriding the profession, if i come across as such it is not my intention). beyond relevance, just how unique is what they do? could what physiatrists do not not easily be supplanted by broadening the horizon and scope of what midlevels do?

[future_doc]

As a pre-med undergrad, firstly I need to disclose total ignorance other than having a curious mind.

 

Is there not a shortage of physiatrists? The PT and OT do, while the physiatrist diagnoses so that the PT and OT act under their instructions. Without a physician specialist, where would the ultimate accountability be?

 

Every field has their own level, there is the psychiatrist and the psychologist, each plays their own role in health care, I think the collaboration with midlevels is required. I hope the duties and responsibilities do not become blurred over time as your question suggests is happening. I guess this is not a black and white issue as the government, professional groups and advocacy groups try to muddle their way through and balance competing interests that may include cost, availability of doctors, greater efficiency, best interests of patients and reducing the time they must wait before receiving needed intervention. I do not think that physiatrists will be done away with in the few decades ahead. But you do raise interesting points in the debate of expanding role of midlevels.

[Satsuma]

Hey...that is actually a fair and interesting question.

 

I was an SLP for 2 years before going to med school and I never really understood what physiatrists did...because I never really saw them, except at weekly pt rounds. I knew they cosigned orders, precribed pain meds and antidepressants, and decided who was appropriate for admission and that was about it!

 

If you are at all interested in physiatry I would really suggest doing a couple of electives (in different areas eg stroke or ABI rehab and MSK or something so you can see a range of things). That way you can get a feel for what they do.

 

I don't think that the role of the physiatrist is threatened by allied health. Physiatry/rehab is one of those few areas I have found that really values a team approach and roles of individual professions. Each person has their role. Someone needs to coordinate treatments and that is the MD - an MD has breadth of knowledge (even though the PT might know more about their specific area, the SLP more about theirs etc). Also the MD needs to manage medical problems related to the injury/problem eg. precribing meds to prevent bone loss in quads, meds to improve concentration or manage behavioural issues following ABI, managing pressure ulcers, give botox injections for spasticity etc. So I think they will always be needed for these things.

 

PTs, OTs and SLPs don`t need MDs to do their job - that is why they are their own profession. But the pt has a need for an MD to do his/her job - which is manage their medical issues.

[Guest copacetic]

i have no doubt that physiatrists will always be needed (and all if not most medical specialties for that matter). However, also seems to be that it is precisely BECAUSE they are so needed (i.e. there is a chronic shortage) that they are threatened. the chonic shortage ends up disenfranchising patients, and physicians alike. what inevitably happens is that the government steps in and passes legislation expanding the scope and powers of midlevels in order that the burden can be taken off the system and more patients can be seen. this is a scenario that can play out across any medical specialty if the right conditions develop and continue for a couple decades (as is the case with family medicine where nurse practioners are steadily being granted more and more medical powers in order to alleviate the burden on the system).

 

now i want to make clear that i dont view the rise of midlevels as a bad thing. anything that ends up saving lives is good in my book. im just wondering, however, if the rise of midlevels would make certain specialites less relevant, or diminished in scope. physiatry seems to be in such a position where the do a little bit of everything, they are essentially a 'team manager' in many respects.

 

if i am wrong on any of this, please tell me, lets get a discussion going. i think this discussion can also be expanded to other medical specialties, most notably family medicine.

[justletmein]

There is a lot of truth to what you guys are saying, but I'm pretty sure the physiatrist is more than just a "team leader".

 

To give you an example, I have seen in one rehab hospital they hired "case managers" who were not necessarily even health professionals. They were simply trained to oversee the case, and manage each person's role while taking care of all the paperwork etc. It was an interesting dynamic in team meetings since they had no expertise and therefore not much to add to the conversation besides directing the conversation and making sure all the needs of the patient were being met. This took the burden off the doctor so he was not responsible for the entire case, he was there to do his job and be a sort of consultant to everyone else.

 

PM&R is a specialty that no one seems to know about. Even as a former PT, I hardly ever came across a physiatrist. A friend of a friend who just matched to PM&R even had a hard time explaining what their exact role is. I think it is really specific to different institutions.

 

 

It would be interesting if there are any physiatry residents on this forum to enlighten us on this mysterious specialty!

[Jochi1543]

It would be interesting if there are any physiatry residents on this forum to enlighten us on this mysterious specialty!

 

I have an interest in this area, so I definitely plan on shadowing a physiatrist this fall. Will report back to p101.

[bayervillager]

Hey everyone!

 

I'm interested in physiatry, and yes, it sure is tough to explain what a physiatrist does...

 

I think one of the difficulties in explaining things is that physiatry is actually two fields in one. It's physical medicine AND rehabilitation, like how Obs/Gyn is obstretics and gynecology.

 

The physical medicine side is a lot of EMG (electromyographic) testing, diagnosing sports/work/performing arts-related injuries, interventional stuff like joint injections, chronic pain management etc. of course, there is some overlap with neurology, sports medicine and anaesthesia here, but there are physiatrists who do only physical medicine and they are never short of patients.

 

The Rehabilitation side is really varied depending on the type of rehab and the setting (inpatient vs. outpatient). Physiatrists do a lot of the "team leader" work that I suppose other health professions could be qualified to do, but they also do unique stuff too.

Ex. Spinal cord rehab - treatment of autonomic dysreflexia(this is a BIG issue), medical management of pain, spasticity, sores, osteoporosis

Ex. Amputee Rehab: management of the sometimes horrific skin problems that can arise at the sites where the amputed limb meets the prosthesis.

 

In every rehabilitation field, there is medical monitoring which the other health professions would not be interested in taking over. I mean, with the exception of maybe traumatic brain injury rehab where you have a lot of young people, patients in Rehab wards are usually older folks with a lot of co-morbidities that need to be managed. As well, the same risk factors that caused someone to be in the Stroke Rehab ward can just as likely give them a myocardial infarction, abdominal aneurysm rupture, or a second stroke, so medical monitoring is really important.

 

But yeah, I can totally see what copacetic suspects may become true in some places and it's definitely part of a broader trend of "territory changes" between medicine and the other health profession. I want to do PM&R, and I'm more interested in the R than the PM side, so this is something that I worry about.

 

However, I don't worry that physiatrists would become jobless. There will be more and more chronic pain patients to treat; a whole of interventional stuff is being pioneered; way more trauma victims are surviving now with improvement in ICU and car safety technology. Plus, physiatrists do a lot of medical-legal work, and people are never going to stop suing each other after getting into accidents!