PM&R is a perfect fit for H&PM.
Physiatrists get a depth and breadth of experience as leaders of inter-disciplinary teams like no other speciality, and they've doing that since they were PGY-2s. For many of their patients, in many of the settings where they practice, they are or become their attending and even their ad hoc "primary care physician," managing their
stable chronic illnesses, e.g., diabetes, hypertension, a fib, etc.
Also, their therapeutic orientation is one of working within constraints, often persistent, chronic constraints (be they traumatic, e.g., spinal cord injuries; definitive management outcomes, e.g., amputations; progessive/degenerative, e.g., ALS; and/or life-limiting primary diagnoses and co-morbidities, e.g., cancer, CHF, COPD), and many of which physiatric constraints progress and narrow into terminal constraints over the course of our care.
As a matter of course, they attain a deft level of comfort with caring for patients, optimizing their QOL and functioning, all while not pursuing any sort cure (because there is no cure for what they have). Many of their sibling specialties begin to move on as the outcomes of their interventions stabilize into their pateints' new and often diminished baseline. That's about when they become physiatry patients, often for the long haul. Physiatrists are accustomed then to operating in the field of grief of one sort or another.
Physiatrists volitionally climb into that tight space which their patients have come to occupy. Often suffering the glaring impotence of their attempts at intervention. Yet they abide with them sometimes only tinkering at the margins of pain and suffering and loss. Over the course of their practice, some of their patients obtain, and some come to them with a diagnosis of life-limiting/life-threatening illness condition that ultimately will be their cause of death. It would seem then a strange and arbitrary decision not to continue the care of their patients into the end of their lives; these patients and their families whom they have come to know so well. It is better and simply more fitting to their type and style of patient care to add some related skills to our repetoire and extend our abiding just a little further.
Adding other more straight-forward patients, e.g., PMH: CAD, HTN, COPD, DM, A Fib, PVD, OA and Stage IV CA, who
does not have C4 ASIA A SCI, vented and spasticity, or (L)MCA with (R) hemi, dysphagia, aphasia and spasticity would be relatively easier work for physiatrists.
Also, while PM&R is the smallest of the co-sponsoring specialties for H&PM, they are the 3rd-leading specialty with respect to board certification, as a percentage of the total specialty:
http://www.pallimed.org/2009/01/palliative-medicine-board-certification.html
"The Bureau of Labor and Statistics estimates about 633,000 physicians employed in 2006. Here are the following reordered breakdown of physicians by specialty (approx) with the number of HPM physicians in each. (1 HPM physician out of x specialists)
Internal Medicine (ABIM) - 177,000 - 1 out of 198
Family Medicine (AFP) - 100,000 - 1 out of 250
Physical Medicine and Rehabilitation (AAPMR) - 8,000 - 1 out of 888
Pediatrics (AAP) - 90,000 - 1 out of 1730
Radiology (ACR) 32,000 - 1 out of 1882
Psychiatry/Neurology (ABPN) - 46,000 & 13,000 - 1 out of 1966
Emergency Medicine (ABEM) - 34,000 - 1 out of 2833
Surgery (ABS) - 55,000 - 1 out of 4583
Obstetrics and Gynecology (ACOG) - 52,000 - 1 out of 5777
Anesthesiology (ABA) - unable to access ABA"
Another little tid-bit.
http://www.pallimed.org/2009/01/palliative-medicine-board-certification.html
What I see is that even when multiple-boarded, very few people wind up practicing across specialties. They usually wind up gravitating in one direction or another. Some people however
do cobble together a wildly varied practice. I see myself as practicing H&PM primarily, being a medical director and perhaps doing EMGs and/or spasticity management clinics as well.
