D
deleted854547
I'm curious.
Is PMR essentially the non-surgical complimentary specialty to Ortho in the way Neurology is to Neurosurg?
- Joined
- Jan 25, 2007
- Messages
- 1,077
- Reaction score
- 1,962
TBH I'm not really sure why that specialty exists since we have PT...
- Joined
- Feb 3, 2014
- Messages
- 956
- Reaction score
- 2,238
My argument is no, since PM&R can also work with patients who are not there for a bone problem.
- Joined
- Dec 22, 2014
- Messages
- 524
- Reaction score
- 829
Seems like a pretty pointless comparison to be making in the first place. Neurology and neurosurgery really don't share too many similarities in the first place. I'd say sports medicine is a closer fit to what you're asking than PM&R.
D
deleted407021
Yeah, PTs are essentially specialists and can work with CNS injury, etc.
The few patients I’ve had who followed with PMR had implanted stim, got regular injections and that sort of thing, so maybe that’s the niche.
- Joined
- May 21, 2013
- Messages
- 3,910
- Reaction score
- 6,254
Thats fighting words
CidHighwind
Full Member
- Joined
- Jun 12, 2019
- Messages
- 603
- Reaction score
- 859
Except, you know, the brain.
- Joined
- Jan 25, 2007
- Messages
- 1,077
- Reaction score
- 1,962
That kind of thinking just made me realize how much in common a hooker has with a urologist.
That's the beauty of it. Neither one has to deal with the other's domain. You can turf everything you don't want to the other side, and the other side can't get enough of the stuff you yawn at.
CidHighwind
Full Member
- Joined
- Jun 12, 2019
- Messages
- 603
- Reaction score
- 859
Last edited:
- Joined
- Sep 16, 2012
- Messages
- 2,212
- Reaction score
- 3,245
Ouch. Et tu, Brute?
Short answer to the OP’s question is no. But we can be. Some physiatrists essentially do non-operative orthopedics. Some specialize in sports medicine.
Explaining why we are different than PT Requires a short explanation and one we as a profession repeat too much. Kind of like the toll-evasion fine I just got sent for a car I’d already sold, sometimes I just don’t have the energy to fight something and it’s simpler/easier to just roll with it.
So I will now go by Ranger Bob, DPT. And then maybe I won’t have to keep explaining to my parents what I do. Or that I’m not “pain medicine and rehabilitation.” If I can’t teach my dad what the acronym stands for after about 7 years, what hope is there really for the rest of us?
- Joined
- Nov 29, 2015
- Messages
- 817
- Reaction score
- 1,614
Dumb question but who usually refers patients to PMR?
I was reading some other threads where couple of FM docs were saying they have never referred anything to PMR.
I was reading some other threads where couple of FM docs were saying they have never referred anything to PMR.
- Joined
- Sep 16, 2012
- Messages
- 2,212
- Reaction score
- 3,245
It’a only to their and their patients’ detriments not to refer to us. I guarantee they’ve had plenty of patients who would’ve benefitted from referral to PM&R. Chronic pain, low back pain, MSK injuries, patients that have had a stroke/spinal cord injury/TBI and have never been referred to PM&R, patients with neuropathies that would benefit from and EMG/NCS to diagnose/prognosticate/help decide if surgery is indicated. I could go on for a while.
With the VA, we got plenty of in-house referrals-inpatient and outpatient. We were a ridiculously busy service because everyone knew what we offered.
I have no shortage of referrals as an inpatient rehab physician. Much of that is case-management driven as they’re just looking to discharge patients. Many hospitalists help cover our unit at times, so they understand what we do and refer to us often. But the surgeons (esp ortho and neurosurgery) are the ones who best know about us and call me personally to try to get their patients into rehab.
In my experience, surgeons are our most common referral base. They seem to best understand what we do and understand that they can’t do it better. Neurosurgeons are asking us for help in the ICU with TBI and SCI patients. Trauma as well. Vascular/ortho consult with us on the optimal amputation level if they’re on the fence, and they often consult us anyway before surgery because they know the patient will need to come to us for rehab afterwards. If one of their patients didn’t get into acute rehab, they typically refer to us as an outpatient.
Neurology is potentially the biggest referral to us (and non-surgical obviously, so my statement above wasn’t totally accurate). Most stroke patients get referred to us for inpatient rehab. Whether the patient is appropriate is another issue, but part of our job is to figure out if they are or not.
On the outpatient side, Neuro often refers to us for long-term management of stoke patients-they don’t get the training in spasticity management/Botox, bowel/bladder and guiding therapies that we do. Plastic/ortho hand surgeons often won’t see a patient until they’ve seen us for a work-up including EMG. Neurosurg and ortho refer to us before they do any spine surgery, as they want to exhaust conservative measures first unless it’s a very clear surgical issue. And plenty of PCPs who know what we do refer to us for what I mentioned above.
The list goes on but this post is long enough.
- Joined
- May 21, 2013
- Messages
- 3,910
- Reaction score
- 6,254
My friends gf mom turned him off from Physiatry because he was sick of hearing how he is going to medical school to become a PT. Def not for those who value prestige.
- Joined
- Oct 18, 2008
- Messages
- 1,106
- Reaction score
- 1,412
I refer people nonstop to PMR for MSK issues that may or may not be surgical. They can assess better, offer alternate treatments that solve most ppls problems and direct to ortho/nus when needed. I don’t have time or interest to inject all the joints, assess for exact rehab and equipment needs, etc etc
I guess that is why PM&R is not extremely competitive given the lifestyle/salary(~300k/yr)... Even physicians do not know what they do.
As an orthopaedic surgeon and someone who has done a PM&R rotation it is most definitely not just non-operative orthopaedics.
On the inpatient side it is someone who can coordinate a complex five day to week long high intensity therapy push to get my elective total joint discharged home rather than to a SNF for 30 days. I don't use them as a case management dumping ground. I use them to get my patients home rather than a SNF which saves the hospital $$$. Also learned from my PM&R rotation in medical school how they help a lot of new spinal cord injury patients and do their ASIA classification which helped quantify their expected disability and the progress they made with therapy.
On the outpatient side I use them for EMG's (carpal tunnel, low back pain/sciatica with altered reflexes/motor deficits, upper extremity radicular pain with altered reflexes/motor deficits), non-operative low back pain (ESI's, facet injections, rhizotomies), and occasionally if I don't want to keep injecting someones knee who doesn't want surgery I send them to a PM&R doc for q6mo knee injections.
Thank you for all you do PM&R docs, I've always enjoyed working with each one of them I've met. Pretty chill bunch of people.
On the inpatient side it is someone who can coordinate a complex five day to week long high intensity therapy push to get my elective total joint discharged home rather than to a SNF for 30 days. I don't use them as a case management dumping ground. I use them to get my patients home rather than a SNF which saves the hospital $$$. Also learned from my PM&R rotation in medical school how they help a lot of new spinal cord injury patients and do their ASIA classification which helped quantify their expected disability and the progress they made with therapy.
On the outpatient side I use them for EMG's (carpal tunnel, low back pain/sciatica with altered reflexes/motor deficits, upper extremity radicular pain with altered reflexes/motor deficits), non-operative low back pain (ESI's, facet injections, rhizotomies), and occasionally if I don't want to keep injecting someones knee who doesn't want surgery I send them to a PM&R doc for q6mo knee injections.
Thank you for all you do PM&R docs, I've always enjoyed working with each one of them I've met. Pretty chill bunch of people.
- Joined
- May 21, 2013
- Messages
- 3,910
- Reaction score
- 6,254
Most dont make that much from my research, thats normally the pain guys. 230k-250k . I could be totally wrong.
- Joined
- Nov 29, 2015
- Messages
- 817
- Reaction score
- 1,614
^Yeah i think 200-250K is the expected starting salary according to the threads here at least.
- Joined
- Sep 16, 2012
- Messages
- 2,212
- Reaction score
- 3,245
I used to think this as well as a resident. Then I received an offer of about $225k from a VA (with classic "VA lifestyle") and $250k from a county hospital.
According to the AAPM&R compensation survey from 2017, median compensation is $300k. Pain brings that up (median is $370k), whereas MSK rehab, CNS rehab, etc, make median of $270-280k. Peds is the lowest at $250k.
I have no idea how representative that data (or any salary data) is. But it is not hard to make over $250k in this field. Perhaps some of my colleagues can chime in with their own experience.
- Joined
- May 21, 2013
- Messages
- 3,910
- Reaction score
- 6,254
shhhhhhh you have already said too much!! Nothing to see here folks. Keep gunning for derm and surgical subspecialties. PMR are just PTs./jk
The few salary surveys I have seen put the median closer to 300k than 200k...
- Joined
- Sep 16, 2012
- Messages
- 2,212
- Reaction score
- 3,245
Sorry. I meant we get paid median of $300k in Rubles. And I definitely don’t work with amazing therapists, and our nurse definitely aren’t really nice and caring people that are fun to chat with. And my patients aren’t extremely grateful and appreciative. They never come back to the rehab unit months later to tell us how they’re doing. We’re just miserable people all day long, and talk about how much we hate pie and puppies...
It really is a great field. But I find that for many it’s just not the right fit, so if you’re interested in PM&R and have decent scores you should be fine. There’s always talk about how we’re getting more competitive but the truth is I believe our board scores are second lowest on average.
If you’re smart, personable, and determined, you can match into into a good PM&R program.
- Joined
- Jul 27, 2013
- Messages
- 38,498
- Reaction score
- 75,461
That's like saying I don't know why psychiatrists exist, we have psychologists... Physical therapists largely focus on reconditioning and functional exercises, while PM&R focuses on the totality of an illness and how it can be treated with comprehensive care plans, medications, pain management, assistive devices, etc.
- Joined
- Jan 25, 2007
- Messages
- 1,077
- Reaction score
- 1,962
That's another phrase I agree with.
- Joined
- Apr 21, 2014
- Messages
- 3,344
- Reaction score
- 5,805
Can’t disagree more. Psychology could not replace psychiatry.
- Joined
- May 21, 2013
- Messages
- 3,910
- Reaction score
- 6,254
I think @Dave1980 is saying he agrees that psychology cant replace psychiatry similarly how PT cant replace PM&R.
- Joined
- Jan 25, 2007
- Messages
- 1,077
- Reaction score
- 1,962
Let me clarify...I'm not trying to offend people but I actually don't see why we have PM&R when we have ortho/PT and I think that a psychologist could do the job of a psychiatrist.
- Joined
- Sep 16, 2012
- Messages
- 2,212
- Reaction score
- 3,245
I think it would help you to do more research on these fields. They are certainly not interchangeable. They each can do some of what the other can (similar to how a nurse can do some of what a physician can, like with screening) but ultimately have quite different scopes of practice.
- Joined
- Dec 26, 2008
- Messages
- 5,436
- Reaction score
- 4,042
exactly
PMR is perhaps the most valuable specialty for stroke patients in the post-acute phase. I never realized how important this specialty is until I started seeing my MCA syndrome pts return to stroke clinic few months after their initial stroke showing significant improvement in their abilities to carry on ADLs, thanks to the tremendous rehabilitation orchestrated by our PMR colleagues.
- Joined
- Jul 27, 2013
- Messages
- 38,498
- Reaction score
- 75,461
psychologists have an entirely different role than us. They largely specialize in fairly normal pathology. They know nothing about medications. They use talk therapy. Psychiatrists are experts in psychopharmacology and generally do not do talk therapy, though we can if we so choose. Psychologists are experts in neuropsychiatric testing and therapy, and we defer to them often in these regards. But you hand a psychologist a patient with even a touch if active psychosis, and they can't do anything.Come spend a few weeks in my psych ward and tell me you'll talk my patients out of their conditions
It's like saying "why do we need cardiologists when we have dietitians." Both can certainly reduce a patient's blood pressure, but there's a lot that a cardiologist does that a dietitian never can even with their best efforts.
Last edited:
- Joined
- Nov 29, 2015
- Messages
- 817
- Reaction score
- 1,614
Sorry to quote an old post. Do the bolded require a fellowship as well?
And which fellowships are ACGME accredited (like Pain.). I heard some PMR docs end up doing unaccredited fellowships. I didn't realize this was a thing.
- Joined
- Sep 16, 2012
- Messages
- 2,212
- Reaction score
- 3,245
ACGME accredited fellowships with PM&R include pain, peds, TBI, sports, SCI. I could be forgetting another. Maybe EMG? You can sit for board subspecialization in PM&R without it (unlike neuro), so I’m not sure if the fellowships are ACGME or not.
The only area a fellowship may actually be needed is pain. Hardly any groups or hospital system will let you do interventional pain without board eligibility/certification.
Demand is so high and supply so low for the others that you can get an SCI, TBI, peds fellowship, etc., just fine without fellowship. In academics it’s strongly preferred you have done a fellowship, but even then if it’s not a top program, some of the attendings may not have board sub-specialization.
No fellowship is needed, or offered to my knowledge, for MSK, general CNS Rehab.
Unaccredited fellowships are rare. Aside from one or two amputee rehab fellowships, the only unaccredited fellowships I’m aware of in PM&R are sports & spine.
Similar threads
