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What is your experience with PM&R docs in the field of palliative care?
Physiatrists in Palliative Care
- Thread starter Courtknee
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- Feb 18, 2006
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I personally do not know any PM&R docs in the field. That doesn't mean there aren't any. Usually, hospice and palliative care physicians tend to have internal medicine or family practice backgrounds, but I know of surgeons and others who do this type of work. I would encourage you to ask yourself these questions:
What does your anticipated future practice look like? and
What training path will help you reach that goal?
What does your anticipated future practice look like? and
What training path will help you reach that goal?
- Joined
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PM&R is a perfect fit for H&PM.
We get a depth and breadth of experience as a leader of inter-disciplinary teams like no other speciality, and we've doing that since we were PGY-2s. For many of our patients, in many of the settings where we practice, we are or become their attending and even primary care physician, managing routine chronic illnesses, e.g., diabetes, hypertension, a fib, etc.
Also, I want emphasize that our 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, we attain a deft level of comfort with caring for patients, optimizing their QOL and functioning, usually all while not pursuing any sort cure. Many of our 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 our patients, often for the long haul. We are accustomed then to operating in the field of grief of one sort or another.
We volitionally climb into that tight space which our patients have come to occupy. Often suffering the glaring impotence of our attempts at intervention. Yet we abide with them sometimes only tinkering at the margins of pain and suffering and loss. Over the course of our practice, some of our patients obtain, and some come to us with a diagnosis of life-limiting/life-threatening illness condition that will be their cause of death. So, to me it is a strange and arbitrary decision not to continue the care of our patients into the end of their lives; these patients and their families whom we have come to know so well. To me it is better and simply more fitting to our type and style of patient care to add some related skills to our repetoire and extend our abiding just a little further.
And when you really think about it, if your practice became adding other more straight-forward patients, e.g., think of the relative ease of dealing with a patient with only CAD, HTN, COPD, DM, A Fib, PVD, OA and Stage IV CA, who does not have a C4 ASIA A SCI, vented and spasticity, or a (L)MCA with (R) hemi, dysphagia, aphasia and spasticity. See? You can easily do that.
Also, while we are the smallest of the co-sponsoring specialties for H&PM, we 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/2010/03/origins-physical-medicine-and.html
We get a depth and breadth of experience as a leader of inter-disciplinary teams like no other speciality, and we've doing that since we were PGY-2s. For many of our patients, in many of the settings where we practice, we are or become their attending and even primary care physician, managing routine chronic illnesses, e.g., diabetes, hypertension, a fib, etc.
Also, I want emphasize that our 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, we attain a deft level of comfort with caring for patients, optimizing their QOL and functioning, usually all while not pursuing any sort cure. Many of our 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 our patients, often for the long haul. We are accustomed then to operating in the field of grief of one sort or another.
We volitionally climb into that tight space which our patients have come to occupy. Often suffering the glaring impotence of our attempts at intervention. Yet we abide with them sometimes only tinkering at the margins of pain and suffering and loss. Over the course of our practice, some of our patients obtain, and some come to us with a diagnosis of life-limiting/life-threatening illness condition that will be their cause of death. So, to me it is a strange and arbitrary decision not to continue the care of our patients into the end of their lives; these patients and their families whom we have come to know so well. To me it is better and simply more fitting to our type and style of patient care to add some related skills to our repetoire and extend our abiding just a little further.
And when you really think about it, if your practice became adding other more straight-forward patients, e.g., think of the relative ease of dealing with a patient with only CAD, HTN, COPD, DM, A Fib, PVD, OA and Stage IV CA, who does not have a C4 ASIA A SCI, vented and spasticity, or a (L)MCA with (R) hemi, dysphagia, aphasia and spasticity. See? You can easily do that.
Also, while we are the smallest of the co-sponsoring specialties for H&PM, we 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/2010/03/origins-physical-medicine-and.html
