PM&R work in Department of Neurology with Neuromuscular Board?

[JBM16BYU]

Can a PM&R physician who is subspecialty-trained and subspecialty-boarded in Neuromuscular Medicine work in a Neurology department? I imagine that figuring out call may be difficult because PM&R has little to no experience with acute stroke, acute seizure, etc., management. Thoughts? Experiences?

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[Telamir]

Unlikely

 

[DrSatan]

I sure hope not unless it is a purely outpatient neuromuscular clinic. Even then they'd have to prove themselves a bit to make me feel confident in them.

 

[sharkbaitwhohaha]

No PMR doctor, regardless of subspeciality is competent enough to handle the most complex of neuromuscular cases. Think MMN, CIDP and variants, several myopathies, etc. This isn't a diss on PMR, but a pro of a neurologists background prior to neuromuscular fellowship. Pretty different fields of medicine.

PMR are fantastic, but with PMR stuff and strightforward EMG/NCS ( entrapment neuropathies, radics, axonal neuropathies)

 

[Bostonspine]

No PMR doctor, regardless of subspeciality is competent enough to handle the most complex of neuromuscular cases. Think MMN, CIDP and variants, several myopathies, etc. This isn't a diss on PMR, but a pro of a neurologists background prior to neuromuscular fellowship. Pretty different fields of medicine.

PMR are fantastic, but with PMR stuff and strightforward EMG/NCS ( entrapment neuropathies, radics, axonal neuropathies)

I think that is an arrogant comment If you fellowship trained your fellowship trained. But to the OP there are Neurology department with PM&R members doing Neuromuscular clinics, just under stand you may not be welcomed at institutions that do not believe in interdisciplinary care. You may get more meaningful information on how PMR doc practice in the PM&R forum

 

[JBM16BYU]

I think that is an arrogant comment If you fellowship trained your fellowship trained. But to the OP there are Neurology department with PM&R members doing Neuromuscular clinics, just under stand you may not be welcomed at institutions that do not believe in interdisciplinary care. You may get more meaningful information on how PMR doc practice in the PM&R forum

Thank you. I realize the training in PMR is different than Neurology, but if the Neuromuscular Fellowship is in a Neurology department and if Neurologists are the ones teaching you, I would assume you would be more prepared for this population. I understand the job may or may not be different (more rehabilitation-focused rather than diagnostic work-up focused) but the EMG training should be compatible.

 

[xenotype]

Thank you. I realize the training in PMR is different than Neurology, but if the Neuromuscular Fellowship is in a Neurology department and if Neurologists are the ones teaching you, I would assume you would be more prepared for this population. I understand the job may or may not be different (more rehabilitation-focused rather than diagnostic work-up focused) but the EMG training should be compatible.

I'm sure there are people doing this, but there aren't that many out there at all. You aren't a neurologist by training which is going to make working with things like myasthenia, certain metabolic diseases like MELAS very complicated for you and yes these things show up in numbers to academic neuromuscular clinics. For example, I am very doubtful that any of your PMR training really prepares you to evaluate diplopia, initiate cellcept/IVIG, deal with complications from IVIG/PLEX, or treat things like myasthenic crisis. I was routinely exposed to all of these things in neurology residency and was expected to have a detailed approach to them as a senior resident long before fellowship. These issues are quite common in neuromuscular medicine and can rapidly become dangerous when complications occur (I had a patient in residency with treatment refractory generalized MG that developed multiple complications from immunosuppression and ultimately passed away). Plenty of NM clinics do their own outpatient LPs for example when radiology availability is poor, which means one needs to know how to do it, what they are looking for on an LP, and how to approach abnormalities like elevated protein in an LP from a differential standpoint. Sure you can say you'll have someone else do it, but in your system it might not be practical for your patients to wait 6+ months for an LP every time its indicated or have to drive 2 hours away for it. They don't reimburse at all, so you are going to have a hard time getting anyone to do them for you. Plenty of things like stiff person syndrome have a lot of other diseases in the differential that are quite rare and can have significant CNS involvement/paraneoplastic encephalitis etc. If you have had zero exposure to any of this stuff, the thought process a neurologist uses in these cases, and the treatments available like IVIG there is a vast gulf of catching up to do that 1 year of extra training is not really going to cover.

So yes you can do it, and the skill set of PMR overlaps a lot with NM neurologists, but skipping the neurology part is going to leave some large gaps in your skillset when patients with rare diseases come into the clinic. And patients with these 'rare' diseases are everywhere, and always end up getting filtered into the NM clinic with time. You'll be expected to be the one to make the diagnosis and not miss anything. EMG is an extension of your exam but won't give you the diagnosis even if you are highly skilled at it. This isn't to discourage you, but there aren't a lot of PMR in NM clinics because you can't do general neurology call at all, you generally can't deal with every type of case for the reasons I listed above, and this makes you a little bit of a round peg in a square hole.