Will/Does PM&R ever see encroachment?

[KobeshouldbeaMD]

by DPTs, PTs, DCs?

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[PMR 4 MSK]

by DPTs, PTs, DCs?

Yes.

DC's aggresively advertise and market for most of our same patient population. Some even do EMGs. Many are now contracting with pain docs to do invasive procedures in the chiro's office to get a cut of it.

DPTs are working on getting direct pt access - w/o MD/DO referral. They have it to some degree in some states. They will get more access, it just depends when. Then many will be just as agressive as Chiros in their advertising and marketing.

 

[lobelsteve]

We are seeing many chiro clinics advertise as Pain Managment and Physical Medicine. They also hie an FP to do the trigger points and Neural-Scan tests. THey also do blind SIJ here.

 

[DeigoT]

by DPTs, PTs, DCs?

I did an elective with a ortho practice and there was a PT who came in the office twice weekly and all he did was EMGs. I didn't even realize that was allowed. And like someone else said, many chiro in my area now advertise themselves as PM&R and pain specialists. If you were to call the office, there are actually no physicians there.

 

[jesspt]

I did an elective with a ortho practice and there was a PT who came in the office twice weekly and all he did was EMGs. I didn't even realize that was allowed. And like someone else said, many chiro in my area now advertise themselves as PM&R and pain specialists. If you were to call the office, there are actually no physicians there.

There are PTs who do EMGs, but they are few and far between. Typically, they have experience as a PT in the military, where they are considered physician extenders. Many are likely board certified in Clinical Electrophysiology via the American Board of Physical Therapy Specialties. But, as of 2011, there are only 143 PTs who hold this credential, so you may practice for 30 years, and never see another PT who does EMGs. And, it is not an area that is being aggresivley promoted by the American Phsycial Therapy Association.

 

[Gauss]

I see DPT as EMG technicians who have their reports signed off by an MD/DO. It's a company on wheels, they drive out to wherever, contract with Wcomp at a lower reimbursement rate than local physicians, and do 4 limb emgs maybe with a paraspinal or two.
Podiatrists are overutilizing MSK US and doing all sorts of laser treatments.
Chiros advertise "cortisone injections", spinal decompression, accupuncture, massage, lasers. A lot of chiros try and compete with my practice calling themselves sports and spine. And the argument that I'm a board certified physician means diddly squat.
In summary everyone is competing for money, good patients with pathology that will respond to treatment, and physicians in general are losing. Some have resorted to primarily narcotic management which hurts our field.

 

[fozzy40]

I think if you are talking about outpatient MSK and/or pain medicine, PM&R sees common diagnoses along with primary care, orthopedics, neurologists, anesthesiologists, etc. I'd be curious to see if anyone feels that their financial bottom line is being significantly threatened.

In terms of inpatient PM&R, there are some internal medicine docs that "manage" rehab patients but otherwise I think that this area is predominantly physiatrist run.

 

[Jitter Bug]

I am always in competition with other physicians and yes with non-physicians who want to be me. (Ha Ha)

But I think if if you are good at what you do, network with your colleagues,and stay in one area long enough, you will build a solid referral base if you provide better care than your competition.

If you are chasing the $ then you will have to jump in the game and get dirty. And do things that probably aren't needed but pay well.

It's a difficult balancing act.

 

[KobeshouldbeaMD]

I see DPT as EMG technicians who have their reports signed off by an MD/DO. It's a company on wheels, they drive out to wherever, contract with Wcomp at a lower reimbursement rate than local physicians, and do 4 limb emgs maybe with a paraspinal or two.
Podiatrists are overutilizing MSK US and doing all sorts of laser treatments.
Chiros advertise "cortisone injections", spinal decompression, accupuncture, massage, lasers. A lot of chiros try and compete with my practice calling themselves sports and spine. And the argument that I'm a board certified physician means diddly squat.
In summary everyone is competing for money, good patients with pathology that will respond to treatment, and physicians in general are losing. Some have resorted to primarily narcotic management which hurts our field.

Is the encroachment THAT severe though? Like as bad as CNAs to mid-level anesthesia?
And how is the encroachment for PM&R specialists; spinal, sports med, ped etc..?

Does it severely cut into income? Will PM&R remain stable throughout the years?


PM&R is just something that I really am interested in (through reading about it, talking to physicians), even though I'm just a freshmen in college.

Thank you.

 

[bedrock]

We are seeing many chiro clinics advertise as Pain Managment and Physical Medicine. They also hie an FP to do the trigger points and Neural-Scan tests. THey also do blind SIJ here.

Very sad to see those things. That's the one good thing about the new SIJ code. Now a blind SIJ is billed as a trigger point, which removes much of the financial motivations.

Pathetic to see MDs working for a chiro

 

[bedrock]

I see DPT as EMG technicians who have their reports signed off by an MD/DO. It's a company on wheels, they drive out to wherever, contract with Wcomp at a lower reimbursement rate than local physicians, and do 4 limb emgs maybe with a paraspinal or two.
Podiatrists are overutilizing MSK US and doing all sorts of laser treatments.
Chiros advertise "cortisone injections", spinal decompression, accupuncture, massage, lasers. A lot of chiros try and compete with my practice calling themselves sports and spine. And the argument that I'm a board certified physician means diddly squat.
In summary everyone is competing for money, good patients with pathology that will respond to treatment, and physicians in general are losing. Some have resorted to primarily narcotic management which hurts our field.

agree

 

[Mattchiavelli]

not to derail too much, but what is the general reaction to these unfortunate trainwrecks when they show up on your doorstep after being mangled by a non-physician acting as a quasi-physician? Report the incident to a board, medical or chiopractic/PT etc? refer them back to the idiot that butchered them by operating outside of their scope of practice? I'd assume there would be a lot of med mal headache to deal with too.

 

[Jitter Bug]

Most patients beat up by the system get discharged from their quasi-clinic when the MVA money runs out, or the work comp case closes.

Then they come to me broke, still in pain, and no longer trusting anyone who calls themselves "Dr." Wrapped in a corset wearing a TENS unit and hobbling on crutches. Covered in pain patches. Holding empty bottles of valium and vicodin.

I spend a lot of time decontaminating them from the crazy ideas they picked up from their fake clinicians.

 

[SSdoc33]

I try to make sure all members of my team line up outside of the neutral zone