PM&R vs Physical Therapy: Interview with a Physical Therapist
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- Опубликовано: 17 май 2024
- What are the differences between physical therapy and physical medicine and rehabilitation (PM&R, Physiatry) and how do we work together to take care of our patients? Physical therapists and physiatrists work together to help treat a wide variety of injuries, but we are two very unique career paths.
I sit down to interview a physical therapist (and my sister!) to talk more about the roles of our two fields and what makes us different!
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This reminds me of a time I was watching Grey's Anatomy. For some background, I have Cerebral Palsy. As a result, I have some experience with PT, OT and orthopedic surgery. I remember there was this scene were a surgeons were conducting physical therapy. I looked over to my mom and asked, "Mom, why are the surgeons doing the physical therapist's job?" She said something to the effect of, "This show is about surgeons. So, they want to make them the stars." My response was, "Okay, but it does not make any sense." My mom did not disagree.
Thats why PM&R exists
I think it is very important to point out that PTs focus on a patients movement system and physical capabilities. PTs evaluate and diagnose a patients movement and physical deficits and address them accordingly. PTs should never be confused with physicians or PAs and NPs cause we are focused on different things. Now when it comes to MSK issues, one of the functions of the musculoskeletal system is movement, strength and support, which are all within a PTs scope of practice. After careful evaluation and differential diagnosis we can definitely say that a persons problems may stem from, cartilage, ligament, muscular compromise, improper biomechanics, overuse injuries, but we will never diagnose a person with a grade 3 muscular strain. We will always ask that the patient have a PCP and follow up with a PCP, not just to follow up on the patients health, but also to guide patients through medication and other possible treatments that may benefit from the patient. PTs have been educated at the doctorate level for quite sometime in the USA and we should give PTs more recognition and respect that they deserve. Furthermore, PTs can get a scrip from a physiatrist, physicians that specialize in physical medicine and rehabilitation, but most of the time PTs get scripts from orthopedic surgeons, neurologists, neuro surgeons, family practice physicians, dentists, podiatrists and chiropractors, all of whom are not extensively trained in rehab. I find it very interesting that PTs would execute the Rehab plans that a Physiatrist would create, understandably, but on all other situations, PTs are in charge of the rehab process for the patient. I love these types of videos and I love your videos Dr. Sutterer. We should definitely have more interprofessional content like this to better inform each other as medical professionals as well as the public.
This is an awesome video. I’ve been dead set on doing DPT but recently started considering PM&R. I feel like this video really helped me to solidify that I wanted to do DPT. I love being able to work with people on a long term basis.
It is amazing the lack of understanding I am seeing in the comment section when the nuanced differences were clearly explained. It seems most folks do not understand the difference between a medical diagnosis from a Physiatrist and a functional diagnosis from a PT. There is a very large difference in the knowledge base between a PT and a Physiatrist in order to do this. They also have a very different focus of study and day to day life. A Physiatrist has a much more broad medical education leading up to their then focus on PM&R. Both are great and needed fields.
Thank you for this video!
Thanks for your video. This is a great material for both physiatrists and physiotherapists to understand each profession in terms of making our community be in a better place!
PT is also function and quality of life. It does not focus on orthopedics/musculoskeletal only. They also treat neurologic, cardiopulmonary, pediatrics, geriatrics, oncology, wound care, womens health and acute/critical care in the hospital.
Great points! As a PMR doc in residency I work with a lot of different types of PTs on our rehab unit and in our clinics and they are all invaluable members of our team
I agrreed on this !
Great video! Really interesting to know how that works in the US, here in Panama we have Bachelors Degree in Physical Therapy which is 4 1/2 years and then when can choose a Masters or PhD. Next year I will be starting my Masters in PT with specialization in Orthopedics and Traumatology 💪🏼
is there anyway to do both at the same time? like do most of their studies overlap?
Thank you to both of you so much for the interview,I want to go into PM&R ,so this cleared up a lot of stuff and gave me ideas how to get other Q&As There is not much on physical therapy beyond basic pain management exercise videos or simple references, it would be awesome if you did more of these type of interviews,though I already follow your channel for quite awhile now and it's been very helpful with figuring stuff out ,good luck and stay safe 👍👍
Thanks for the great insight, I was really looking forward to seeing this video!
You bet! Let me know if you have any other specific questions about it
I’m a PMR and we specialize in neurological, cardiovascular, pelvic, pediatrics and every kind of Rehabilitaction that’s possible in a patient and we have to evaluate other comorbilities like previous strokes, renal function, diabetes, high blood pressure, that would affect the capacity of the patient to do except ose of the type of physical agents you can use
You can definitely communicate a diagnosis as a physical therapist. I am surprised Kim said she cannot make a medical diagnosis that is MSK based once red flags are ruled out. We are more than qualified to make that diagnosis. Odd. Maybe it's different in the U.S. vs Canada but we definitely don't require a Physiatrist's or a GPs approval for a treatment plan or await for their diagnosis prior to beginning to see a patient.
Yeah. I am surprised that PT can't give diagnosis. She didn't have to study DPT if she can not even diagnose. I am a physiotherapist too. Pt can give diagnosis within there scope
I’m getting ready to start my senior year of undergrad and have been working to go to medical school (learning towards DO). I’m majoring in exercise science and absolutely love the sports performance/training side of things but know my heart lies in the clinical side. PM&R sounds like my home, but I am passionate about the rehab side of things as well (starting an internship in my university’s sports medicine clinic as a student athletic trainer and going to be very hands on with the actual rehab). Is there a place for being hands on with rehab in Physiatry? Obviously collaboration and respecting each profession’s sphere of expertise is crucial, but is it really that a Physiatrist doesn’t have the training necessary to really asses in the way a DPT does (you mentioned the kinetic chain in particular) or is that Physiatrists, while able to conduct the rehab they might often order, focus on the clinic side as that is the part in which they’re trained that really no other healthcare profession is?
Would really like to see these questions answered.
Me too
I want to start off by saying that I am not a physiatrist nor am I a DPT, so if anyone with more experience wants to chime in, feel free. Having that stated, I did have a very similar question as I too have been thinking about physiatry, so I asked some of my friends who are in the field. From what I understand, your main job is for you to work with patients in assessing their pain and making sure that you solve their medical diagnoses properly. Typically though once you give your medical diagnoses, if no procedures are needed, they hand them off to DPT's. It's typically the DPT's job to kind of go through the training with them, but that isn't to say that you can't also check up on the patients and help them do some of the training, but that most likely won't be what you're specialized in. Most physiatrists focus on doing procedures that they may need to do and providing their medical diagnoses (after all that is what they get paid to do). You have to remember as well that, unless you specialize, you will be seeing patients with more than just physical rehabilitation problems, so you will also have to work with speech therapists and many more, as I understand. To me, it seems that physiatrists are kinda like the main gate where they give more of a medical diagnosis, start them off on the right path with whichever therapy is needed, and then hand them off to other professionals that know the full training better.
I'd like to add to the original question, that if you were to then specialize in sports medicine as a physiatrist, would you be able to get more hands on?
Hi OMS-2 here! Thank you so much for these informational videos. I've been interested in PM&R and stumbled upon your channel. I wanted to ask you a couple questions. What are your thoughts on osteopathic manipulative medicine? If any of your colleagues are DO's, were there any differences you noticed, in regards to treatment and/or application of certain techniques like OMT? Thanks!
Thanks for the comment! There are actually quite a few DO residents here and some of the do use OMM in their continuity clinics, I believe. I think if stuff is safe then it's a great took to have to offer patients
@@BrianSuttererMD Thanks for the super quick reply!!
It's so different in the US. In Australia you don't need a doctor of physiotherapy, but you can get a doctorate if you wish to and you don't need a referral from your doctor either.
As God intended😅
Since i have worked with a physiatrists so i understand that physiatry and physiotherapy has same way of diagnosing and treatment, physiatrist don't go for biomechanical corrections or any recent tenchniques used in physiotherapy i mean they didnt aware about that they always go foe some what usual modalities, and giving pain killers. But a PT's way of treating goes foelr biomechanichal correction and more. ways..
Really helpful. All my doubts got cleared👌👍
Is there an in-between option? I like the idea of working closely with my patients and building that trust and rapport. But I also want to make a liveable wage like a physiatrist.
It seems like it would make more sense to be able to create AND execute treatment plans.
Liveable wage? Average household income in the US is 50k a year. Anything at or above that level is a liveable wage. PT will put you in the upper middle class and a doctor will have making you way more money than you will need
I'm a PT, I make 6 figures. What do u mean by liveable wage?
@@kaufmanat1hi! I’m looking into career paths like PM&R or PT. What type of PT are you, how long did it take you to make six figures?
Thank you!
@@Raymesola I worked outpatient for my first year, then got bumped up and managed a small op clinic my second year, then got tired of the terrible pay and started working home health my third year. Home health paid nearly double the hourly rate I made in outpatient, but it's per patient so it varies. So took a little over 2 years.
You can also travel as a PT and clean up. I get offers now paying up to 3k a week for travel jobs (after taxes).
I'm doing dpt in Pakistan, and here a PT Doctor can go with her own diagnosis.
But peolpe here are still unaware about physiotherapy :( Hoping that one day they will understand it's importance✨
We can give our own diagnoses as DPTS in USA
In most countries,the doctor of physical therapy can diagnose and assess the patients(within the field of work) without the need of a MD prescription. Some countries still don't allow this because it will harm the md salary
still cannot decide whether i'd wanna fall into the career of a pm&r or a pt... both occupations genuinely sound really intriguing to me
go pmr, they make much more and get the same amount of education in terms of physical therapy
@@maccha663 i’ll see man.. med school debt & their extensive knowledge scares me lol
@@amm_09 yea they do have a wide knowledge base but don’t like the debt scare you they make 3x more than a PT
@@maccha663 Private practice pt has huge earning potentials compared to pm&r. but if youre just looking to work a 9-5 job until youre 65 then this is true.
@@bluethunder9102 if they both work at a hospital then its true but outpatient pt clinics can make the same as an MD so its all up to how good you are at your job
As of recently, I’ve been trying to decide if DPT or PM&R is best for me. This video has helped me tremendously.
SN: I’m from Indiana and completed my undergraduate degree in Terre Haute 🥳
So good to hear! My wife went to ISU, sister (in the video) went to Evansville. I went to Rose then IU med school
i wish if you can explain more for me what an physiatrist do via message or comments . Thank you
Can physiotherapist are allowed to do physical medicine and rehabilitation residency program or fellowship?
of course, if he/she go to medical school first
PTs have their own residencies, recognized by the APTA, where they can specialize in different areas like pediatrics, geriatrics, sports, neurology, orthopedics, pelvic health, clinical electrophysiology, oncology, orthopedics, etc. A PT can do a residency once they are licensed to practice. Residencies are normally a year in length and optional.
I have done DPT doc of physical therapy but i want to get admission in physiatry 2 year program. is it a good idea?
Not a bad idea. Did you do it?
Omg 280k vs 80k
The name alone does not describe the cv
The schooling is much more strenuous for an MD, they own their pay as do PTs
That's rude bro , we study 8 years to get that degree 😡😡😠
@@BossofBosses111 not true, my friend who dropped out of DO school because of depression went to PT school and dropped out again because it was just as difficult
To sum it up.
A physiatrist, would assess the problem, diagnose, and if seen needed would refer you to a physiotherapist.
Who would take this diagnosis, and follow certain guidelines to improve the problem whether it’s range of motion or else.
a bit more complicated than that with open access
This sum up isn't correct
I'm having trouble deciding which of these I should be!
What types of questions have you stumped about doing one over the other? What are your particular interests?
Go MD/DO
Dr. R. Brandon Smith PT, DPT, MPH can you explain why you suggest that?
ProDoc18 More loan forgiveness options - less justifying why you have a doctorate - the amount of education for the PT is not how its used. You take cadaver gross anatomy in both and so but right now medicare is fucking over PTs and salary will drop for PT. MD/DO is. a bit longer but the payoff is worth more IMO especially when PT school costs the same amount of $
@@dr.smith_dpt is there a remedy for this prevailing pay issue and/or are there other ways PTs supplement their income (e.g. working at two clinics, having private patients, etc.)?
Brush this is dope
She is misleading. A medical doctor don't have to approve physiotherapist plan of care. A physiotherapist is solely legally responsible and capable for all plan of care.
Yess , we only work with our seniors , no need even reporting to surgeons 👍
HERE IN MEXICO, PATIENTS CAN GO DIRECTLY TO THE PHYSICAL THERAPIST AND GET THEIR DIGNOSIS WITHOUT GOING TO THE PM&R
los fisioterapeutas no diagnostican!!, si sabes eso no?
@@eliasdavidreyes8611 claro que si diagnosticamos, 🙄
Hey Brian! Why didn't you choose to become a PT? Did you ever consider it? Why didn't your sister decide to become a PM&R physician? Did she ever consider it? As a PM&R physician, are you able to treat patients with techniques/exercise or you just treat them by prescribing medication, referring to a therapist, and/or suggesting exercise (like are you able to be hands-on)?
I had no idea about the possibilities
Same questions I have in mind
You can diagnose as a PT within your scope she’s wrong. If a patient has lateral elbow pain, worse with wrist extensions and gripping then have all positive “special test” . You can diagnose the patient with tennis elbow etc. Doctors just talk about PT based on their experience in acute care where I’ll admit PTs don’t really do shit lol
English isn't your first language huh. None of what you wrote makes sense.
she said that pts do make diagnoses, just not medical ones
USA's system seems to be so costly and inefficient it's madness. Why does a 200k+ doctor do the same job as a 70k+ physiotherapist. The literally have the same knowledge that's relevant in the scope of physical therapy. They both evaluate and treat the patients using the same methods. Ridiculous.
When profit is all that matters, morality, logic and ethics to an extent go out the window
Because the doctor went to school longer and paid way more money to go to school.
Yeah it's dumb but that's the reason why
@@mustang8206 No I understand and a doctor has a lot more knowledge which can be useful absolutely.
They absolutely do NOT have the same knowledge, and the scope of PMR is much wider thag physical therapy stuff.
The doctor can give pain shots, while PT can’t.
At Special Strong, we LOVE the special needs population :D 2 Thessalonians 3:16
Why are people still ignorant and being politically incorrect by saying the word doctor when they mean to say physician. There are so many PhDs and clinical doctorates other than medical doctorates. This guy needs to work on his interprofessional development. There should be more pride in the title of “Physician”
Old school model. Many physios around the globe have direct access. No point in holding a Doctor of Physiotherapy if it’s going to stay on an old fashioned physician referral model. A physio can’t call a sprain a sprain. Madness.
She’s wrong you can call a sprain a sprain I’m a DPT
In fact schools really push this now as well
Sure, many PTs do have direct access and have the competency to "call a sprain a sprain" in your context, but you know what? Insurance doesn't see eye to eye with that.
Truth be told, for many cases globally, unless you have a physician-referred Physiotherapy treatment, then can the PT treatment be claimed under health or personal accident or even work injury compensation insurance.
Sure, a patient can seek direct PT treatment without a physician's referral, then the patient would have to be prepared to pay full price for it via their own wallet.
I'm not a Physiotherapist, but I'm an Exercise Physiologist who works closely with a multidisciplinary team including PTs & physcians. For EP services, patients would need to be cleared and referred by the physician (and sometimes even needs Physiotherapist's referral alongside) in order for their treatments to be either 1) government subsided, or 2) claimable under insurance.
@@littlebluedolphin yes what you say is true in some countries including the US. My point was that what is the point in having a clinical doctorate and 150-200k in debt for a BSc and DPT if you’re going to use the aforementioned system. Might as well have kept it at Bachelors/Masters. In addition look at the burn out rate in the US of clinics taking insurance. Many fellowship trained physios are going cash based. If your happy to accept insurance in many countries then yes you’re absolutely right.
@@Shogun973 Hello. What are the rules for the use of medical diagnosis in your state? Am interested.
So basically the physiatrist says the medical diagnosis which any doctor as in neurology and orthopaedic that's make no sense physiotherapist can do basically the same job in addition to movement analysis 😅
I am a Physical Therapist from the netherlands and we have a Total different system from the one she Just explaind.
It seem like she is more a Physical Therapy assistent than a doctor of Physical Therapy
I can also sens a lot of stress when she is explaining topics regarding Physical Therapy as a profession.
Why i fell that physical therapy is just a fake job .. I’m studying PT but i see that physicians can do all the work without PTs . So why there is so many colleges teach physical therapy?
Huh ? How can physicians do our job they even don't study it
If you aren’t comfortable making a diagnosis as a Doctor of Physical Therapy then you should have become a Physical Therapy Assistant.
Definitely
She is a doctor who can not decide her own treatment ! , can any body define technician again?