THE
FUTURE OF PHYSICAL MEDICINE & REHABILITATION
IN
THE STATE’S WORKER’S COMPENSATION SYSTEM
By
Behzad Emad,
M.D.
The Physical
Medicine & Rehabilitation (P M & R) specialty, although previously,
regrettably, prone to being under-utilized, has always been the model for
treating sports and work injuries. I
personally believe that
P M & R holds a significantly advantageous position in dealing with the
impact of the new reforms to California’s Worker’s
Compensation laws. More than ever,
there will be an excellent opportunity for our specialty to demonstrate its
value in treating injured workers.
Physical Medicine
& Rehabilitation specialists will likely replace Orthopedic Surgeons as
Primary Treating Physicians for managing neuromusculoskeletal
injuries. The P M & R specialty
focuses on cost-effective diagnosis and treatment of injury
(non-surgical orthopedic), with the emphasis on functional restoration and return
to work. In special cases ---
and then only if needed --- patients can be referred out to our surgical
colleagues for appropriate surgical intervention. Physical Medicine &
Rehabilitation will be preferred to Orthopedic Surgery, since P M & R
specialists believe in a minimally-invasive treatment plan. The treatment is patient-focused, not
disease-focused. Psychosocial issues
are considered and respected. Team
approaches and communication skills have been a major part of the training
of any Physical Medicine & Rehabilitation specialist.
Physical Medicine
& Rehabilitation specialists will be preferred to Neurologists, since P
M & R practitioners have extensive education in, and exposure to,
Orthopedic Medicine. Training
involves not only a thorough understanding of the body’s neurological
system, but also biomechanical, musculoskeletal and functional
assessments. The same will apply
when Anesthesiologists are to be considered. In addition, Med-Legal evaluation is not
a new concept to the specialty since functional assessment has also been an
integral part of practitioner training. Physical Medicine &
Rehabilitation specialists will be proven as preferred to Chiropractors,
since the P M & R specialist offers comprehensive treatment plans that
include physical as well as medical protocols. In fact, often times
non-neuromusculoskeletal issues are better managed by a PMR treater due to
their exhaustive integrated medical and psychosocial background.
There will be an increase
in the demand for the Physical Medicine & Rehabilitation specialist as
a Qualified Medical Examiner (QME) in the future. Physical Medicine &
Rehabilitation physicians have become increasingly active in the
Worker’s Compensation system, especially within the past decade. This has led to an escalating number of
patients receiving quality, results-oriented medical treatment from P M
& R practitioners. Many cases
actually require QME evaluations by P M & R physicians. This trend will doubtless continue
because the rationale is clear-cut: the more patients treated, the more
QMEs required. Furthermore, the
subspecialty of Pain Medicine (under the American Board of Physical
Medicine & Rehabilitation) is now accepted within the Pain Medicine
Category of QME evaluations. This
has given P M & R specialists an opportunity to participate in a
dual-category capacity in the QME specialty list.
P M & R specialists will be more in demand than
ever, by employers and by insurers, to be named as the Primary Treating
Physician for injured workers, along with providing pain management and
electrodiagnostic services.
Don’t forget, there will always be a need for
Electrodiagnostic testing in Med-Legal evaluations. P M & R
practitioners have all the necessary attributes to be the patient’s
neuromusculoskeletal specialist of choice.
Of course, there
may perhaps be some initial detriment caused by the upcoming legislative
reforms --- which will likely affect “all” the specialties ---
but, in the long run, our specialty will thrive.
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