MEMBER
COMMENTARY
(previously published
in PULSE)
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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