Is there a role for non-PM&R trained SCI physicians in the community setting?

[OutWestDoc]

Hello,

I was hoping to get the opinion from PM&R attendings concerning whether non-PM&R, SCI fellowship trained physicians could conceivably build an outpatient practice following the longitudinal care of patients with spinal cord injury in the community setting? My background is internal medicine and I'm currently exploring off kilter fellowship options and both TBI and SCI caught my interest (although it appears one would need to have completed a sports med fellowship to sit for the BIM boards).

Thanks in advance!

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[flapjack3d]

I have never heard of outpatient IM sci doc. I am not sure there would be a need, outside of a very niche practice in a big metro. But then again you could just have a portion of your practice as SCIs and the rest as normal primary care population. That sounds pretty doable.
However, I have worked with IM docs at the VA on their inpatient spinal cord units. Some of them have worked as rehab doctors basically indistinguishable in scope of practice (except didn't do any botox, afaik), and some of them worked as IM hospitalists seeing only SCI patients. I think either of these would be viable for you, but the former is probably not do-able nowadays outside of less desirable areas where they can't get a PMR-SCI doc. Those sorts of places aren't getting very complex spine cases anyways though.

Research opportunities are abundant. endocrine dysfunction after sci is pretty big rn, e.g. bone health and hypogonadism/reproductive health

 

[j4pac]

I have never heard of outpatient IM sci doc. I am not sure there would be a need, outside of a very niche practice in a big metro. But then again you could just have a portion of your practice as SCIs and the rest as normal primary care population. That sounds pretty doable.
However, I have worked with IM docs at the VA on their inpatient spinal cord units. Some of them have worked as rehab doctors basically indistinguishable in scope of practice (except didn't do any botox, afaik), and some of them worked as IM hospitalists seeing only SCI patients. I think either of these would be viable for you, but the former is probably not do-able nowadays outside of less desirable areas where they can't get a PMR-SCI doc. Those sorts of places aren't getting very complex spine cases anyways though.

Research opportunities are abundant. endocrine dysfunction after sci is pretty big rn, e.g. bone health and hypogonadism/reproductive health

That's my concern as well. There are only so many places in the country that can support a higher volume SCI practice and they are typically academic practices, where they will be looking for SCI training PM&R physicians. There are IM docs out in the community running rehab units, but they are typically not high volume SCI centers.