Recently we looked at the online ratings from about 20 well-known chronic fatigue syndrome and fibromyalgia doctors. Now we're taking a different dive at the online rating system: we're using the ability to search for doctors using conditions on Healthgrades to see what kinds of doctor treat ME/CFS and FM patients.
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[/fright]Many times people with FM and ME/CFS have trouble finding good doctors. Many doctors worry about the time needed to learn how to treat these complex disorders and some simply don't want to treat them.
There are a group of practitioners, however, who actually want to treat people with ME/CFS and/or FM. When they fill out their information on review systems like Healthgrades or Vital.com they include fibromyalgia or chronic fatigue syndrome in the list of conditions they treat.
That means that review systems like HealthGrades and Vitals.com that allow you to search for practitioners using conditions provide another way of finding a practitioner. (Healthgrades also allows you to search by types of procedure practitioners use.)
In an attempt to determine the kinds of practitioners interested in treating people with fibromyalgia and/or chronic fatigue, I searched through the databases of seven cities located on both coasts, the Midwest and the South in Healthgrades.
Some proviso's. Healthgrades does not provide the entire list of doctors treating chronic fatigue syndrome or fibromyalgia in these cities. I assume that doctors need to input their data into the review website but I haven't tried to input data into Healthgrades.
Findings
Several findings stood out:
• FM Much More Popular - Practitioners are much more likely to state they will treat fibromyalgia than chronic fatigue syndrome.
• Specialists Common in FM: Rare in ME/CFS - Specialists commonly state they treat FM few specialists are interested in treating ME/CFS. Alternative practitioners play a much larger role in treating ME/CFS than FM
• High Practitioner Heterogeneity in ME/CFS - The types of practitioners that state they're interested in treating ME/CFS can differ greatly from state to state. Similar types of FM practitioners, on the other hand, treat FM from state to state.
• Little Overlap - There appears to be little overlap between practitioners who state they treat FM and those who state they treat FM. ME/CFS practitioners may state they treat FM but specialists such as rheumatologists and pain medicine specialists rarely state they treat ME/CFS.
• Stable Practitioner Base in FM: Not So in ME/CFS - Fewer practitioners treat ME/CFS, but more types of practitioners state they treat ME/CFS.
Finding a Practitioner
ME/CFS
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[/fleft]Only two of the seven cities (Seattle, San Diego) had enough ME/CFS practitioners to met my goal of assessing 60 practitioners. The average number of ME/CFS practitioners per city was 42. Practitioners on the coast were more plentiful than practitioners in the Midwest. Kansas City and Minneapolis - two cities of about 1/2 million people - listed 9 and 17 practitioners.
FM
Relative to ME/CFS, the FM practitioners appeared relatively plentiful. The average number of practitioners Healthgrades stated treated FM in the seven cities was 281.
Types of Practitioners
Chronic Fatigue Syndrome
Family medicine, internal medicine and alternative medicine practitioners dominate the ME/CFS group. Specialists are exceedingly rare. Of the 294 ME/CFS practitioners assessed only 22 or about 7% came from traditional specialties.
The types of ME/CFS practitioners could differ dramatically from city to city. Naturopaths, for instance, dominated the list of ME/CFS practitioners in Boston and Seattle while internal medicine and family medicine practitioners did in San Diego.
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[/fright]Alternative medicine practitioners (acupuncture, naturopathy, etc.) were common. They were the most abundant category of ME/CFS practitioners listed in five of the seven cities.
While many fewer ME/CFS practitioners were found more types of practitioners stated they treated ME/CFS than FM in five of the seven cities. ME/CFS's less understood and much less well studied main symptom (fatigue), and the fact that it doesn't fit into any one specialty undoubtedly contributes to the wider spread of practitioners purporting to treat it.
The fields of immunology, infection and neurology may garner attention on the Internet and in research but specialists in these areas rarely treat people with ME/CFS. No endocrinologists stated they treated ME/CFS or FM on Healthgrades in any of the seven cities tested.
Fibromyalgia
The practitioner base for fibromyalgia was more specialized and stable than for ME/CFS. Seventy-one percent of the FM practitioners listed came from specialties such as rheumatology, pain medicine and physical therapy and rehabilitation. (Rheumatologists, pain medicine and physical medicine and rehabilitation practitioners filled three of the top four slots in six of the seven cities assessed. )
The one type of practitioner that varied substantially from city to city were chiropractors. Chiropractors were rare in the top 60 practitioners in Boston, San Diego, and Seattle but common in Minneapolis and Kansas City.
Procedures Used
A look at the procedures used suggests FM and ME/CFS patients may treated differently when they get to a practitioner.
The top procedures used by FM practitioners in Seattle included: joint drainage (91), myofascial trigger point injection (49), steroid injection (47), viscosupplementation (41), trigger point injection (40), spinal nerve block (25), EMG (electromyography) (24), epidural block, facet blocks (24), etc.
The top procedures used by ME/CFS practitioners in Seattle included: stress management (30), wellness physical examination (30), diet counseling (29), nutritional counseling (28), pain management (27), detoxification (26), bioidentical hormone replacement therapy (25), pap smear (25), chronic pain management (24), exercise counseling (22), hormone replacement therapy (20), allergy testing (19), etc.
Conclusion
According to Healthgrades, it's much, much easier to find a practitioner if you have fibromyalgia than if you have ME/CFS. While people with FM will often see specialists, few specialists are interested in treating ME/CFS. For the most part, people with FM will find similar types of practitioners across the country while people with ME/CFS may find different type of practitioners depending on where they live
FM's long-term inclusion in a specialty (rheumatology), and a significant research field (pain), plus the three drugs approved for it has clearly benefitted it in the treatment arena. FM may not be easy to treat and good FM practitioners may not be common. but at least a significant pool of practitioners appear to be present. Unless Healthgrades is off in some way - a base has been built.
The same cannot be said for ME/CFS. Finding an ME/CFS practitioner is a bit like going back to the Wild West; practitioners are scarce, many different types of practitioners are attempting to treat it and it's not clear who is good at it. Fatigue science is just beginning to appear as a topic and has not shown up as a specialty ME/CFS practitioners can fit into.
SURVEY RESULTS
City - # number of providers listed in HealthGrades, # of different types of providers
CHRONIC FATIGUE SYNDROME
Atlanta, Georgia - 26 (17)
Family medicine - 7
Internal medicine - 2
Chiropractic - 2
Pain Medicine - 2
Integrative Medicine, Rheumatology, Infectious Disease, Nutrition, Chiropractic, Alternative Medicine, Functional Medicine, Pediatrics, Hospice, Gynecology, Allergy and Immunology, Bariatric - 1
Boston - 50 (13)
Naturopathy - 20
Acupuncture - 6
Internal Medicine - 4
Integrative Medicine - 3
Psychiatry, Psychotherapy - 2
Functional Medicine, Infectious Disease Medicine, Age Management Medicine, Neurology, Environmental Medicine, Chiropractic, Neuropsychology - 1
Denver 42 (7 from Vitals.com) (12)
Acupuncture - 7
Naturopathy - 6
Family medicine - 5
Psychiatry/Psychology/Counseling- 4
Chiropractic, Pediatrics - 3
Anesthesiology, Internal medicine, Physical therapy - 2
Osteopathy, Homeopathy, Alternative Medicine - 1
Kansas City, MO - 9 (6)
Naturopathy - 3
Functional medicine - 2
Marriage and Family Therapy, Counseling, Gynecology, Integrative medicine - 1
Minneapolis - 17 (7)
Chiropractic - 6
Acupuncture - 2
Naturopathy - 4
Integrative Medicine - 2
Functional Medicine, Family Medicine, Physical Therapy
San Diego - 84 (20)
Family medicine - 12
Internal medicine - 14
Chiropractic - 8
Allergy and Immunology - 2
Vascular radiology, Infectious disease, Neurology, Psychiatry, Anesthesiology, Rheumatology , Public Health, Nutrition, Gynecology, Geriatrics, Sports Medicine, Cardiology, Naturopathy, Integrative Medicine, Critical Care, Functional Medicine - 1
Seattle - 66 (10)
Naturopathy - 38
Acupuncture - 4
Massage Therapy - 5
Family Medicine - 4
Nursing - 2
Counseling, Nutrition, Chiropractic, Complementary Medicine, Psychology - 1
FIBROMYALGIA
City - # number of providers listed in HealthGrades
Atlanta, Georgia - 362 (12)
Pain Medicine - 24
Chiropractic - 9
Physical Medicine and Rehabilitation - 6
Rheumatology - 6
Neurology - 2
Internal Medicine -2
Family Medicine, Pulmonology, Bariatric Medicine, Anesthesiology, Public Health, Bone & Joint Orthopedics - 1
Boston - 305 (8)
Rheumatology - 30
Pain Medicine - 11
Physical Medicine and Rehabilitation - 10
Spinal Cord Injury, Acupuncture, Sports Medicine - 2
Chiropractic, Pediatrics
Denver - 264 (7)
Rheumatology - 21
Physical Medicine and Rehabilitation - 14
Pain Medicine - 6
Chiropractic - 4
Neurology - 1
Orthopedic Surgery - 1
Orthopedic Sports Medicine - 1
Kansas City, Mo - 228 (8)
Rheumatology - 16
Chiropractic - 13
Pain Medicine - 11
Physical Medicine and Rehabilitation - 11
Neurology, Neurosurgery, Anti-aging, Sports medicine - 1
Minneapolis - 268 (8)
Chiropractic - 22
Rheumatology - 14
Physical Medicine and Rehabilitation - 8
Pain Medicine - 7
Spinal Cord Injury - 3
Integrative Medicine - 2
Ear, Nose and Throat, Family Medicine - 1
San Diego, Ca - (1.4 million) - 282 (10)
Rheumatology - 11
Internal Medicine - 13
Pain Medicine - 10
Family Medicine - 9
Physical Medicine and Rehabilitation - 5
Chiropractic - 5
Public Health, Cardiology, Orthopedic Surgery, Geriatric Medicine - 1
Seattle - 264 (9)
Rheumatology - 20
Pain Medicine - 19
Physical Medicine and Rehabilitation - 15
Spinal Cord Injury/Decompression - 3
Family Medicine, Sports Medicine, Psychology, Chiropractic
[fright]
There are a group of practitioners, however, who actually want to treat people with ME/CFS and/or FM. When they fill out their information on review systems like Healthgrades or Vital.com they include fibromyalgia or chronic fatigue syndrome in the list of conditions they treat.
That means that review systems like HealthGrades and Vitals.com that allow you to search for practitioners using conditions provide another way of finding a practitioner. (Healthgrades also allows you to search by types of procedure practitioners use.)
In an attempt to determine the kinds of practitioners interested in treating people with fibromyalgia and/or chronic fatigue, I searched through the databases of seven cities located on both coasts, the Midwest and the South in Healthgrades.
- Denver - 660,000 people
- San Diego, Ca - 1.4 million
- Kansas City - 467,000
- Atlanta, GA - 447,000
- Boston, MA - 646,000
- Seattle, WA - 652,000
- Minneapolis, MN - 400,000
Some proviso's. Healthgrades does not provide the entire list of doctors treating chronic fatigue syndrome or fibromyalgia in these cities. I assume that doctors need to input their data into the review website but I haven't tried to input data into Healthgrades.
Findings
Several findings stood out:
• FM Much More Popular - Practitioners are much more likely to state they will treat fibromyalgia than chronic fatigue syndrome.
• Specialists Common in FM: Rare in ME/CFS - Specialists commonly state they treat FM few specialists are interested in treating ME/CFS. Alternative practitioners play a much larger role in treating ME/CFS than FM
• High Practitioner Heterogeneity in ME/CFS - The types of practitioners that state they're interested in treating ME/CFS can differ greatly from state to state. Similar types of FM practitioners, on the other hand, treat FM from state to state.
• Little Overlap - There appears to be little overlap between practitioners who state they treat FM and those who state they treat FM. ME/CFS practitioners may state they treat FM but specialists such as rheumatologists and pain medicine specialists rarely state they treat ME/CFS.
• Stable Practitioner Base in FM: Not So in ME/CFS - Fewer practitioners treat ME/CFS, but more types of practitioners state they treat ME/CFS.
Finding a Practitioner
ME/CFS
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FM
Relative to ME/CFS, the FM practitioners appeared relatively plentiful. The average number of practitioners Healthgrades stated treated FM in the seven cities was 281.
Types of Practitioners
Chronic Fatigue Syndrome
Family medicine, internal medicine and alternative medicine practitioners dominate the ME/CFS group. Specialists are exceedingly rare. Of the 294 ME/CFS practitioners assessed only 22 or about 7% came from traditional specialties.
The types of ME/CFS practitioners could differ dramatically from city to city. Naturopaths, for instance, dominated the list of ME/CFS practitioners in Boston and Seattle while internal medicine and family medicine practitioners did in San Diego.
[fright]
While many fewer ME/CFS practitioners were found more types of practitioners stated they treated ME/CFS than FM in five of the seven cities. ME/CFS's less understood and much less well studied main symptom (fatigue), and the fact that it doesn't fit into any one specialty undoubtedly contributes to the wider spread of practitioners purporting to treat it.
The fields of immunology, infection and neurology may garner attention on the Internet and in research but specialists in these areas rarely treat people with ME/CFS. No endocrinologists stated they treated ME/CFS or FM on Healthgrades in any of the seven cities tested.
Fibromyalgia
The practitioner base for fibromyalgia was more specialized and stable than for ME/CFS. Seventy-one percent of the FM practitioners listed came from specialties such as rheumatology, pain medicine and physical therapy and rehabilitation. (Rheumatologists, pain medicine and physical medicine and rehabilitation practitioners filled three of the top four slots in six of the seven cities assessed. )
The one type of practitioner that varied substantially from city to city were chiropractors. Chiropractors were rare in the top 60 practitioners in Boston, San Diego, and Seattle but common in Minneapolis and Kansas City.
Procedures Used
A look at the procedures used suggests FM and ME/CFS patients may treated differently when they get to a practitioner.
The top procedures used by FM practitioners in Seattle included: joint drainage (91), myofascial trigger point injection (49), steroid injection (47), viscosupplementation (41), trigger point injection (40), spinal nerve block (25), EMG (electromyography) (24), epidural block, facet blocks (24), etc.
The top procedures used by ME/CFS practitioners in Seattle included: stress management (30), wellness physical examination (30), diet counseling (29), nutritional counseling (28), pain management (27), detoxification (26), bioidentical hormone replacement therapy (25), pap smear (25), chronic pain management (24), exercise counseling (22), hormone replacement therapy (20), allergy testing (19), etc.
Conclusion
According to Healthgrades, it's much, much easier to find a practitioner if you have fibromyalgia than if you have ME/CFS. While people with FM will often see specialists, few specialists are interested in treating ME/CFS. For the most part, people with FM will find similar types of practitioners across the country while people with ME/CFS may find different type of practitioners depending on where they live
FM's long-term inclusion in a specialty (rheumatology), and a significant research field (pain), plus the three drugs approved for it has clearly benefitted it in the treatment arena. FM may not be easy to treat and good FM practitioners may not be common. but at least a significant pool of practitioners appear to be present. Unless Healthgrades is off in some way - a base has been built.
The same cannot be said for ME/CFS. Finding an ME/CFS practitioner is a bit like going back to the Wild West; practitioners are scarce, many different types of practitioners are attempting to treat it and it's not clear who is good at it. Fatigue science is just beginning to appear as a topic and has not shown up as a specialty ME/CFS practitioners can fit into.
SURVEY RESULTS
City - # number of providers listed in HealthGrades, # of different types of providers
CHRONIC FATIGUE SYNDROME
Atlanta, Georgia - 26 (17)
Family medicine - 7
Internal medicine - 2
Chiropractic - 2
Pain Medicine - 2
Integrative Medicine, Rheumatology, Infectious Disease, Nutrition, Chiropractic, Alternative Medicine, Functional Medicine, Pediatrics, Hospice, Gynecology, Allergy and Immunology, Bariatric - 1
Boston - 50 (13)
Naturopathy - 20
Acupuncture - 6
Internal Medicine - 4
Integrative Medicine - 3
Psychiatry, Psychotherapy - 2
Functional Medicine, Infectious Disease Medicine, Age Management Medicine, Neurology, Environmental Medicine, Chiropractic, Neuropsychology - 1
Denver 42 (7 from Vitals.com) (12)
Acupuncture - 7
Naturopathy - 6
Family medicine - 5
Psychiatry/Psychology/Counseling- 4
Chiropractic, Pediatrics - 3
Anesthesiology, Internal medicine, Physical therapy - 2
Osteopathy, Homeopathy, Alternative Medicine - 1
Kansas City, MO - 9 (6)
Naturopathy - 3
Functional medicine - 2
Marriage and Family Therapy, Counseling, Gynecology, Integrative medicine - 1
Minneapolis - 17 (7)
Chiropractic - 6
Acupuncture - 2
Naturopathy - 4
Integrative Medicine - 2
Functional Medicine, Family Medicine, Physical Therapy
San Diego - 84 (20)
Family medicine - 12
Internal medicine - 14
Chiropractic - 8
Allergy and Immunology - 2
Vascular radiology, Infectious disease, Neurology, Psychiatry, Anesthesiology, Rheumatology , Public Health, Nutrition, Gynecology, Geriatrics, Sports Medicine, Cardiology, Naturopathy, Integrative Medicine, Critical Care, Functional Medicine - 1
Seattle - 66 (10)
Naturopathy - 38
Acupuncture - 4
Massage Therapy - 5
Family Medicine - 4
Nursing - 2
Counseling, Nutrition, Chiropractic, Complementary Medicine, Psychology - 1
FIBROMYALGIA
City - # number of providers listed in HealthGrades
Atlanta, Georgia - 362 (12)
Pain Medicine - 24
Chiropractic - 9
Physical Medicine and Rehabilitation - 6
Rheumatology - 6
Neurology - 2
Internal Medicine -2
Family Medicine, Pulmonology, Bariatric Medicine, Anesthesiology, Public Health, Bone & Joint Orthopedics - 1
Boston - 305 (8)
Rheumatology - 30
Pain Medicine - 11
Physical Medicine and Rehabilitation - 10
Spinal Cord Injury, Acupuncture, Sports Medicine - 2
Chiropractic, Pediatrics
Denver - 264 (7)
Rheumatology - 21
Physical Medicine and Rehabilitation - 14
Pain Medicine - 6
Chiropractic - 4
Neurology - 1
Orthopedic Surgery - 1
Orthopedic Sports Medicine - 1
Kansas City, Mo - 228 (8)
Rheumatology - 16
Chiropractic - 13
Pain Medicine - 11
Physical Medicine and Rehabilitation - 11
Neurology, Neurosurgery, Anti-aging, Sports medicine - 1
Minneapolis - 268 (8)
Chiropractic - 22
Rheumatology - 14
Physical Medicine and Rehabilitation - 8
Pain Medicine - 7
Spinal Cord Injury - 3
Integrative Medicine - 2
Ear, Nose and Throat, Family Medicine - 1
San Diego, Ca - (1.4 million) - 282 (10)
Rheumatology - 11
Internal Medicine - 13
Pain Medicine - 10
Family Medicine - 9
Physical Medicine and Rehabilitation - 5
Chiropractic - 5
Public Health, Cardiology, Orthopedic Surgery, Geriatric Medicine - 1
Seattle - 264 (9)
Rheumatology - 20
Pain Medicine - 19
Physical Medicine and Rehabilitation - 15
Spinal Cord Injury/Decompression - 3
Family Medicine, Sports Medicine, Psychology, Chiropractic
