Authors:
Abna A. Ogle, MD
Susan J. Garrison, MD
Darryl L. Kaelin, MD Student Survey
James W. Atchison, DO
Yong I. Park, MD
Donald M. Currie, MD
Affiliations:
Education & Administration
From the Department of
Rehabilitation Medicine, University of
Kansas Medical Center (AAO), Kansas
City, Kansas; Baylor College of
Medicine (SJG), Houston, Texas;
University of Indiana Medical Center
(DLK), Bloomington, Indiana; Roadmap to Physical Medicine and
University of Florida (JWA),
Gainesville, Florida; UMDNJ/New
Rehabilitation
Jersey Medical School (YIP), Newark,
New Jersey; and University of Texas/
Answers to Medical Students’ Questions
Health Science Center at San Antonio
(DMC), San Antonio, Texas.
About the Field
Reprints: ABSTRACT
Ogle AA, Garrison SJ, Kaelin DL, Atchison JW, Park YI, Currie DM:
All correspondence and requests for
reprints should be addressed to Abna Roadmap to physical medicine and rehabilitation: answers to medical
A. Ogle, MD, Department of students’ questions about the field. Am J Phys Med Rehabil
Rehabilitation Medicine, University of 2001;80:218 –224.
Kansas Medical Center, 3901 Rainbow
Boulevard, Kansas City, KS Medical specialty training has undergone dramatic changes in the last
66160-7306. 5 yr. This article was prepared by the Undergraduate Education Com-
mittee of the Association of Academic Physiatrists in an attempt to help
0894-9115/01/8003-0218/0
American Journal of Physical guide medical students who are considering a career in physical med-
Medicine & Rehabilitation icine and rehabilitation. This report is an update of two previous articles
Copyright © 2001 by Lippincott addressing medical students’ questions to assist them in making edu-
Williams & Wilkins
cated decisions about residency training and medical practice.
Key Words: Specialty Training, Residency Training, Physiatrist, Physia-
try, Graduate Medical Education, Career, Rehabilitation
H ealth care has undergone tremendous changes in recent years, with
increasing market expansion by managed care organizations. Currently,
greater numbers of medical school graduates are choosing “generalist” fields,
specifically primary care training, rather than specialty areas. It is imperative
that medical students have access to clear, factual, and concise information
about the specialty of physical medicine and rehabilitation to assist them in
their career choices. Answers to students’ questions about the practice of
physical medicine and rehabilitation, residency training, and its future are
provided.
Practice of Physiatry
1. What Is Physical Medicine and Rehabilitation? What Types of Patients Do
You See? How Do You Pronounce “Physiatrist”? What Types of Procedures Do
218 Am. J. Phys. Med. Rehabil. ● Vol. 80, No. 3
, You Do? Physical medicine and reha- terdisciplinary team of allied health according to time demands, practice
bilitation (PM&R) was developed in professionals to tailor a comprehen- characteristics, and organizational
the 1930s to address neurologic and sive rehabilitation program to a pa- support, among other factors. Physia-
musculoskeletal problems, with an tient’s specific needs. These team trists expressed high satisfaction re-
emphasis on the use of physical members include physical therapists, lated to autonomy in their practice
agents, such as heat and cold, for occupational therapists, speech-lan- and unique skills for patient
treatment. Its growth and recogni- guage pathologists, social workers, management.
tion were accelerated after World War rehabilitation nurses, dietitians, and
II, primarily as a result of the treat- psychologists. Therapeutic recreation 3. What Career Options Do I Have
ment of disabled veterans. In 1947, specialists, rehabilitation engineers, After Training? Do All Physiatrists
the American Board of Medical Spe- orthotists, prosthetists, and case co- Work in Hospitals? Where Is There
cialties recognized PM&R as a ordinators are also important team the Most Need for Physiatrists?
specialty. members. Practitioners in this field PM&R continues to offer a wide di-
Physiatrists (pronounced fizz-ee- are trained in the evaluation and pre- versity of practice settings. Future
at'-trists) treat patients of all age scription of prosthetic limbs and or- demand and supply for the specialty
groups who have a variety of acquired thoses (braces), as well as in the pre- were studied by a comprehensive task
or congenital neuromuscular/muscu- scription of physical agents such as force in 19962 and conclusions updated
loskeletal illnesses or injuries. The superficial and deep heat, ice applica- in 1999.3 It seems that the demand for
goal of treatment is to prevent, min- tion, and massage. They are also ex- physiatric services will roughly approx-
imize, and/or alleviate deficits in tensively trained to manage medical imate the number of practicing special-
function, regardless of the underly- complications resulting from disabil- ists from 1996 to 2017. The study
ing etiology. Typical neurologic prob- ity such as spasticity, neurogenic found that the number of physiatrists
lems include traumatic brain injury, bladder, and autonomic hyperre- will actually double over that period;
cerebrovascular accidents, spinal flexia. Physiatrists perform intramus- however, demand is expected to match
cord injury, multiple sclerosis, and cular and intra-articular injections this growth, which is attributable to
cerebral palsy. Primary muscle disor- and motor point and peripheral nerve slower than anticipated managed care
ders requiring rehabilitation include, blockade in addition to nerve conduc- market expansion and physiatry’s con-
but are not limited to, muscular dys- tion studies and electromyography. tinued success in raising awareness of
trophy, polymyositis, and limb girdle our unique contributions to patient
dystrophies. In addition, physiatrists 2. Is Physiatry a Satisfying Career care.
are trained in the diagnosis and treat- Choice? Do You Like Being a Physi- A 1988 survey4 revealed that
ment of neuromusculoskeletal disor- atrist? Why Did You Go Into This 35.8% were exclusively hospital
ders such as peripheral neuropathies, Field? Is There Time for a Personal based and that 17.1% were exclu-
radiculopathies, limb amputations, and Family Life? Physiatry is a re- sively office based. Since then, it
tendon strains and tears, sports in- warding area of practice for several seems that office-based patient care
juries, and work-related injuries. reasons. There are a wide variety of has grown dramatically and that hos-
Physiatrists often evaluate patients clinical problems to be addressed. As pital based care is declining.3
within hours of a major illness or practitioners in this field, it is possi- Significant administrative op-
injury; they have the satisfaction of ble to develop long-term relation- portunities remain. In addition to
coordinating not only their patients’ ships with patients and their families, private practice, academic and re-
acute rehabilitative care, but also, facilitating a more holistic approach search positions are available. Since
over time, their community reinte- to their care. Because of the breadth PM&R remains primarily a referral
gration and return to work. of diagnostic categories, it is possible specialty, practice sites tend to be as-
Using a patient’s medical history to focus on specific areas at varying sociated with population bases of at
and physical examination findings, times in their career. This flexibility least 100,000.
physiatrists determine the extent of makes the field a continuous intellec-
the physical and/or cognitive deficits tual challenge. Because of the in- 4. Where Do Physiatrists Live and
and also assess the functional impli- creasing emphasis on ambulatory Work? What Is Their Geographic Dis-
cations of a patient’s impairment. Ra- care and the relative medical stability tribution? Physiatrists are repre-
diographic imaging, laboratory studies, of hospitalized rehabilitation pa- sented in every state in the nation.
and/or electrodiagnostic evaluations tients, most practice settings allow There has been an average increase of
may be used to evaluate the extent of for the pursuit of a satisfying family 43% in the “physiatrist to popula-
the patient’s dysfunction. Physiatrists life. In a recent survey,1 career satis- tion” ratio between 1985 and 1994.2
often function as members of an in- faction among physiatrists was rated According to one comprehensive
March 2001 Medical Student’s Questions 219
