While the field of physiatry was coined in 1938 when a need for the specialty was proposed by Dr. Frank H. Krusen and 14 other physicians, it still to this day often gets confused with psychiatry, the study and treatment of mental illness.
However, the two fields couldn’t be more different.
Physiatrists, or physical medicine and rehabilitation (PM&R) physicians, focus on the restoration of function for patients who have experienced physical and cognitive impairments from major illnesses and injuries including strokes, brain injuries, spinal cord injuries, musculoskeletal conditions and amputations.
Physiatrists in action
Two significant historical events that really showed the value and need of the specialty are WWII and the polio epidemic.
With many WWII veterans coming back to the U.S. with major injuries and disabilities, the physiatrist role was important in helping the soldiers restore as much function and independence as possible.
Prior to the polio vaccine’s discovery, the disease swept the U.S. in the 1940s and 1950s. The infection caused muscle weakness and paralysis that was well served by the physiatry training and knowledge of the neuromuscular functions.
Education and training
Physiatrists follow a similar educational path as other physicians. They complete a bachelor’s degree, typically in biology, chemistry or another life science, then apply to medical school, where they study medicine for an additional four years. Post medical school, they apply and interview at physical medicine and rehabilitation residency programs, which are spread across the country. Then, once accepted, they complete a one-year general clinical internship and three years of residency training geared completely toward physical medicine and rehabilitation.
After residency, a physiatrist may then take a computer-based and oral examination, which qualifies them to be certified by the American Board of Physical Medicine and Rehabilitation. Board certification confirms they have the knowledge and capability to treat patients who need their specialized care. Throughout their career, physiatrists must also obtain continuing education credits and take a board recertification test every 10 years to maintain their certification and continue practicing.
Physiatrists may also further their education and become subspecialized in fields including spine medicine, spinal cord injury medicine, brain injury, pediatric rehabilitation, pain medicine, neuromuscular medicine, sports medicine, cancer rehabilitation, electrodiagnostic medicine and hospice and palliative medicine.
Physiatrists in the inpatient rehabilitation hospital setting
A physiatrist’s training and knowledge base is what makes them a key element to the interdisciplinary care team in Encompass Health hospitals. Physiatrists oversee the patient care plan and work alongside physical therapists, occupational therapists, speech-language pathologists, pharmacists, nurses, case managers among others to make sure patients are making the most of their recoveries while in inpatient rehabilitation.
In addition to being part of the patient meetings or huddles with other members of the patient’s care team, physiatrists have frequent visits with patients during their stay to discuss their functional improvement, level of pain, medical complications and personal and medical goals. If the patient isn’t quite at the point of recovery the physiatrist feels they should be, he or she will work with the therapy team to alter their current therapy plan. Or, if a patient is experiencing a lot of pain and feels unable to complete therapy, the physiatrist will evaluate the patient’s medications with help from a pharmacist. The physiatrist may also work with the patient’s therapists to try alternative forms of pain management such as modalities, biofeedback or taping.
Since the average patient stay in an Encompass Health rehabilitation hospital is 12-13 days, physiatrists get the great reward of seeing their patients come into the hospital at a lower function then see them leave with greater function, confidence and independence.
Why do they choose to become physiatrists?
With so many medical fields to choose from, many physiatrists have a unique story of why they chose to work in this field.
Dr. Lisa Charbonneau, who currently serves as the chief medical officer for Encompass Health, worked 23 years in the inpatient hospital setting at New England Rehabilitation Hospital of Maine, the Company’s inpatient rehabilitation hospital in Portland, Maine. She chose the field of physiatry because “I was drawn to the holistic approach of patient care that is the basis of physiatry; not just treating patients for a few days and then not knowing their long term outcomes. I always followed my patients to the rehab unit to see how they were recovering and regaining function after a catastrophic illness or injury. I also had the good fortune of meeting great role models while I was in medical school and did elective rotations at Rusk Institute and the International Center for the Disabled in New York City.”
Encompass Health’s Vice President of Medical Services Dr. Joseph Stillo served as medical director of Encompass Health Rehabilitation Hospital of Toms River in New Jersey before moving into his current role. “Physiatry is truly a special field of medicine, and I’m blessed to have been exposed to its noble roots during my medical school externship at the Rusk Institute in NYC from where Dr. Howard Rusk sensitized the world to the need for systematic and focused physical and emotional rehabilitation of those affected by disabling illness or injury,” stated Stillo. “To that end, he oversaw the birth and development of a field of medicine dedicated to serving this population. As he autographed my copy of his autobiography ‘A World to Care For,’ he thanked me for considering PM&R for my field of specialization. I, in turn, thanked him for the inspiration that later served to propel and sustain my privilege of 32 years of physiatry practice administering to the disabled as clinician and educator.”
For Dr. Eliam Fuentes-Tirado, medical director of Encompass Health Rehabilitation Hospital of Altamonte Springs, the care his 2-year-old daughter received after a hemorrhagic stroke is what helped him find his calling in physiatry. “The sentiment of feeling powerless is something that I understand and helps me to interact with my patients,” he explained.
No matter their “why” or the road they took to get there, physiatrists play a key role in improving quality of life for many patients faced with new challenges as a result of life-altering illnesses and injuries. And even though there is only slightly more than 13,000 board-certified physiatrists practicing in the U.S., they work hard to put people back in motion and get their lives back.