Demystifying PM&R: A Look into the Disparity in Knowledge of this Specialty in the Medical Community
Written by Lucila Beuses. Last updated 09/2023
TLDR: Despite PM&R being a specialty that encompasses a wide range of experience and expertise, the field is still not well known in the medical community. The root of this disparity in knowledge of PM&R is likely due to lack of exposure in medical school and lack of understanding of the field by other physicians.
What is part of the solution?
1) Increase and promote opportunities to learn about PM&R as a medical student.
2) Invite physiatrists to give lectures to residents of all specialties.
3) Physiatrists should talk to non-PM&R friends/colleagues about the field.
Defining PM&R and the Role of a Physiatrist
Physical Medicine and Rehabilitation (also known as PM&R or physiatry) was founded as a field in the early 20th century and officially established as a specialty under the authority of the American Board of Medical Specialties in 1947. To become a PM&R physician (also known as a physiatrist), one must complete 4 years of undergraduate education (bachelor’s degree), 4 years of medical school (M.D. or D.O.), 1 year of pre-liminary internal medicine or transitional residency training, and 3 years of PM&R residency training. If one decides to pursue a fellowship, this adds 1-2 additional years of training.
PM&R is the branch of medicine that emphasizes the prevention, diagnosis, treatment, and rehabilitation of individuals with medical conditions causing temporary or permanent disability, especially conditions that affect the musculoskeletal and neurological systems. Physiatrists specifically focus on the improvement and restoration of function in patients ranging from those with a short transition back to mobility to others with severe cognitive disorders that will last a lifetime. Furthermore, physiatrists focus on enhancing quality of life by considering the patient’s living space, activities of daily living, and other social aspects that allow for patient-centered treatment and rehabilitation.
Physiatrists are equipped to treat patients holistically; however, they are especially equipped to treat complications secondary to a variety of disabling conditions like brain injury, spinal cord injury, amputations, transplant surgery, cancer, cerebral palsy, etc. In combination with therapies, physiatrists can use various medications and injection-types to manage pain, bowel/bladder issues, spasticity and movement disorders, sleep, agitation, etc. Physiatrists are also trained in electromyography, BOTOX and phenol injections, ultrasound-guided/fluoroscopy-guided joint injections, and other procedures.
Physiatrists can work in both inpatient and outpatient settings depending on the patient population they want to work with. Inpatient settings for PM&R include general hospitals (consult physiatry service) or rehabilitation hospitals in acute rehabilitation units. Outpatient settings for PM&R include clinics ranging from general rehab needs to specific spinal cord injury needs to sports medicine to many more.
Subspecialties of PM&R (not an exhaustive list):
Brain Injury Medicine
Neuromuscular Medicine
Spinal Cord Injury Medicine
Pediatric Rehabilitation Medicine
Hospice & Palliative Medicine
Cancer Rehabilitation
Pain Medicine
Interventional Spine and Musculoskeletal Medicine (NASS Fellowship)
Sports Medicine
Electrodiagnostic Medicine
Despite PM&R being a specialty that encompasses a wide range of experience and expertise, the field is still not well known in the medical community. Why is that?
Many medical students graduate from medical school (possibly) hearing of PM&R, but not really knowing what PM&R is. They commonly learn that PM&R works with physical therapists and has something to do with the musculoskeletal system – and that’s about it. As residents, most trainees will learn to consult PM&R purely for disposition of patients (whether they should go home, to a skilled nursing facility, or an inpatient rehabilitation facility). Past this, most residents do not know what the role of a physiatrist is. This then carries over to attending physicians also not knowing what PM&R is and when PM&R should be consulted or referred to.
The root of this disparity in knowledge of PM&R is likely due to lack of exposure in medical school and lack of understanding of the field by other physicians.
What is part of the solution?
Increase and promote opportunities to learn about PM&R as a medical student.
Medical schools can try to expose medical students to PM&R early in their education by incorporating educational lectures and social events with physiatrists. This is especially possible if the medical school is associated with a hospital with a PM&R department or PM&R residency program. Medical schools can also encourage students to gain exposure to PM&R via an elective rotation. Offering different length clinical rotations can increase interest from medical students. Furthermore, medical schools can promote local and national PM&R organizations (AAP, AAPM&R, AOCPM&R, PM&R Scholars, RiR, Pathways in PM&R, etc.) to their students, where they can find resources to learn and become involved with the PM&R community.
Invite physiatrists to give lectures to residents of all specialties.
Residency programs from all specialties can expose their residents to PM&R by incorporating an educational lecture given by a physiatrist. This could help increase understanding of the scope of practice within PM&R and maximize the use of PM&R consults and referrals. This could also help many patients receive the specialized care that they may need.
Physiatrists should talk to non-PM&R friends/colleagues about the field.
Those within the field of PM&R should take the opportunity to educate other physicians outside of the field. There may be friends or colleagues in your life that have known you for years, but do they really know what you do for a living? Help others understand the amazing world of physiatry!
Helpful links:
https://www.aapmr.org/about-physiatry/history-of-the-specialty
https://www.physiatry.org/page/WhatIsPhysiatry
https://thedo.osteopathic.org/columns/what-i-wish-other-doctors-knew-about-pmr/
