What kind of training do
physiatrists have?
To become a
physiatrist individuals must successfully complete four years of graduate
medical education followed by four additional years of postdoctoral
residency training. Residency training includes one year spent developing
fundamental clinical skills and three additional years of training in the
full scope of the specialty. There are currently 80 accredited residency
programs in physical medicine and rehabilitation in the United States. Many
physiatrists choose to pursue additional advanced degrees (MS, PhD) or
complete fellowship training in a specific area of the specialty.
Fellowships are available for specialized study in such areas as
musculoskeletal rehabilitation, pediatrics, traumatic brain injury, spinal
cord injury, and sports medicine.
To become board
certified in physical medicine and rehabilitation, physiatrists are required
to take both a written and oral examination administered by the American
Board of Physical Medicine and Rehabilitation (ABPM&R). The ABPM&R also has
agreements with each of the boards of pediatrics, internal medicine, and
neurology to allow special training programs leading to certification in
both specialties.
How did the specialty
develop?
The field of
physical medicine and rehabilitation (PM&R) began in the 1930s to address
musculoskeletal and neurological problems, but broadened its scope
considerably after World War II. As thousands of veterans came back to the
United States with serious disabilities, the task of helping to restore them
to productive lives became a new direction for the field. The Advisory Board
of Medical Specialties granted PM&R its approval as a specialty of medicine
in 1947.
What types of conditions
does a physiatrist treat?
Physiatrists are
physicians who treat a wide range of problems from sore shoulders to spinal
cord injuries. The focus of the specialty is on restoring function to
people. Physiatrists treat acute and chronic pain and musculoskeletal
disorders. They may see a person who lifts a heavy object at work and
experiences back pain, a basketball player who sprains an ankle and needs
rehabilitation to play again, or a knitter who has carpal tunnel syndrome.
Physiatrists' patients also include people with arthritis, tendonitis, any
kind of back pain, and work- and sports-related injuries.
Physiatrists treat
serious disorders of the musculoskeletal system that result in severe
functional limitations as well. They would treat a baby with a birth defect,
someone in a bad car accident, or an elderly person with a broken hip.
Physiatrists coordinate the long term rehabilitation process for people with
spinal cord injuries, brain injuries, strokes, amputations, cancer, and
multiple sclerosis.
What is the physiatrist's
role in treatment?
A physiatrist may
treat patients directly, lead an interdisciplinary team, or act as a
consultant. Here are some scenarios that illustrate the varied roles of a
physiatrist:
-
A carpenter is
lifting some heavy wood when he feels pain in his lower back and down his
leg. He sees a physiatrist who does a thorough history and physical
examination and performs all the testing needed to make the diagnosis: a
herniated disc. The physiatrist develops an appropriate treatment program,
monitoring and adjusting it as needed. With this treatment and
rehabilitation program, the patient does not need surgery.
-
A woman in a
diving accident has a spinal cord injury and is paralyzed below the waist.
The physiatrist assesses her injury and with the patient and a team of
health care professionals determines the course of her rehabilitation. The
physiatrist treats the array of medical issues that occur as the result of
a spinal cord injury, and also leads the interdisciplinary team to enable
the woman to reach the highest level of functioning possible. The team
varies in composition depending on the needs of the patient. In addition
to other physicians, the team may include health care professionals such
as nurses, physical therapists, occupational therapists, social workers,
neuropsychologists, and vocational counselors.
-
A baby is born
with cerebral palsy. The physiatrist is called in as the expert who
advises on the correct treatment and rehabilitation that can affect the
rest of the child's life.
How do physiatrists
diagnose?
Physiatrists'
diagnostic tools are the same as those used by other physicians, with the
addition of special techniques in electrodiagnostic medicine like
electromyography (EMG), nerve conduction studies, and somatosensory evoked
potentials. These techniques help the physiatrist to diagnose conditions
that cause pain, weakness, and numbness.
What kinds of treatments do
physiatrists offer?
Physiatrists offer
a broad spectrum of medical services. They do not perform surgery.
Physiatrists may prescribe drugs or assistive devices, such as a brace or
artificial limb. They also use diverse therapies such as heat and cold,
electrotherapies, massage, biofeedback, traction, and therapeutic exercise.
Where do physiatrists
practice?
Physiatrists
practice in rehabilitation centers, hospitals, and in private offices. They
often have broad practices, but some concentrate on one area such as
pediatrics, sports medicine, geriatric medicine, brain injury, and many
other special interests.
What kinds of differences do
physiatrists make?
Since physiatrists
focus on restoring patients to maximum function, the difference they make
can be dramatic. In the case of the herniated disc, the physiatrist not only
takes care of the acute problem, but also treats the patient until he or she
returns to optimal functioning, usually without surgery. The physiatrist
also teaches the patient how to prevent the injury in the future.
A broken hip in an
elderly patient is another example. Physiatrists can provide aggressive
rehabilitation so patients can walk and even exercise again. And because the
physiatrist is concerned with all areas of rehabilitation – social,
vocational, and medical – the quality of life is significantly increased for
patients. |
