Thursday, March 15, 2007

Blogging, general - On Physiatrists and Wiping The Egg Off My Face

This is my 90th blog in 90 days, which must be a world record for bloggorhea. Unfortunately, when you write a blog each day, you may occasionally commit a sin of omission. Yesterday morning, when I posted “On Physical Therapists and Keeping Patients Moving,“I committed a whopper.

In speaking of physical therapists, I failed to mention physiatry, the long established and respected medical specialty defined as follows by the American Academy of Physical Medicine and Rehabilitation:

A physiatrist is a physician specializing in physical medicine and rehabilitation. Physiatrists treat a wide range of problems from sore shoulders to spinal cord injuries. They see patients in all age groups and treat problems that touch upon all the major systems in the body. These specialists focus on restoring function to people.

To become a physiatrist, individuals must successfully complete four years of graduate medical education and 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 79 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

My Oversight Corrected

My physiatrist readers quickly corrected my oversight.

• First, my good friend, Val Jones, MD, senior medical director of the portal for the Revolution Health Group, and a fellow blogger (ValJonesMD’s blog: The Voice of Reason) weighed in with this observation.

Thanks for your nice blog post about the importance of movement to good health. I must tell you, though, that I was disappointed by the lack of even a mention of Physiatrists (my specialty)… it’s kind of like talking about how great the field of pathology is because of lab technicians, but not mentioning the pathologist.

I have meant for a long time to write a post about “What the heck is a Rehab Doctor?” and now you have galvanized me into action.

It is so sad that my specialty has the poorest PR efforts known to medicine. It is rare for anyone to know who we are or what we do, though we labor on… caring for the poor and unwanted (those disabled by stroke, spinal cord injury, cerebral palsy, amputations and the like), doing what we can to improve life through movement and generally non-invasive therapies.

To me, physiatry IS the original integrative medicine. These Bastyr types like to take all the credit, but we PM&R docs have known since the turn of the century that rehabilitating people takes a masterful mix of art and science.

I’ll create a post today or tomorrow about this… so stay tuned.”

My comment: Val really stung me with her comment about pathologists. We pathologists tend to be the Rodney Dangerfields – the Digger O'Dells - of medicine. We get no respect from the public. Once I mentioned to a society matron I was a pathologist. After a second’s hesitation, she remarked, “Oh, did your mother have any children who lived?” Physiatrists may experience similar problems connecting with the public. Because of similarly sounding names, physiatrists may be confused with psychiatrists and draw a blank when asked their specialty.

Val wasn’t done yet, She posted this comment on my blog”

Dear Dr. Reece,

Movement therapy is indeed a wonderful thing, and I applaud the work of Physical Therapists. Do keep in mind, though, that the field was developed by Physiatrists (the medical specialty of Physical Medicine & Rehabilitation)m and our role in advancing the field and promoting physical activity should not be overlooked.

Comment: Just to make sure I got it right, Val sent me a powerpoint presentation on the history of Physical Medicine and Rehabilitation Medicine “ PM&R : Proud History, Bright Future, “ It was given at grand rounds at St. Vincent Hospital in New York, on February 2, 2006. In it Val goes back to the Civil War. She traces the history of physiatrists in treating amputations and their work with polio and spinal cord injuries, and proceeds to envision a future where physiatrists will deal with geriatric rehabilitation, nutritional rehabilitation, complications of obesity, and research on developing neurostimulator devices to treat those suffering from paralysis.

• In another response to my blog, Julie K. Silver, MD, Assistant Professor, Harvard Medical School, Dept. of PM&R , a blogger in her own right ( had this to say:

Dear Dr. Reece,

I am always delighted when people point out the tremendous benefits of rehabilitation medicine which is led by physicians who opt to specialize in a small, but important medical specialty called Physical Medicine and Rehabilitation (PM&R).
Those of us who complete medical school and then a four year internship and residency training program and go on to become board-certified physiatrists do much more than prescribe physical therapy, however.
Though we used to be called "physical therapy doctors" modern physiatrists are quick to point out that this is a very antiquated term and that while we work closely with our physical therapy colleagues and we certainly write very specific orders for PT to help people physically recover, we do much more than that including prescribing medications, ordering medical studies, performing many types of injections, and so on.
The list is long; however, for more information about physiatrists visit the American Academy of Physical Medicine and Rehabilitation website at

Comment: So there you have, two prominent physiatrists setting me straight on the past, present, and future accomplishments of their distinguished specialty. Physiatrists, who tends to be on the backlines of care rather than in the frontlines, don’t receive the credit they so richly deserves. It is probably a case of out of sight, out of mind.

I should point out that Drs. Jones and Silver have done and are doing meritorious work outside their specialty and have voiced their views in their respective blogs.

Dr. Jones has undertaken the Herculean task of helping develop a comprehensive website,, designed to empower consumers so they can better control their health and their disease through superior information and through consultation with specialists focused on helping consumers.

Dr. Silver was editor- in- chief of a marvelous book The Business of Medicine (Hanley & Belfus, 1998) which was beautifully written and was designed to lead her fellow physicians through the rocks and shoals of modern medical business dilemmas and practices.

I know when I am outgunned. I know better than to challenge the Voice of Reason and the Voice of the Business of Medicine. I apologize to Drs. Jones and Silver. I regret I neglected to mention how physiatry has contributed so much to improving care of patients with neuromuscular disabilities, stroke, amputations, spinal cord paralysis, and traumatic war and civilian injuries. They deserve our gratitude, and they certainly have mine. I feel better now that the egg is off my face.


Dr. Val said...

Dear Dr. Reece,

It was very kind of you to post this thoughtful summary. Your "sin of omission" was completely unintentional - and I feel a little bit guilty for making you feel so badly (that was unintentional too)! I think the lack of understanding of what physiatrists do is largely to be blamed on physiatrists. We have not done a good job of PR to our peers or to the world at large.
Physical Therapists have great PR - and they are understood and appreciated for their good work. Dr. Silver can tell you that PM&R specialists are often asked if we are physical therapists... it's just such a common misconception. In reality, though, many of us are working on bionic arms for military amputees, we're doing cutting edge research in nerve regeneration, we're working day and night to understand pain pathways so that we can manage it more effectively, and we're rehabilitating people after debilitating strokes (among many other innovative things). So, stay tuned for more... I'll post a blog in the next couple of days about PM&R.
Warm Regards,

Spine-health said...

Great discussion topic!
We at get hilarious questions (well, at least we think they're funny) from people about why we have articles written by foot doctors on Spine-health when the site about back pain :) or why did their GP refer them to a psychiatrist when they need treatment for a herniated disc? There is definitely a lot of confusion about physiatrists.
As part of our efforts to provide complete and accurate patient education about all aspects of back pain, we have several articles about physiatry (such as "What is a physiatrist?"), and perhaps more importantly, physiatry is integrated into just about all our articles about non-surgical care.
Stephanie Burke

Eric Robertson said...

I enjoyed your piece about Physical Therapy, but found the comments from Physiatrists and your response a bit curious. I wrote a brief synthesis of the two professions' history at my blog:

Please check it out. I included links to historical sites and some of my own commentary. Thanks.

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