What is a Physiatrist? Not a Psychologist or a Psychiatrist, or a Physiologist. A Physiatrist (Fizz-Eye-Uh-Trist) is a physician (MD or DO) who is trained to care for individuals as they recover or rehabilitate from diseases or injuries. It is the type of physician you become after training in a ‘physical medicine and rehabilitation’ (PM&R) residency program for 4 years after medical school. The breadth of the specialty is vast but unified by the underlying focus on treating the musculoskeletal system. In fact over 80% of disability in the world is musculoskeletal in nature. Physiatrist are trained to treat all that can go wrong either in traumatic injuries like car accidents or in chronic diseases like muscular dystrophy, multiple sclerosis (MS) or even diabetes. PM&R doctors treat the whole patient, not just the injury/disease. This means that they place a heavy emphasis on improving quality of life and restoring function and ability through non-surgical means.
It is the second smallest medical specialty, but is one with great breadth and creativity. The core tenets of physiatry (PM&R) align perfectly with those of osteopathic medicine. PM&R doctors are inherently holistic in their evaluation and treatment of a patient, still value the physical exam, listen to the body tissues by employing palpatory diagnostics, and continue to value certain manipulative treatments in the management of their patients. Physiatrists can practice in many fields including sports medicine, electrodiagnostic medicine, musculoskeletal, and pursue various subspecializations within rehab medicine, including traumatic brain injury, spinal cord injury, and cardiac/pulmonary disease.
The PM&R specialty is not that new. In fact it started back in the 1920s and 30s with physicians who actually received a medical degree and then received an additional degree in physical therapy. By incorporating the two fields, a new specialty was created that approached health and healing in a new light incorporating more of the whole body principles. Then, World War II veterans returning from the war with incredible injuries were in great need of a new type of medical treatment that focused on regaining function and adapting to life with physical impairments. In 1947 the new specialty was officially named PM&R.
Now there are over 80 PM&R residency programs across the country training physicians to treat diseases affecting every organ system and every part of the body. It is an incredible field of medicine that embraces teamwork, relies on collaboration, includes the patient in treatment design, incorporates all aspects of life, demands depth and breadth of medical knowledge, but most importantly elevates the humanistic elements of medicine to primary importance. What does the patient want out of this treatment, how does the patient feel, how are they coping, what makes them happy, etc. The PM&R doctor is a team leader working closely with therapists (OT’s, PT’s, Speech), nurses, other physicians, techs, and other staff to treat a single patient’s physical maladies and improve their quality of life.
The PM&R specialty is ideal for all of the reasons I just mentioned, which is why I am actively pursuing this specialty as my future career path. Some might say, “But Ryan, you’re only a first year, what do you know about what specialty you want to pursue?”. And I would say to you, good sir/maam, you are exactly right! I am not 100% sure, without a doubt, going to become a PM&R doctor but I know that it is an amazing field of medicine that combines teamwork, patient care, musculoskeletal medicine, procedures, exercise physiology, sports medicine, and humanistic aspects of medical care (patience, compassion, diligence, etc.) that make you a better person while at the same time making you a better doctor.
I have had a glimpse into rehab medicine through my wife’s experiences working at Vanderbilt’s rehab hospital for the past three years. In fact, if it had not been for her, I may not even know what PM&R stands for right now. From her I have learned that PM&R is a very patient centered specialty with a collegial atmosphere amongst team members. In-patient rehab allows the physicians to treat acute injury/illness while developing a plan and setting goals WITH the patients for their recovery process. Outpatient rehab provides a different perspective and allows a physician to monitor a patient’s progress and work with them to develop plans to improve the quality of life of patients with chronic debilitating disease like multiple sclerosis, chronic low back pain, or muscular dystrophy.
Overall, I love the idea or working WITH patients to develop goals for their recovery that are important to them. I don’t appreciate the “I’m the doctor!” attitude that so many physicians maintain, however, part of me can also recognize where it comes from. (After 12 years of training, and hundreds of thousands of dollars of debt, a physician who is not guarding against it could develop an attitude of “the world owes me for working so hard”.) I think PM&R is a great specialty to learn to truly CARE for patients – physically and emotionally – and to be reminded to always put the patient first.