Physical Medicine and Rehabilitation

What is a physiatrist?

A specialist in Physical Medicine and Rehabilitation, also called a physiatrist, evaluates and treats patients with physical and/or cognitive impairments and disabilities that result from musculoskeletal conditions (such as neck or back pain, or sports or work injuries), neurological conditions (such as stroke, brain injury, or spinal cord injury), or other medical conditions. Physiatrists have expertise in therapeutic exercise, medications, and injections for management of pain and spasticity; electrodiagnosis; prostheses (artificial limbs); orthoses (braces); and other equipment to assist daily activities, and coordinate treatment to help patients improve their physical, psychological, social, and vocational function.

How to become a physiatrist?

Specialty training required prior to certification: Four years

What does a physiatrist do?

The specialty of physical medicine and rehabilitation, also known as physiatry, manages medical issues that affect the way people function. Unlike other medical specialties that focus on a medical “cure,” the goals of the physiatrist are to maximize patients’ independence in activities of daily living and improve quality of life.

PM&R physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons. PM&R physicians evaluate and treat injuries, illnesses and disability, and are experts in designing comprehensive, patient-centered treatment plans. Physiatrists utilize cutting‐edge as well as time‐tested treatments to maximize function and quality of life.

Some of the common diagnoses and populations seen by inpatient physiatrists include spinal cord injury, brain injury (traumatic and non- traumatic), stroke, multiple sclerosis, polio, burn care, and musculoskeletal and pediatric rehabilitation. Outpatient physiatrists are experts at nonsurgical management of conditions including orthopaedic injuries, spine-related pain and dysfunction, occupational injuries and overuse syndromes, neurogenic bowel/bladder, pressure sore management, spasticity management and chronic pain. Procedures commonly performed by physiatrists include:

• EMG/Nerve Conduction Studies

• Ultrasound guided procedures

• Fluoroscopy guided procedures

• Injections of spine

• Discography, Disc Decompression and Vertebroplasty/Kyphoplasty

• Nerve Stimulators, Blocks and Ablation procedures—Peripheral and Spinal

• Injections of joints

• Prolotherapy

• Spasticity Treatment (Phenol and Botulinum toxin injections, intrathecal baclofen pump trial and implants)

• Nerve and Muscle Biopsy

• Manual Medicine/Osteopathic Treatment

• Prosthetics and Orthotics

• Complementary-alternative medicine (i.e., acupuncture, etc.)

• Disability/impairment assessment

• Medicolegal consulting

Patient interaction is important in order for physiatrists to understand and treat both the medical and biopsychosocial issues that accompany issues of acute/chronic disability. Inpatient physiatrists often are trained using collaborative team skills for working with social workers and other allied health therapists (e.g., physical, occupational and speech) to manage these issues. Outpatient physiatrists are typically found in multidisciplinary groups consisting of other physiatrists, orthopaedic surgeons and/or neurosurgeons.

Physical medicine and rehabilitation offers a high level of flexibility in practice, which enables practitioners to curtail and revitalize their careers as they see fit. Positions can be found in both academic and private practice settings. Physicians can choose to have a mixed inpatient/outpatient practice or a predominantly outpatient practice.

How much do physiatrists make?

Income varies according to region, years in practice and type of practice. According to the 2012 PM&R Compensation Survey, full-time physiatrist salaries ranged $183,000 to $299,900 for full-time medical school faculty. Overall, physiatrists have demonstrated a high level of satisfaction with respect to autonomy of practice and unique skill set in patient management.