Physical medicine and rehabilitation
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Physical medicine and rehabilitation (PM&R), or physiatry, is a branch of medicine dealing with functional restoration of a person affected by physical disability. A physician who has completed training in this field is referred to as a physiatrist (fizz eye' a trist). In order to be a physiatrist in the United States, one must complete four years of medical school, one year of internship and three years of residency. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system (such as stroke victims).
Basic Medical Education
Basic medical Education in the United States of America (USA) takes about four years but before medical education a three-year undergraduate course must be taken (on any subject, but best if scientific, chemical or biological). In the US, this is called college. Some students may even take four-years college courses.
Only then can a medical student take the four-year medical course. After the medical course, students must enter a one-year intenship (training). To qualify as a proper medical practitioner in the US, a student must now complete a residency. The lengths of a residency may range from three years to ten, determined by which specialty the student chooses.
In the UNited Kingom, medical students could enter medical education straight after secondary school. They can choose how long they want the medical education to be, usually five to six years (depending on University or progress). Several universities now offer an accelerated medical course, and this takes four years (pre-clinical and clinical). After medical education, students will enter a Foundation phase (two years). The first year of the Foundation phase is called F1, and the student has already become a physician (entering F1 means entering paid employment). F1 practitioners are supervised, but F2 (year two of Foundation) practitioners may be unsupervised by a professional physician or trained medical supervisior.
After F2, a practitioner can choose to study general practice, or specialised practice. The physician can quit, or he can study further whilst worjing as an 'infant' physician. After the specialty or general studies, the physician qualifies as a proper medical practitioner.
Salaries afterwards range from several thousand per year to a million per year (the most common million-per-year being the specialty of private neurology).
The term 'Physiatry' was coined by Dr. Frank H. Krusen in 1938. The term was accepted by the American Medical Association in 1946. The field grew notably in response to the demand for sophisticated rehabilitation techniques for the large number of injured soldiers returning from World War II.
Scope of the field
Physical medicine and rehabilitation involves the management of disorders that alter the function and performance of the patient. Emphasis is placed on the optimization of function through the combined use of medications, physical modalities, and experiential training approaches. Electrodiagnostics are used to diagnose and provide prognosis for various neuromuscular disorders.
Common conditions that are treated by physiatrists include amputation, spinal cord injury, sports injury, stroke, musculoskletal pain syndromes such as low back pain, fibromyalgia and traumatic brain injury. Cardiopulmonary rehabilitation involves optimizing function in those afflicted with heart or lung disease. Chronic pain management is achieved through multidisciplinary approach involving psychologists, physical therapists, occupational therapists, and interventional procedures when indicated.
The major concern of the field is the ability of the person to function optimally within the limitations placed upon them by a disease process for which there is no known cure. The emphasis is not on the full restoration to the premorbid level of function, but rather the optimization of the quality of life for those who may not be able to achieve full restoration. A team approach to chronic conditions is emphasized, using transdisciplinary team meetings to coordinate care of the patients.
Six formal sub-specializations are recognized by the field in the United States: pain medicine, pediatric rehabilitation, spinal cord injury medicine, neuromuscular medicine, sports medicine, and hospice and palliative medicine. Many in the field also subspecialize in areas of amputee care, musculoskeletal medicine, electrodiagnostics, traumatic brain injury (TBI), and cardiopulmonary rehabilitation.
Residencies in the United States
There are no clear rankings among PM&R residencies, but a list of the most commonly cited top programs in the United States would include
- Kessler Institute for Rehabilitation, West Orange, NJ (UMDNJ: New Jersey Medical School, Newark, NJ)
- Mayo Clinic Program, Rochester, MN
- Ohio State University Program, Columbus, OH
- Rehabilitation Institute of Chicago (RIC) at Northwestern University, Chicago
- Spaulding Rehabilitation Hospital of Partners HealthCare affiliated with Harvard Medical School, Boston
- Temple University Program, Philadelphia
- Thomas Jefferson University Program, Philadelphia
- Baylor College of Medicine/UT Houston, Houston
- University of Colorado Program, Aurora, CO
- University of Michigan Program, Ann Arbor, MI
- University of Texas Health Science Center Program, San Antonio
- University of Washington Program, Seattle
- University of Utah Program, Salt Lake City, UT
- University of Pittsburgh Program Pittsburgh, PA
There are approximately 350 total positions available via the National Resident Matching Program (NRMP) per year.
Notable Rehabilitation Hospitals in the United States
In addition to those associated with elite PM&R residency programs, notable US rehabilitation hospitals, many of which are teaching hospitals, include:
- Children's Specialized Hospital in Mountainside, New Jersey, a pediatric teaching hospital affiliated with both UMDNJ programs
- Rehabilitation Institute of Chicago (RIC) at Northwestern University, Chicago
- Craig Hospital in Englewood, Colorado, a teaching hospital for University of Colorado
- Magee Rehabilitation, Philadelphia, a major teaching hospital for Thomas Jefferson University
- Moss Rehabilitation Hospital in Elkins Park, Pennsylvania, a teaching hospital for Temple and Thomas Jefferson University
- Marshfield Clinic in Marshfield, Wisconsin
- National Rehabilitation Hospital in Washington, principal teaching hospital for Georgetown University
- Rancho Los Amigos National Rehabilitation Center in Downey, California
- Rusk Institute of NYU Medical Center in New York, major teaching site for New York University
- Shepard Hospital in Atlanta, major teaching affiliate for Emory University
- Spaulding Rehabilitation Hospital in Boston, a member of Partners HealthCare, affiliated with Harvard Medical School
- TIRR The Institute for Rehabilitation and Research in Houston, TX, principal teaching hospital for Baylor/UT residency program.
- Johns Hopkins Physical Medicine and Rehabilitation in Baltimore, Maryland with inpatient rehabilitation at Good Samaritan Hospital, Kennedy Krieger Institute, and Johns Hopkins Hospital.
- Rehabilitation Center at Santa Clara Valley Medical Center, San Jose, CA www.tbi-sci.org/rehab/index.html
Two main textbooks often used by those in the specialty are Physical Medicine and Rehabilitation: Principles and Practice by Joel DeLisa and Physical Medicine and Rehabilitation Medicine by Randall Braddom. Useful handbooks for medical students and residents include PM&R Secrets by Mark Young, Brian O'Young and Steven Stiens, and PM&R Pocketpedia by Howard Choi and colleagues.
- Joel DeLisa (2004). Physical Medicine and Rehabilitation: Principles and Practice. Lippincott Williams & Wilkins. ISBN 0-7817-4130-0.
- Randall Braddom (2006). Physical Medicine and Rehabilitation. WB Saunders. ISBN 978-1416026105.
- Bryan J. O'Young, Mark A. Young, Steven A. Stiens (2002). Physical Medicine and Rehabilitation Secrets. Hanley & Belfus. ISBN 1-56053-437-0.
- Howard Choi, Ross Sugar, David E. Fish, Matthew Shatzer, Brian Krabak (2003). Physical Medicine and Rehabilitation Pocketpedia. Lippincott Williams & Wilkins. ISBN 0-7817-4433-4.
The two main journals of the PM&R field are Archives of Physical Medicine and Rehabilitation and American Journal of Physical Medicine and Rehabilitation. Archives, which had been co-owned by the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and the American Congress of Rehabilitation Medicine (ACRM), will be solely owned by the Congress beginning January 2009. At that time, the Academy will launch a new journal: PM&R, The journal of injury, function and rehabilitation.
Individual Residency Programs
- Famous Canadian Physicians: Dr. Gustave Gingras at Library and Archives Canada
- American Academy of Physical Medicine and Rehabilitation National medical society, has a PM&R resident/medical student mentoring feature
- American Board of Physical Medicine and Rehabilitation ABMS recognized entity for board certification in PM&R
-  Courage Center, Minneapolis-based nonprofit rehabilitation and resource center for people of all ages and abilities.
- Association of Academic Physiatrists Organization consisting largely of those with interests in academic PM&R
- StudentDoctor.Net Student mentoring site, has a PM&R forum
- Physical Medicine and Rehabilitation - eMedicine Journal medical reference
- Canadian Association of Physical Medicine and Rehabilitation - Canadian National PM&R Medical Society
- International Society of Physical Medicine and Rehabilitation
- American Association of Neuromuscular and Electrodiagnostic Medicine - National medical society comprised primarily of physiatrists and neurologists who perform electrodiagnostic studies (eg. electromyography and nerve conduction studies) and provide medical care to individuals with neuromuscular disorders.
- Iranian Society of Physical Medicine and Rehabilitation
- Department B National organization providing comprehensive business resources to practicing physiatrists
- http://www.iapmr.com/ Indian Association of Physical Medicine and Rehabilitation- Physiatrists from anywhere in the world can be a life member.
- Physiatry Practice Management Portal Resources for physiatrists
- Patient Information Physiatry-related informtion for patients including searchable database of physicians.
- Accurate Billing/Coding resources Comprehensive business resources for practicing physiatrists
- SpineUniverse Portal for spine-related physiatry - glossary of terms, procedures explained, global physician directory.
- Johns Hopkins Department of Physical Medicine and Rehabilitation
- The Howard A. Rusk Institute of Rehabilitation Medicine at the New York University Medical Center
- TIRR - The Institute for Rehabilitation and Research Houston
- New York-Presbyterian Hospital
- CNS Centre for Neuro Skills