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Physiatry (Physical Medicine and Rehabilitation, or PM&R) has been a well-established field of medicine for many years. In spite of this, many people are unfamiliar with the specialty. What procedures do they perform?
Physical Medicine and Rehabilitation is a specialized field of medicine that centers on helping those with disabilities return to their prior level of function. Physicians are referred to as "physiatrists" (fizz-I-a-trists), in reference to "physical" medicine. The two components of physiatry are rehabilitation - the prescription of the appropriate physical, occupational, vocational, or speech therapy - and physical medicine. The latter refers to any application of a substance, device, modality, or maneuver to the body in order to alleviate dysfunction. Examples include heat, ice, electricity, bracing, massage, and manipulation. A physiatrist is also able to utilize injections for management of pain and spasticity, most often of the spine and extremities. Physiatrists have a thorough understanding of the anatomy and biomechanics of the musculoskeletal system, as well as ergonomics. They are physicians (meaning, they have the education and tools to form diagnoses) and should not be confused with physical therapists. Physiatrists are the only doctors required to perform and interpret electrodiagnostic studies. They generally do not operate or fix fractures and should not be confused with orthopaedists, who go through a surgical orthopaedic residency. "Physiatry" has also been confused with "physiology," "podiatry," and "psychiatry." Physiatrists are suitable in many arenas where an overseer of care is needed, a physician who understands what the many disciplines are capable of. They provide integrated care in the treatment of all neurologic and musculoskeletal disabilities from traumatic brain injury to lower back pain. Ultimately, the specialty focuses on the restoration of function.
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. The goal of restoring veterans to productive lives triggered expansion of the field into a specialty that deals with all functional aspects of people with disabilities. Today, physiatry is a diverse specialty. Physiatrists practice in major rehabilitation centers, in acute care hospitals, and in outpatient settings. Their approach to patients requires listening and observing, but also employs state-of-the-art technological support to assist in the healing process. In recent years, physiatry has seen an increased focus on musculoskeletal medicine and industrial medicine, pain management, sports medicine, and electromyography. In 1947, when PM&R became a board-certified specialty, there were 91 board-certified physiatrists; by 1975, there were 1,164. In only ten years, that number doubled, reaching 2,377 in 1985. It more than doubled again in the next decade. In 1995, there were nearly 5,000 board-certified physiatrists.
Physiatrists care for patients with acute and chronic pain, like back and neck pain, tendinitis, pinched nerves and fibromyalgia. They also treat people who have experienced catastrophic events resulting in paraplegia, quadriplegia, or traumatic brain injury. Physiatrists coordinate the long term rehabilitation process for people with spinal cord injuries, brain injuries, strokes, amputations, cancer, and multiple sclerosis. This is a list of some conditions treated: As medicine becomes more sophisticated, and as life expectancy for Americans increases, the goal of good health has spawned a new theme: quality of life. PM&R is often called the quality of life profession because its aim is to restore optimal patient functioning. The job of a physiatrist is to treat any disability resulting from disease or injury involving any organ system. The focus is not on one part of the body, but instead on the development of a comprehensive program for putting the pieces of a person's life back together – medically, socially, emotionally, and vocationally – after injury or disease. The problems that physiatrists manage span the entire spectrum, from the most complicated multiple trauma to injury prevention for athletes.
Physical Medicine and Rehabilitation is one of the 24 medical specialties certified by the American Board of Medical Specialties. To become a physiatrist individuals must successfully complete four years of graduate medical education followed by four additional years of postdoctoral residency training. There are currently 80 accredited residency programs in PM&R in the United States. Many physiatrists choose to pursue additional fellowship training in a specific area of the specialty. Fellowships are available 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).
What Procedures Do They Perform? Click here for more information on pain management.
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Dr. Marlowe has been in practice privately since 1999, when he finished his PM&R residency in Philadelphia. Prior to this he completed a surgical internship in Oregon. He got his medical degree in 1995 from the University of Arkansas for Medical Sciences, during which time he published his medical school text, Medico Mnemonica, a compilation of medical memory tools. Before he was Dr. Marlowe, Mr. Marlowe went to college at
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the University of California in Riverside, studying biomedical sciences with a minor in philosophy, and graduating with honors and with Phi Beta Kappa. Dr. Marlowe went into the field of PM&R because of the tremendous need for it in Southern California, his home. His goal in moving back was to educate people about this amazing field, and to provide the "gate-keeper" role for people with injuries and disabilites. Dr. Marlowe founded The Marlowe Institute for Sport, Spine and Nerve in 2003. His vision is a multidisciplinary group of physicians and other providers, whose common goal is restoring lost function. His Institute works in conjunction with other local physicians, physical therapists, and chiropractors.