What is Physiatry?
Physiatry is a medical specialty that trains physicians specifically to identify and treat functional loss, making physiatrists uniquely suited to restore independence and maximize quality of life in patients with disabilities, pain, or physical impairments affecting the musculoskeletal system, brain, and spinal cord. 1
Core Definition and Scope
Physiatrists are physicians who specialize in Physical Medicine and Rehabilitation (PM&R), focusing on maximizing functional outcomes rather than curing disease. 2 The specialty is also known as "rehabilitation medicine" and represents the second-fastest-growing medical specialty in the United States. 2
Primary Focus Areas
- Functional restoration: Physiatrists diagnose and treat patients with the goal of maintaining or restoring function, reducing symptom burden, maximizing independence, and improving quality of life 1
- Disability management: They provide care primarily for patients who have disabilities or physical impairments, working to restore meaning to life while reducing the duration and costs of disability 3
- Pain management: Physiatrists are invaluable in treating musculoskeletal pain through accurate diagnosis and a wide range of treatment modalities 4
Clinical Approach and Philosophy
Physiatric assessment focuses on deficiencies at a physiological and functional level rather than being driven solely by medical diagnosis. 1 This approach leads to identification of specific functional problems and prescription of targeted interventions.
Treatment Philosophy
- Least invasive first: Emphasis is placed on using the least invasive modality before employing more invasive treatments 4
- Comprehensive evaluation: Physiatrists assess body composition, aerobic capacity, strength, flexibility, and balance to guide treatment planning 1
- Interdisciplinary coordination: The interdisciplinary team-management system is the key to success of physiatric services 2
Treatment Modalities
Physiatrists provide a comprehensive range of interventions including:
- Management of pain medications 4
- Osteopathic manipulative therapy 4
- Trigger point injections 4
- Intra-articular steroid injections 4
- Orthobiologic therapy 4
- Interventional spinal procedures 4
- Exercise prescription and physical activity promotion 5
- Diagnostic imaging and electrodiagnostics 2, 6
Role in Healthcare Teams
Physiatrists typically coordinate the rehabilitation team and manage medical conditions pertaining to various diagnoses and comorbidities. 1 They work collaboratively with other healthcare professionals including:
- Physical therapists (who focus on neuromuscular problems affecting movement) 1, 5
- Occupational therapists (who address skills of living necessary for independence) 1
- Speech-language pathologists 1
- Rehabilitation nurses 1
- Social workers 1
Unique Positioning
Physiatrists are particularly well-suited to assist in the acute and long-term management of medically complex patients, including those with cancer, stroke, spinal cord injury, cerebral palsy, muscular dystrophies, multiple sclerosis, and rheumatoid arthritis. 1, 3
Clinical Settings
Physiatrists practice in both inpatient and outpatient settings 4:
- Inpatient: Acute rehabilitation hospitals, skilled nursing facilities, long-term care facilities 1
- Outpatient: Clinic-based practice focusing on pain management and functional restoration 4
- Community: Integration with community-based exercise and wellness programs 1
Growing Importance
The need for physiatrists is increasing with the aging population, expanding workforce of older adults, and growing population of people with disabilities, especially since the COVID-19 pandemic. 4 Despite this growing need, there are relatively few rehabilitation specialists available to meet the demands of the population requiring these services. 1