The state of physical medicine: A broad specialty ready to assist physicians and patients

Physical medicine and rehabilitation is a broad specialty serving patients from children to seniors across a wide range of conditions, from catastrophic acute injuries to chronic musculoskeletal problems, The specialty's biggest external challenge is that rehabilitation is often treated as an afterthought in medical care, with physicians and health systems focused on immediate treatment rather than involving rehabilitation specialists early enough to help patients return to their lives more quickly and effectively. John C. Cianca, M.D., FAAPMR, president of the American Academy of Physical Medicine and Rehabilitation, explains more.

Medical Economics: Regarding the specialty, what's the biggest challenge facing the specialty right now?

John C. Cianca, M.D., FAAPMR: Well, physical medicine is a broad specialty. We take care of kids to senior adults, and we do so across the spectrum of medicine, insofar as we take care of people who have acute injuries that are catastrophic in nature, to more longstanding issues that are day-to-day. So my end of the field is less in the catastrophic realm, and more in the day-to-day musculoskeletal injuries that slow people down but don't necessarily leave them disabled, at least not permanently. My colleagues, on the other hand, take care of people who are impaired permanently, usually [due to a] brain injury, amputees, effects of stroke. Internally, one of our challenges is appealing to everybody in the field in a way that's common to everyone. Reaching everybody across their varied practices can be a little bit of a challenge internally, insofar as being able to be on message for everyone.

Externally, it's a longstanding issue that rehab is sometimes an afterthought. There's acute care medicine. Everybody thinks in terms of, OK, what are we going to do right now? How are we going to treat these people? Can we keep them alive? But what are you going to do after that? And that's where we come in. And so sometimes that’s overlooked or not appreciated till the wheels are already in motion. So I would say recognition of what we do, how we fit into the picture of medicine as a whole, and getting us involved early enough that we can make a difference sooner and more efficiently. Basically, getting people back to their lives.