The state of physical medicine: Helping patients over time

While misconceptions about physical medicine and rehabilitation — known as physiatry — have faded over the decades, many primary care physicians still default to referring nonsurgical musculoskeletal cases to orthopedics rather than physiatrists, who are better suited for long-term, non-operative care. John C. Cianca, M.D., FAAPMR, president of the American Academy of Physical Medicine and Rehabilitation, discusses how PM&R physicians can develop relationships for long-term care.

Medical Economics: What misconceptions do you encounter about physical medicine and rehabilitation among primary care physicians, and what would you like PCPs to better understand about the scope and value of your specialty?

John C. Cianca, M.D., FAAPMR: I would say many of the misconceptions have cleared during my career. I mean, early on, we were looked at as inpatient doctors, and then my generation of physicians started doing outpatient and that early on was construed as chronic pain only, or back pain only. So over the course of my career now, we've been recognized more and more as experts in musculoskeletal care, from acute to chronic, post-surgical to nonsurgical. So I think a lot of those misconceptions have waned. But not everybody thinks of physiatry, physical medicine, first. They often still kind of default to orthopedics, and orthopedics certainly welcomes those kinds of cases. But if they're nonoperative, why would you send to an orthopedist? Because they're not going to be as interested in the long-term care of such an issue as we would. So physiatry is really a specialty that helps people across a spectrum of time, not just for an incident, and letting people know that, specialists or patients themselves, is still a bit of a challenge. You know, our ability to maintain a relationship with somebody beyond just an incident is still probably not top of mind for a lot of people.