All about PM&R

What I wish other doctors knew about PM&R

Physical medicine and rehabilitation specialists often collaborate with other doctors. Here’s what you need to know about PM&R.

As a physical medicine and rehabilitation resident at the University of Texas Health Science Center in San Antonio, I greatly enjoy connecting and collaborating with physicians from other specialties. In my experience working with other specialists, I’ve thought of a few things that might be helpful for them to know about my specialty. Please see below for what you should know about PM&R.

There is no “N” in PM and R

PM&R stands for physical medicine and rehabilitation. The field is also known as physiatry or rehabilitation medicine. PM&R physicians are also called physiatrists. If I had a dollar for every time I saw “consult PMNR” written in other specialists’ notes, I wouldn’t have any student loans to worry about.

Physiatry is a broad specialty and physiatrists practice in a variety of clinical settings, including inpatient and outpatient. We have a deep understanding of the neurological and musculoskeletal systems. We tailor our medicine to optimize our patients’ overall function and quality of life.

You can consult us for more than disposition

We get many consults for patients’ disposition – whether they are safe to go home or whether they need inpatient care such as inpatient rehabilitation facility (IRF), skilled nursing facility (SNF) or long-term acute care (LTAC). While we are happy to help determine a patient’s disposition, it is often helpful for us to get involved with the patient’s care earlier than discharge so that we have a better understanding of their medical condition and functional status.

So what else can you consult us for? Some of the most common diagnoses we help with on the inpatient side include brain injuries, strokes, spinal cord injuries, musculoskeletal injuries such as hip fractures and amputations and neurologic conditions such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS) and Parkinson’s disease … and so much more!

Some of the most common symptoms we can help with are pain, spasticity, skin and soft tissue injuries, agitation and bowel and bladder issues (e.g. neurogenic bowel and bladder). We love to be consulted early so we can help with these things and prevent further complications – you can even consult us while the patient is in critical care.

If you do need help with disposition, we will typically ask for both physical and occupational therapy evaluations so that we can assess the patient’s functional status. So if you have these consults placed in advance, things will move faster!

We are not physical therapists

While we do work very closely with therapists – including physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP) – and often prescribe or recommend therapy based on a patient’s functional deficits, we are not therapists.

On the inpatient side, we often round on our patients in the gym and observe them in therapy, however, we leave the exercise regimens and physical modalities to the therapists. We focus on the medicine, ensuring that we are supporting our patient to make therapy and recovery as safe as possible.

Inpatient rehab isn’t for everyone

Everyone can benefit from some therapy, right? Well sure, but IRF level of care is meant for patients who require physician supervision and active medical management while undergoing an intensive therapy program. If we don’t recommend IRF for a patient you are rooting for, know that we do have reasons for our recommendations.

The CMS guidelines outline the criteria we use to determine a patient’s eligibility for IRF. As stated above, the patient must require physician supervision by a rehabilitation physician due to medical complexity and also require an interdisciplinary team approach including nursing, social work/case management and licensed/certified therapists.

The patient must require active and ongoing therapeutic intervention of multiple therapy disciplines in an intensive rehabilitation program. This intensive program must consist of at least three hours of therapy per day at least five days per week, which the patient must be capable of participating in. The patient must also be capable of making measurable functional improvements.

Patients that do not meet these criteria may benefit instead from a lower level of care such as at a SNF or LTAC or be able to return home with home health or outpatient therapies.

Many physiatrists practice in the outpatient setting

PM&R isn’t just about IRF. In fact, inpatient rehab is only a small portion of the field of PM&R. You can refer your patients to an outpatient physiatrist for diagnoses such as spinal cord injuries, brain injuries, strokes, musculoskeletal injuries and more.

We specialize in nonsurgical management of pain, spasticity, bowel and bladder dysfunction. We are skilled in procedures such as electromyography (EMG), nerve conduction studies (NCS), spasticity management (e.g. botulinum toxin injections, phenol injections and intrathecal baclofen pump management), peripheral joint injections, trigger point injections and interventional spinal therapeutics.

Additionally, many physiatrists go on to fellowships to further specialize in sports medicine, pain medicine, brain injury medicine, spinal cord injury, pediatric rehab and even cancer rehab.

Connect with me

You can connect with me, Nicolet Finger, DO, on my blog, Instagram, TikTok or YouTube.

Related reading:

California DO thrives as an OMM specialist in a hospital system

Is there still an art to practicing medicine?

4 comments

  1. Michael Brogna, MD

    Dr. Finger, Thank you for this article. I am a practicing Internist for many years. During my residency I had the opportunity to do a month long elective rotation in PM&R with a great clinician. I am so glad that I did because it was a really informative experience and I have used it over the years in my practice. Your article gives very practical advice for primary care physicians. Thanks again

  2. Timir banerjee

    The late Dr. Ernest Johnson was one of my professors at OSU during residency. As a neurosurgical resident I learned so much from him.

  3. John T. Hinton, DO, MPH

    Excellent for information and challenge to others of us in the profession. I work regularly from a health plan platform as a medical director with PM&Rs on site at many facilities. More dialogue with them has facilitated improved patient/member outcomes and efficient use of health care resources. DO PM&Rs really get the whole bio-psycho-social approach to care. We need more of them.

Leave a comment Please see our comment policy