February 21, 2025 | Brain Science

Physiatry: An Introduction to PM&R–Part 1

What is Physiatry?

Physical Medicine and Rehabilitation (PM&R) physicians, also known as physiatrists, treat a wide variety of medical conditions that affect the central nervous system (the brain and spinal cord), the peripheral nervous system (other nerves), and the musculoskeletal system (the bones, joints, and associated soft tissues). Physiatrists have extensive training to treat medically complex, disabling, and painful conditions in adults, adolescents, and children.

Physiatrists complete four years of training and achieve primary board-certification by the American Board of PM&R (ABPM&R). They may also be certified in one or more of the following medical subspecialty areas with additional training and examinations: Brain Injury Medicine, Hospice and Palliative Medicine, Neuromuscular Medicine, Pain Medicine, Pediatric Rehabilitation Medicine, Spinal Cord Injury Medicine, and/or Sports Medicine.

PM&R/Physiatry can be difficult to describe to patients, families, and even healthcare providers because physiatrists treat such a broad and diverse range of conditions. This is unfortunate, because many patients, from those with concussions to those with chronic pain could benefit from physiatry expertise.

Growth of Physiatry

Here are the numbers of Board-certified physiatrists from the 1940s to 2024:

The field grew relatively slowly from its founding after World War II into the 1980s. Training numbers then began to increase sharply and now there are more than 15,000 Board-certified physiatrists in the US. The map below shows the location of the 98 US PM&R residency training programs. The striking geographic variation means many patients may not be able to access physiatric care. We need to continue the progress.

PM&R Residency Programs

Lawyer and historian Richard Verville discusses the Progressive Era (1890s to 1920s) approach to political and social problem-solving in the US in his book War, Politics, and Philanthropy: The History of Rehabilitation Medicine. Verville argues that the Progressive Movement’s discontent among workers, farmers, and those wounded in wars joined with public health problems such as the 1919 flu pandemic to lay a foundation for PM&R to emerge and grow. The Great Depression drew this period to a close and devastated the county. Presidents Theodore Roosevelt and Woodrow Wilson, and social reformers such as Jane Addams and Frances Perkins Gilman, led efforts to address unrest and misery by establishing social programs and public benefits for US citizens and advancing women’s rights.

Here is a link to a timeline that tracks the growth of physiatry with associated Federal government programs, in particular, for those with disabilities and the elderly.

Some of our current polarizing circumstances resemble those that gave impetus to the medical specialty of PM&R. In my 2025 blogs, I’ll cover other aspects of the history of PM&R and the evolution of physiatric therapies and approaches to treatment.

(featured image at top, © Photo: Susan Freundlich.)

Physiatry Perspectives form the Association of Academic Physiatrists

A Brief History of PM&R

November 19, 2021

Brain Science

In this podcast, Dr. Elizabeth Sandel gives a brief history of the medical specialty of PM&R. She outlines the major US and world events that helped to lay the foundation for physical and rehabilitation medicine. She emphasizes the role of early leaders such as Frank Krusen, Howard Rusk and others who helped to establish the field within organized medicine.

Dr. Elizabeth Sandel: Former AAPM&R Executive Discusses Critical Elements of the Field

September 28, 2017

Brain Injury Diagnosis & Treatment, Diagnostics, Mental Health Services, Procedures, Rehabilitation Therapies

In part one, Dr. Sandel talks about physical medicine and rehabilitation and it’s broad scope. In part two, she discusses her mission to educate the public about brain injuries, including concussion. In part three, she discusses what happens to the brain with concussions and repeated concussions. She ends with a case of a patient with a complex diagnosis after a traumatic event that required the diagnosis in order for the best treatment approaches.