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Background: Physical medicine and rehabilitation (PM&R) is a diverse specialty, growing and evolving over a variety of subspecialty and practice focus areas. Accurate data regarding practice patterns of physiatrists are essential for updating requirements in training and certification, particularly as the Accreditation Council for Graduate Medical Education begins its process to update of the PM&R core residency training requirements. This study analyzes practice trends for nearly 98% of physiatrists in active practice, the largest study to date., Objective: To update current demographics of physicians specializing in PM&R, including current areas of practice focus, to analyze the alignment of practice focus with subspecialty certification, and to determine the extent that electromyography is a component of current physiatric practice., Design: Retrospective analysis of deidentified responses from American Board of Physical Medicine and Rehabilitation (ABPMR) board-certified PM&R physicians (diplomates) on annual enrollment in the ABPMR Continuing Certification program., Participants: A total of 9543 ABPMR diplomates., Main Outcome Measures: Demographics - age, gender, years in practice, practice setting(s) and area(s). Practice focus, subspecialty certifications., Results: The majority of practicing physiatrists are men (62%) although the percentage of women in the field is growing (38%). Nearly 80% of physiatrists report more than one practice focus area, with pain medicine and sports medicine/musculoskeletal practices most commonly reported., Conclusions: This study confirms the growth trends in PM&R in pain and sports medicine but also highlights the substantial number of physiatrists focusing their practices in areas related to neurorehabilitation and medical rehabilitation. The large majority of physiatrists incorporate multiple focus areas into their practices. Electromyography is a focus for a declining percentage of practicing physiatrists., (© 2023 American Academy of Physical Medicine and Rehabilitation.)

Abstract: When developing a new medical device, it is essential to assess the usability of such a device through various stakeholders.This study assessed the usability of pain medical devices through a Delphi survey administered to physiatrists and physiotherapists.A Delphi survey was conducted on the problems and improvements in hardware and software for a panel consisting of 10 physiatrists and 10 physiotherapists. A total of 3 rounds of surveys were conducted, and the third round of survey was confirmed through a Likert scale (1 = strongly agree to 5 = strongly disagree).The 2 groups generally had a common perception of the problems and improvements in pain medical devices. However, the physiatrist group mostly identified problems such as linking patient information, whereas the physiotherapist group deemed hardware problems such as device weight or connection cables as being more important (mean [standard deviation]; physiatrist, hardware 2.90 [0.93], software 2.28 [0.91] / physiotherapist, hardware 3.04 [0.84], software 3.03 [1.13]).To date, analysis has not been conducted by dividing the focus of various stakeholders using pain medical devices. The difference in view of the usability of these 2 stakeholder groups should be considered when improving the hardware or software of pain medical devices in the future. Further research is warranted to investigate other stakeholders such as patients and device developers to improve the devices., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: The aim of this study was to assess the current and future adequacy of physiatrist supply in the United States., Design: A 2019 online survey of board-certified physiatrists (n = 616 completed, 30.1% response) collected information about demographics, practice characteristics, hours worked, and retirement intentions. Microsimulation models projected future physiatrist supply and demand using data from the American Board of Physical Medicine and Rehabilitation, national and state population projections, American Community Survey, Behavioral Risk Factor Surveillance System, Medical Expenditure Panel Survey, and other sources., Results: Approximately 37% of 8853 active physiatrists indicate that their workload exceeds capacity, 59% indicate that workload is at capacity, and 4% indicate under capacity. These findings suggest a national shortfall of 940 (10.6%) physiatrists in 2017, with substantial geographic variation in supply adequacy. Projected growth in physiatrist supply from 2017 to 2030 approximately equals demand growth (2250 vs. 2390), suggesting that without changes in care delivery, the shortfall of physiatrists will persist, with a 1080 (9.7%) physiatrist shortfall in 2030., Conclusion: Without an increase in physiatry residency positions, the current national shortfall of physiatrists is projected to persist. Although a projected increase in physiatrists' use of advanced practice providers may help preserve access to comprehensive physiatry care, it is not expected to eliminate the shortfall., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The aim of the study was to describe the current physiatrist workforce in the United States., Design: An online, cross-sectional survey of board-certified physiatrists in 2019 (N = 616 completed, 30.1% response) collected information about demographic and practice characteristics, including age, sex, practice area, practice setting, hours worked, patient characteristics, staffing, and work responsibilities. Physiatrists were stratified by substantive practice patterns using a cluster analysis approach. Survey responses were arrayed across the practice patterns and differences noted., Results: The practice patterns identified included musculoskeletal/pain medicine, general/neurological rehabilitation, academic practice, pediatric rehabilitation, orthopedic/complex conditions rehabilitation, and disability/occupational rehabilitation. Many differences were observed across these practice patterns. Notably, primary practice setting and the extent and ways in which other healthcare staff are used in physiatry practices differed across practice patterns. Physiatrists working in musculoskeletal/pain medicine and disability/occupational rehabilitation were least likely to work with nurse practitioners and physician assistants. Physiatrists working in academic practice, general/neurological rehabilitation, and pediatric rehabilitation were most likely to have primary practice settings in hospitals., Conclusions: Physiatry is an evolving medical specialty affected by many of the same trends as other medical specialties. The results of this survey can inform policy discussions and further research on the effects of these trends on physiatrists and physiatry practice in the future., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Intramuscular botulinum toxin injections are used for treatment of focal spasticity in children, particularly in those with a diagnosis of cerebral palsy. There are a variety of techniques used when performing botulinum toxin injections without clear standards for pediatric providers., Objective: To describe current practice techniques for botulinum toxin injections among pediatric physiatrists., Design: Cross-sectional survey using RedCap Software., Setting: Pediatric physiatrists who perform botulinum toxin injections., Participants: Survey of 307 pediatric physiatrists., Methods: Analysis of data from the 2017 practice survey of pediatric physiatrists in the United States., Main Outcome Measurements: Physicians were asked the primary botulinum toxin used, common dosing information, the role of localization, and the role of sedation and distraction in their practice., Results: Nearly all pediatric physiatrists use OnabotulinumtoxinA as the primary formulation of botulinum toxin. The maximum dose per body weight used per injection series had a median of 15 units/kilogram and a median maximum total dose of 500 units. Sixty-five percent of pediatric physiatrists report using sedation, of any type, for botulinum toxin injections. When using sedation, the most common primary method was general anesthesia (38.9%), followed by enteral or nasal anxiolytic with the patient awake (26.2%). The most common reported intended injection site for botulinum toxin was "in multiple sites spread throughout the muscle" (67.9%), and then "one site of the muscle at the motor point" (17.1%). Large muscles were injected using primarily anatomic guidance (75.6%) and electromyography (50.8%), and small muscles were primarily completed with electromyography (73.6%) and anatomic guidance (49.2%)., Conclusion: There is considerable variability present in one common procedure performed by pediatric physiatrists., Level of Evidence: NA., (© 2018 American Academy of Physical Medicine and Rehabilitation.)

Aim: This study aims to assess the attitudes and opinions of clinicians practicing in psychiatry toward pharmacogenomic testing, and in so doing elicits possible barriers and risks to employ this technology in patient care., Materials & Methods: Doctors and pharmacists presently practicing in psychiatry were invited to participate in an anonymous web-based survey. Besides information on participant characteristics and experience in psychiatry, specific themes on pharmacogenomics including self-assessed competency, perceived usefulness in clinical situations, perceived risks and preferred mode of education were evaluated., Results: A total of 81% of respondents believed that pharmacogenomic testing would be useful for identifying suitable treatments and 71% believed that pharmacogenomic testing would be useful for medication intolerance. However, only 46.4% felt competent to order these tests. There were significant differences in responses for gender, doctors versus pharmacists and seniority in position. A total of 94.3% of respondents were concerned about costs and 84.5% were concerned about the lack of clear guidelines on its use. A total of 98.5% of respondents were keen on learning more about the applicability of pharmacogenomics, and the most preferred format of education was a lecture (44.5%)., Conclusion: Most clinicians acknowledge the potential of pharmacogenomic testing in clinical practice. However, concerns with regard to its cost-effectiveness and the lack of clear guidelines are possible barriers to its clinical implementation.

Study Design: An observational study., Objective: The aim of this study was to evaluate the impact of a health plan's prior authorization (PA) programs for low back pain (LBP) in a non-Medicare population by assessing changes in pre-surgical nonoperative care; lumbar fusion trends; and overall back surgery rates compared with another health plan with a similar program and national benchmarks. The PA programs require mandatory physiatrist consultation before surgical evaluation, with subsequent additional LBP surgery PA., Summary of Background Data: LBP is prevalent and concern exists that spinal fusion is overutilized for LBP., Methods: Annual rates of lumbar fusion trended over 6 years, and analysis of changes in standardized costs for LBP-related services among a 501-member subset who underwent lumbar fusion before and after program implementations, during the period January 1, 2008, through December 31, 2013, among commercial members aged 18 and 65 years enrolled in a health maintenance organization with commercial membership averaging >500,000 annually., Results: After initiation of the physiatrist PA in December 2010, lumbar fusions decreased from 76.27/100,000 in 2010 to 62.63/100,000 in 2011 with subsequent increases to 64.24/100,000 and 73.84/100,000 in years 2012 and 2013. For members who had lumbar fusion, per-member, pre-surgical costs increased by $2,233 with the physiatrist PA and an additional $1,370 with implementation of the LBP surgery PA (March 2013). Spinal injections and inpatient admissions were the greatest contributors to the overall increase in costs. The physiatrist and LBP surgery PA programs were also associated with lengthening of LBP episodes ending in surgery by 309 and 198 days., Conclusion: Mandatory referral to a physiatrist before surgical evaluation did not result in persistent reduction in lumbar fusions. Instead, these programs were associated with the unintended consequence of increased costs from more nonoperative care for only a transitory change in the lumbar fusion rate, likely from delays due to the introduction of both PA programs., Level of Evidence: 3.