Of everything that’s changed in the one year since the WHO declared COVID-19 a pandemic, one medical specialty is finally getting its turn in the spotlight. Physiatrists have become key players in the rehabilitation of COVID-19 patients.
What is physiatry?
A physiatrist is a physician who specializes in physical medicine and rehabilitation, also known as physiatry or rehabilitation medicine. Because they trained in physical medicine, these rehab doctors focus on the care and recovery of the whole person rather than a specific organ or system.
With a multi-faceted approach to care, physiatrists collaborate with cardiologists, pulmonologists and others to diagnose a patient’s needs and direct a rehabilitation plan to ensure the best possible outcomes. And they work directly with all therapy and nursing teams to carry out the treatment plans.
Physiatry was already becoming more popular prior to the pandemic because of the growing number of aging Baby Boomers and the fact that people are living longer with advanced medical treatment. The number of COVID-19 patients needing rehabilitation has made physiatry even more necessary.
Glen Rundell, the founder and CEO of National Physiatry, has been providing physiatrists to skilled nursing facilities and other post-acute rehab settings for more than a decade, and says he’s only now seeing more recognition among colleagues.
Physiatry vs. physical therapy
People often mistake physiatry for physical therapy for good reason. Both providers focus on rehabilitation and work closely together to treat the same conditions. However, a physiatrist is a medical doctor with four years of medical school and four years of residency training.
Physiatrists diagnose and identify patient issues and work collaboratively with therapy and nursing teams to develop a recovery and post-recovery plan. The physiatrist measures the patient’s improvement, and equally important, identifies declines and pain for prompt intervention.
Physiatrists direct a comprehensive rehabilitation team of professionals that can include physical therapists, speech therapists, occupational therapists and recreational therapists, along with psychologists, social workers, and others. They work closely with the rehab team in skilled nursing facilities to ensure residents get a holistic therapy approach.
How the role of physiatry has changed due to COVID-19
The need for physiatrists has grown during the pandemic and is expected to grow even more as an increasing number of patients need rehabilitation.
Glen says, “Physiatrists are optimally suited by way of the unique combination of medical and functional knowledge to work with patients with COVID-19 or post-COVID-19 symptoms, now called long COVID-19 or long haul COVID-19. They work to maximize physical functioning, decrease or eliminate pain, and foster independence, while also addressing the individual’s physical, emotional, medical, vocational and social needs.”
Many with long COVID-19 symptoms, now called “long haulers,” may suffer with issues of the heart, lungs and kidneys, as long as six months afterward, even if they weren’t hospitalized.
That’s why a multi-disciplinary approach is especially important involving cardiologists, pulmonologists, psychologists and others.
Of course, any particular illness or disease can affect multiple areas of the body, but the sheer scale of people faced with COVID-19 globally means that specialists in multiple areas are having to collaborate in new ways to find the best treatments.
Cheryl Slavinsky, vice president of National Physiatry, has consulted in the healthcare and senior living profession for several decades, often promoting innovations. She’s excited about physiatry and says, “Physiatrists are all about function. They look at the whole body, the whole person from all angles whether physical or psychological to help them.”
The goal of National Physiatry is to bring continuous care to patients. They see themselves as the key to unlocking the power of rehab in skilled nursing facilities, improving their effectiveness and patient outcomes.
Glen says, “If a patient goes to the hospital for a procedure, they may spend days in a higher level of acuity care. In that scenario, they will be discharged to short-term rehab and then back home. The idea of physiatry is to ensure continuity of care so the patient sees improvement in each step.”
According to Cheryl, “Physiatrists are jazzed about the opportunities they have for the future right now. Recently a group of physiatrists shared results of post-COVID clinics they started in Boston and New York last year. These physiatry-led post-COVID clinics have had success pulling in other specialties like cardiology and pulmonology to establish a web of specialists.”
Physiatrists treat patients with all levels of acute care for rehab
The nature of physiatry allows physiatrists to see patients with a wide range of challenges.
Some of the common conditions physiatrists treat are the following:
- Cardiovascular issues
- Injuries from falls
- Stroke or other brain injury
- Neuromuscular disorders
- Spinal cord injuries
- Parkinson’s disease
- Multiple sclerosis
- Guillain-Barre syndrome
- Cancer rehabilitation
Physiatrists have been uniquely qualified to treat patients with COVID-19 symptoms or post-COVID symptoms.
Glen says, “Research has shown that people with COVID-19 commonly experience anxiety, insomnia, depression, and post-traumatic stress disorder. So we may be dealing with psychological issues not only by the caused by the physical effects but pandemic stress and loneliness from isolation. That’s why our doctors often will work side by side with psychiatrists, cardiologists or pulmonologists in order to set that plan and determine the next steps for rehabilitation.”
Telehealth helps physiatrists support more patients in skilled nursing facilities
Telehealth has afforded physiatrists the opportunity to support more patients in a convenient way. Especially for Glen, who is also spearheading cardiology and pulmonology services, telehealth enables National Physiatry to see more patients regardless of their location.
National Physiatry was already using telehealth in rural areas about a year prior to the pandemic, but insurance barriers were removed during the pandemic, making this an even more popular choice.
Physiatry provides umbrella of care
National Physiatry partners with other specialty providers to ensure the best care for their patients. Glen says, “We work with specialists in cardiology, pulmonology and nephrology, always seeking continuity of care and the best outcomes for our patients.”
Cheryl calls physiatry “a new frontier because it brings so many different specialties together and provides a huge opportunity for healing.”
Physiatrists support recovery through custom treatment
Following the patient’s discharge from the hospital and then through each stage of recovery, the team at National Physiatry sets a custom plan for each patient for ongoing treatment. Glen says, “If a patient is not being discharged at their original functioning level, they will be discharged to an outpatient or home-health program. Or they may need a short-term rehab program like many skilled nursing/rehab centers offer. The idea is to get them back to previous levels of function.”
The physiatrist is available to speak with families about the patient’s continued care, which has been especially important during the pandemic. Cheryl says, “The education piece is important to get everyone on the same page. It makes a huge difference improving the communication between families, therapists and physicians. The customer satisfaction is higher, and the referrals and census increase, so it’s beneficial all-around.”
Communication and education are key to bringing awareness to physiatry. Cheryl says, “I get excited about the opportunity to share the benefits of physiatry because just a few years ago I didn’t even know what it was. It’s new to many people because physiatrists often worked behind the scenes in hospitals and in-patient rehab facilities that were affected by the pandemic. Physiatry has the potential to help so many people in skilled nursing and beyond, so education and communication are important.”