Physiatrist

What is a physiatrist?

A physiatrist is a doctor who manages illnesses and injuries that make it hard for you to do necessary or desired tasks — like going to work, taking care of your family or engaging in hobbies. These are typically conditions affecting your skeletal system or nervous system. But physiatrists gain a broad base of knowledge on the entire human body. This allows them to see the big picture of how a condition affects your physical functioning and quality of life.

Maybe you’ve lived with pain or other symptoms for years and have come to accept this is what life feels like. Or maybe you were recently in a car accident or got injured at softball practice. One minute you were active and feeling great, but now you have pain when getting out of bed, washing your hair or even just sitting still.

Whatever the cause and however you’re feeling, physiatrists take the time to get to know you and your needs. They design a treatment plan unique to you. The goal is to find nonsurgical options for managing your symptoms so you can move and function better from day to day.

What is physiatry?

Physiatry is a branch of medicine that focuses on preventing, diagnosing and treating medical conditions that affect how well you can function in your daily life. These include conditions that can be disabling. Physiatry involves finding treatments other than surgery to help you feel better.

Physical medicine and rehabilitation (PM&R) is another name for physiatry. Both terms refer to the same medical specialty. That’s why other names for a physiatrist include:

• Physical medicine and rehabilitation (PM&R) doctor.
• PM&R physician.
• Rehabilitation doctor.

What does a physiatrist do?

Physiatrists diagnose and treat medical conditions that limit your mobility, activities or interactions with the world around you. These include conditions that affect your ability to move, walk, eat, speak or complete activities of daily living (ADLs) like bathing and getting dressed.

Physiatrists work with many other healthcare providers — including your primary care provider and other specialists — to coordinate your care. You may see a physiatrist for yourself or a loved one, including your child. Physiatrists work with children and adults of all ages, from infancy on up.

You’ll likely work with a physiatrist for a long time, especially if they’re helping you or a loved one manage a chronic condition.

What conditions do physiatrists manage?

In adults, physiatrists help manage a wide range of conditions, including:

• Age-related changes (like reduced bone density).
• Cancer (including side effects of treatment).
• Chronic obstructive pulmonary disease (COPD).
• Chronic pain.
• Heart conditions that require rehab.
• Injuries.
• Joint diseases (like arthritis or bursitis).
• Parkinson’s disease.
• Scleroses (like MS and ALS).
• Spinal cord injury.
• Stroke.

These are just some examples. Physiatrists manage many other chronic conditions that affect your ability to move and do the things you want and need to do.

In children, physiatrists most commonly manage:

• Acute flaccid myelitis.
• Amplified musculoskeletal pain syndrome (AMPS).
• Brachial plexus injury.
• Cerebral palsy.
• Complex regional pain syndrome.
• Ehlers-Danlos syndrome.
• Muscular dystrophy.
• Pediatric stroke.
• Scoliosis.
• Spina bifida.
• Torticollis.
• Traumatic brain injury.

How do physiatrists diagnose a condition?

To diagnose your condition, your physiatrist will do a thorough physical exam and possibly a neurological exam. They’ll ask about your medical history and talk to you about your symptoms. They may also order testing, including:

• Blood tests.
• Electromyography (EMG).
• Magnetic resonance imaging (MRI).
• Nerve conduction study.
• X-rays.

Your doctor will explain what each test involves and go over the results with you.

Physiatrists are trained to see you as a whole person and to consider how a condition affects your mind, body and spirit. When diagnosing your condition and its underlying cause, they also consider questions like:

• How does your condition affect your life?
• What specific movements or activities are challenging?
• What does the condition keep you from doing?
• What would you like to do?
• How does this condition affect your mental health?

Your physiologist will use all this information to decide the best treatment plan for you.

What treatments do physiatrists offer?

Physiatrists offer nonsurgical treatments that target symptoms and/or help your body heal itself. Many conditions aren’t curable, so physiatrists use treatment to help you function from day to day with as much independence as possible. Treatment typically manages symptoms like pain, muscle weakness, spasticity and abnormal sensations (paresthesia).

Examples of specific treatments your doctor might give you or order for you include:

Injections

• Trigger point injections.
• Injections to ease joint pain.
• Epidural steroid injections (ESIs).
• Botulinum toxin injections.

Therapies

• Physical therapy.
• Occupational therapy.
• Speech therapy.
• Hydrotherapy.
• Osteopathic manipulation treatment (OMT).

Procedures

• Functional electrical stimulation (FES).
• Transcutaneous electrical nerve stimulation (TENS).
• Vertebroplasty and kyphoplasty.
• Integrative medicine techniques.

Things you use in your daily life

• Prosthetics and orthotics.
• Assistive devices (like wheelchairs and walkers).
• Changes in your living space.
• Medications.

Where do physiatrists work?

Physiatrists work in:

• Hospitals.
• Rehab centers.
• Private practices.

When should I see a physiatrist?

You may benefit from seeing a physiatrist if you:

• Have a chronic condition or injury that causes pain or difficulty moving as you go about your daily tasks.
• Are recovering from a stroke.
• Had surgery and are experiencing pain or limited mobility as you recover.
• Experience exhaustion, pain or discomfort due to treatment for a medical condition.
• Can’t move as easily or comfortably as you’d like for any reason.

How do I become a physiatrist?

Here are the basic steps you take to become a physiatrist:

• Earn an undergraduate degree (pursuing a pre-med track is helpful).
• Go to medical school to earn a Doctor of Medicine (MD) or Doctor of Osteopathy (OD) degree.
• Complete a residency in physical medicine and rehabilitation (PM&R).
• Follow the requirements in your state to earn your license to practice medicine.
• Pass the two-part certification exam offered by the American Board of Physical Medicine and Rehabilitation to get board-certified in PM&R.
• Complete a fellowship to gain experience in a subspecialty.
• Take a subspeciality exam for an additional board certification.
• Begin work as a physiatrist and complete continuing education tasks as you advance in your career.

Physiatrist subspecialties

Once you get certified in PM&R, you may choose to gain experience and get certified in a more focused area called a subspecialty. The American Board of Physical Medicine and Rehabilitation offers exams in the following seven subspecialties:

• Brain injury medicine.
• Hospice and palliative medicine.
• Neuromuscular medicine.
• Pain medicine.
• Pediatric rehabilitation medicine.
• Spinal cord injury medicine.
• Sports medicine.

Physiatrist vs. physical therapist — what’s the difference?

Physiatrists and physical therapists are two different types of healthcare providers who share a common goal — helping you feel better and move around more comfortably as you go about your day. These providers differ in the training they receive and the specific kinds of care they give you.

Physiatrists attend medical school to become doctors. Physical therapists complete a physical therapy program to earn a Doctor of Physical Therapy (DPT) degree. Their different types of training qualify these providers to do different types of tasks:

• Physiatrists can diagnose medical conditions and prescribe medications.
• Physical therapists can’t diagnose medical conditions or prescribe medications. But they can reach a physical therapy diagnosis (PTD), which is sometimes called a functional diagnosis (FD). A PTD or FD identifies specific movement limitations that you’re experiencing. It also describes their severity, how they affect your life and how intervention might help.

While your physiatrist’s diagnosis will identify the specific condition you have and its cause, your physical therapist’s diagnosis will identify the effects of that condition on your ability to move and function.

For example, your physiatrist might diagnose you with osteoarthritis of the knee. Your PT might then evaluate you and diagnose you with reduced range of motion in your knee, which affects your ability to walk around your workplace or even within your home.

Physiatrists and physical therapists typically work together to coordinate your care. Your physiatrist will diagnose your medical condition and make sure it’s safe for you to do physical therapy. They’ll then refer you to see a physical therapist.

As part of their referral, your physiatrist will include information about your condition that will help your physical therapist develop an appropriate care plan. Your physical therapist will then create a therapy plan and work with you on a regular basis from that point on. Your physiatrist and physical therapist will stay in contact about your progress and update each other on any changes.

Psychologist vs. physiatrist — what’s the difference?

Psychologists and physiatrists are two different types of healthcare providers who specialize in different areas.

A psychologist is a mental health professional who uses talk therapy (psychotherapy) to treat a wide range of mental health disorders. Psychologists also help you cope with life stressors, whether they’re temporary or last a long time.

Physiatrists are doctors who diagnose and treat a wide range of conditions affecting your physical body — specifically, your skeletal system and nervous system. These are often conditions that cause pain and other symptoms that affect your daily life.

A psychologist can’t diagnose or treat such medical conditions. But they can talk to you about how the condition is affecting your life and help you find ways to cope. Many people living with chronic pain or other illnesses affecting their bodies find it helpful to meet with a psychologist to support their mental health.

Psychologists attend graduate school to earn a Doctor of Philosophy (PhD) degree. Physiatrists attend medical school to earn an MD or DO degree.

How do you pronounce physiatrist?

There are two ways to pronounce physiatrist:

• Fizz-EYE-uh-trist.
• Fizz-ee-AT-trist.

You may hear your provider use either physiatrist pronunciation. Both are correct according to the Merriam-Webster dictionary.

A note from Cleveland Clinic

One diagnosis can have a ripple effect on your entire life. Physiatrists understand this, and they’re prepared to help you manage your condition in all its complexity. They understand that your condition doesn’t just affect your arm, or your leg or your back — it affects you, all of you, including your thoughts, emotions and vision for the future.

If you schedule a meeting with a physiatrist, be prepared to share what you’re feeling and what you hope to achieve through treatment. Your doctor will listen to you and create a plan with your goals and priorities at the center.