Awareness of interventional radiology and image guided musculoskeletal interventions among orthopaedic surgeons, rheumatologists, and physiatrists: A multi-site analysis.

PURPOSE: Evaluate physicians who treat musculoskeletal (MSK) disorders in their knowledge of image-guided MSK interventions, and identify areas that could benefit from education. MATERIALS AND METHODS: A 17-question survey was distributed to orthopaedic surgeons, physiatrists, and rheumatologists in the 14-hospital health system. It inquired about demographics, practice environment, awareness of interventional radiology (IR) and MSK radiology (MSKR) training, referral patterns, and knowledge of image-guided MSK interventions. RESULTS: In total, 59 of 303 physicians completed the survey (41% orthopaedists, 35% physiatrists, and 24% rheumatologists). Most (93%) were attendings and 41% were female. A minority of survey respondents (17%) recognized the designation of IR as a distinct specialty of medicine per the American Board of Medical Specialties, in contrast to MSKR, which is not designated as a distinct specialty. When queried about IR procedures not under investigation, 24% selected genicular artery embolization and 31% selected embolization for adhesive capsulitis. Barriers to referral were as follows: 21% of specialists performed the procedure, 17% listed electronic medical record challenges, 14% reported scheduling difficulty, 13% reported no barriers, 11% reported difficulty consulting, 11% referred to another specialty, 10% did not have enough knowledge of image guided procedures, and 3% reported the procedure is not performed by IR or MSKR. CONCLUSIONS: Survey data reveal a knowledge gap among surveyed physicians regarding IR as a specialty as well as areas of IR research in MSK disorders. Findings suggest areas where referring physicians can be educated and identify barriers to referral.

Burnout and Wellness Strategies Used by Academic Physiatry Programs: An Analysis and Perspective From the AAP Chairs Council.

ABSTRACT: Physiatrists are at elevated risk of burnout, a work-related exhaustion syndrome resulting from chronic stress associated with emotionally draining work demands. The high reported rate of burnout in physical medicine and rehabilitation led the Association of Academic Physiatrists Chair Council to convene a workgroup to address burnout among academic physical medicine and rehabilitation physicians. The council recognizes that leaders of departments are accountable for all organizational stakeholders, including faculty, trainees, and staff. Department leaders are expected to understand and effectively manage the drivers of burnout among stakeholders. The workgroup identified several opportunities, including identifying and disseminating effective burnout mitigation across US academic medical center physical medicine and rehabilitation programs. As a result, in 2019, a work group conducted a survey of US academic physical medicine and rehabilitation program leaders to ascertain the use of strategies for reducing physician burnout. With the aim of identifying, educating, and advancing the development of effective interventions to address burnout among academic physical medicine and rehabilitation departments, the Association of Academic Physiatrists Chair Council advocates for increased education and utilization of effective strategies aimed at promoting physician well-being across organizational levels (national, organizational, work unit, and individual).

Occupational Characteristics Associated With Professional Fulfillment and Burnout Among US Physiatrists.

INTRODUCTION: Multiple national studies suggest that among physicians, physiatrists are at increased risk for occupational burnout. OBJECTIVE: The aim of the study is to identify characteristics of the work environment associated with professional fulfillment and burnout among US physiatrists. DESIGN: Between May and December 2021, a mixed qualitative and quantitative approach was used to identify factors contributing to professional fulfillment and burnout in physiatrists. SETTING: Online interviews, focus groups, and survey were conducted. PARTICIPANTS: The participants are physiatrists in the American Academy of Physical Medicine and Rehabilitation Membership Masterfile. MAIN OUTCOME MEASURES: Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index. RESULTS: Individual interviews with 21 physiatrists were conducted to identify domains that contributed to professional fulfillment followed by focus groups for further definition. Based on themes identified, scales were identified or developed to evaluate: control over schedule (6 items, Cronbach α = 0.86); integration of physiatry into patient care (3 items, Cronbach α = 0.71); personal-organizational values alignment (3 items, Cronbach α = 0.90); meaningfulness of physiatrist clinical work (6 items, Cronbach α = 0.90); teamwork and collaboration (3 items, Cronbach α = 0.89). Of 5760 physiatrists contacted in the subsequent national survey, 882 (15.4%) returned surveys (median age, 52 yrs; 46.1% women). Overall, 42.6% (336 of 788) experienced burnout and 30.6% (244 of 798) had high levels of professional fulfillment. In multivariable analysis, each one-point improvement in control over schedule (odds ratio = 1.96; 95% confidence interval = 1.45-2.69), integration of physiatry into patient care (odds ratio = 1.77; 95% confidence interval = 1.32-2.38), personal-organizational values alignment (odds ratio = 1.92; 95% confidence interval = 1.48-2.52), meaningfulness of physiatrist clinical work (odds ratio = 2.79; 95% confidence interval = 1.71-4.71), and teamwork and collaboration score (odds ratio = 2.11; 95% confidence interval = 1.48-3.03) was independently associated with higher likelihood of professional fulfillment. CONCLUSIONS: Control over schedule, optimal integration of physiatry into clinical care, personal-organizational values alignment, teamwork, and meaningfulness of physiatrist clinical work are strong and independent drivers of occupational well-being in US physiatrists. Variation in these domains by practice setting and subspecialty suggests that tailored approaches are needed to promote professional fulfillment and reduce burnout among US physiatrists.

Occupational Characteristics Associated with Professional Fulfillment and Burnout Among U.S. Physiatrists.

INTRODUCTION: Multiple national studies suggest that, among physicians, physiatrists are at increased risk for occupational burnout. OBJECTIVE: To identify characteristics of the work environment associated with professional fulfillment and burnout among U.S. physiatrists. DESIGN: Between May and December 2021, a mixed qualitative and quantitative approach was used to identify factors contributing to professional fulfillment and burnout in physiatrists. SETTING: Online interviews, focus groups, and survey. PARTICIPANTS: Physiatrists in the AAPM&R Membership Masterfile. MAIN OUTCOME MEASURES: Burnout and professional fulfillment assessed using the Stanford Professional Fulfillment Index. RESULTS: Individual interviews with 21 physiatrists were conducted to identify domains that contributed to professional fulfillment followed by focus groups for further definition. Based on themes identified, scales were identified or developed to evaluate: control over schedule (6 items; Cronbach's alpha = 0.86); integration of physiatry into patient care (3 items; Cronbach's alpha = 0.71); personal-organizational values alignment (3 items; Cronbach's alpha = 0.90); meaningfulness of physiatrist clinical work (6 items; Cronbach's alpha = 0.90); teamwork and collaboration (3 items; Cronbach's alpha = 0.89). Of 5760 physiatrists contacted in the subsequent national survey, 882 (15.4%) returned surveys (median age 52 years; 46.1% women). Overall, 42.6% (336 of 788) experienced burnout and 30.6% (244 of 798) had high levels of professional fulfillment. In multivariable analysis, each one-point improvement in control over schedule (odds ratio [OR] = 1.96; 95% confidence interval [CI] = 1.45-2.69), integration of physiatry into patient care (OR = 1.77; 95% CI = 1.32-2.38), personal-organizational values alignment (OR = 1.92; 95% CI = 1.48-2.52), meaningfulness of physiatrist clinical work (OR = 2.79; 95% CI = 1.71-4.71) and teamwork and collaboration score (OR = 2.11; 95% CI = 1.48-3.03) was independently associated with higher likelihood of professional fulfillment. CONCLUSIONS: Control over schedule, optimal integration of physiatry into clinical care, personal-organizational values alignment, teamwork, and meaningfulness of physiatrist clinical work are strong and independent drivers of occupational well-being in U.S. physiatrists. Variation in these domains by practice setting and subspecialty suggests tailored approaches are needed to promote professional fulfillment and reduce burnout among U.S. physiatrists.

High prevalence of insomnia among physiatrists in the Czech Republic: A web-based questionnaire survey.

BACKGROUND: Physicians who suffer from poor sleep quality are at an increased risk of mistakes and poor decision-making. We deemed it noteworthy to assess sleep quality in practicing physiatrists, previously reported to be at higher risk of physician burnout, which was documented associated with sleep deprivation. OBJECTIVE: The aim was to estimate the prevalence of sleep disturbance among practicing physiatrists and evaluate the association of sleep quality with their sleep hygiene habits and depression. METHODS: Of the 101 study participants (77 females) who met the inclusion criteria, the majority was between the age of 25 and 40 years (70.3%); 62 (61.4%) were specialists and 39 (38.6%) were in training. In this cross-sectional study, practicing physiatrists were invited to complete an anonymous and voluntary web-based survey. The survey consisted of questions covering demographic information, nicotine and caffeine consumption, exercise habits, and three questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the Beck Depression Inventory-II (BDI-II), and the Sleep Hygiene Index (SHI). RESULTS: Sixty-five (64.4%) respondents showed poor sleep quality (PSQI > 5), and 23 (22.8%) showed at least mild symptoms of depression (BDI-II>13). The mean PSQI, SHI, BDI-II scores were 6.85±3.09, 18.18±5.35, and 8.36±7.52, respectively. Poor sleep quality was significantly positively correlated with symptoms of depression and sleep hygiene misbehavior. CONCLUSION: We found that 64.4% of practicing physiatrists suffered from poor sleep quality, and 22.8% showed at least mild symptoms of depression. Considerable efforts should be directed toward sleep hygiene behavior and mental health improvement.

The Physiatrist's Guide to Cyclist Palsy: A Narrative Review.

TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: At the conclusion of this educational module, participants will be able to: (1) Describe the possible clinical presentations of Cyclist Palsy based on Ulnar nerve anatomy in the wrist and hand; (2) State the cycling-related risk factors for Cyclist Palsy; and (3) Outline the principles in management for Cyclist Palsy. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Telemedicine Use Among Physiatrists During the Early Phase of the COVID-19 Pandemic and Potential for Future Use.

Introduction: With the coronavirus disease 2019 (COVID-19) pandemic causing the need for social distancing, telemedicine saw a significant increase in use to provide routine medical care. As a field, physiatry had already been implementing telemedicine prior to the pandemic. In this study, we characterized the use of telemedicine among physiatrists during the early phase of the COVID-19 pandemic to understand the barriers and facilitators to implementing telemedicine use in the field of physiatry in the future. Methods: Online survey of a cross-sectional sample of physiatrists. Analysis was conducted using logistic regression. Results: One hundred seventy one (n = 171) participants completed the survey. Before the pandemic, only 17.5% of respondents used telemedicine. In the logistic regression, physicians who used a hospital-provided platform were more likely to use telemedicine in the future compared with those who used their own secure platform, conducted a phone visit, and used a non-secure platform or other platforms. The three most popular barriers identified were "inability to complete the physical examination," "patients lack of access to technology," and "patients lack of familiarity with the technology." Discussion: Focus on education on telemedicine functional examination strategies and technology strategies for patients and providers (including addressing the digital divide and hospital-provided secure platforms) are potential targets of implementation strategies for greater telemedicine uptake for physiatrists in the future.

[Consensus measurement of innovation in physical medicine and rehabilitation]. / Medida por consenso del estado de la innovación en medicina física y rehabilitación.

OBJECTIVE: To measure by consensus the level of innovation and its potential within the physical medicine and rehabilitation (PM&R) medical specialists. METHOD: Three consecutive techniques are applied using digital tools for consensus among professionals, first synchronously to a group of 17 professionals; posteriorly extended to a group of 169 professionals who participate asynchronously and the third technique is done synchronously with 25 physiatrists. RESULTS: The analysis of the consensus done by the PM&R physicians on the innovation potential of the group during October and November 2020 shows: starting situation, strengths and weaknesses, as well as their innovation priorities. CONCLUSIONS: PM&R physicians believe that innovation could improve the cost-effectiveness of their departments, and could increase their clinical efficiency, also that to innovate they need a close relationship with the industry.

First year impacts of the COVID-19 pandemic on pediatric physiatrists.

PURPOSE: The objective of this study was to determine how the COVID-19 pandemic impacted the work and compensation of pediatric physiatrists during the first year of the pandemic. METHODS: Pediatric physiatrists were surveyed in the spring of 2021 about how the first year of the COVID-19 pandemic impacted their practices as a part of a larger survey examining pediatric rehabilitation medicine practices. The COVID-19 specific questions covered three topic areas: 1) personal experiences with COVID-19; 2) occupational workflow changes due to COVID-19, including telehealth; and 3) employment consequences of the COVID-19 pandemic. RESULTS: Thirteen of 259 pediatric physiatrists reported having a COVID-19 infection, of whom none required hospitalization. Nearly all (96.5%) of pediatric physiatrists reported using telehealth during the pandemic compared to 14% prior to the pandemic. They reported numerous changes to their clinical operations, and 50% reported not having adequate personal protective equipment available for themselves or their staff all of the time. Fifteen pediatric physiatrists (5.9%) reported being furloughed, and three reported job loss during the first year of the pandemic. CONCLUSION: While only a small percentage of pediatric physiatrists contracted COVID-19 during the first year of the pandemic, nearly all experienced workflow changes.

Advancing Academic Capacity in Physical and Rehabilitation Medicine to Strengthen Rehabilitation in Health Systems Worldwide: A Joint Effort by the European Academy of Rehabilitation Medicine, the Association of Academic Physiatrists, and the International Society of Physical and Rehabilitation Medicine.

Not available.

A rapid response for burnout among inpatient physiatrists: A survey of leaders of inpatient rehabilitation facilities.

BACKGROUND: Symptoms of burnout are highly prevalent among physiatrists, and prior studies have helped identify key contributors to this epidemic of burnout. Little is known about the physician stressors unique to those providing care in inpatient rehabilitation facilities (IRFs) and what strategies such facilities have used to help mitigate burnout among inpatient physiatrists. OBJECTIVE: To identify what IRF leaders perceive as stress points contributing to burnout among inpatient rehabilitation physicians and what, if any, interventions their programs have implemented to help mitigate physician burnout. DESIGN: 10 item cross-sectional survey study of IRF physician and nonphysician leaders in the United States. PARTICIPANTS: 104 physicians serving in the roles of IRF medical director, director of rehabilitation, and/or executive leadership and 19 nonphysician IRF leaders. RESULTS: Regulatory demands, late admissions, understaffing, and on-call responsibilities were the major stress points most identified as contributing to physician burnout among both the physician and nonphysician respondents. The use of advanced practice providers and hospitalists were the most common system changes reportedly used to help mitigate physician burnout. Although 57.8% of physician leaders felt late admissions were a major stress point for physicians, only 18.2% of those responding reported having implemented admission cutoff times. CONCLUSIONS: There are stressors unique to the practice of inpatient rehabilitation that are likely contributing to physiatrist burnout, including late admissions and on-call responsibilities. Many IRFs have begun to implement system changes to help mitigate burnout among inpatient physiatrists. The use of nonphysiatrist providers is a commonly reported strategy. Future studies are needed to determine the effectiveness of such a strategy on reducing symptoms of burnout among IRF physicians as well as its effect on IRF patient outcomes.

A Conversation Between Past and Present Chairs of the American Board of Physical Medicine and Rehabilitation: Four Decades of History and the Future of Board Certification.

ABSTRACT: On the 75th anniversary of the founding of the American Board of Physical Medicine and Rehabilitation, 11 of the surviving chairs of the board convened virtually to reflect on the past 40 years of major trends for the accrediting body of physiatrists. The field rapidly expanded in the 1980s, driven by changes in the reimbursement environment. This rapid expansion drove an improvement in the caliber of residents choosing the field and in the quality of training programs. As physical medicine and rehabilitation evolved from a small- to medium-sized specialty, the board addressed many challenges: securing a credible position within the American Board of Medical Specialties; addressing a rising demand for subspecialty certification; improving training and exposure to physiatry; enhancing the quality of the accreditation process; and reducing the burden of accreditation on diplomates. The future development of physiatry includes improving diversity, equity, and inclusion, while restoring provider morale, well-being, and meaningfulness in work. Although challenges remain, physiatry as a field has grown to be well established through the board's efforts and respected within the larger medical community.

Integrating Palliative Care Into Physiatric Care: Perspective of the Association of Academic Physiatrists Physiatry Palliative Care Task Force.

ABSTRACT: There are opportunities for physiatrists to apply a palliative care lens within clinical encounters across rehabilitation settings. The expanding population of patients with serious illness and injury cared for by physiatrists and the anticipated shortage of specialty palliative care clinicians make it important that physiatrists hone and apply basic palliative care skills as part of comprehensive physiatric care. In this article, four clinical vignettes highlight relevant palliative care communication skills and demonstrate the value of integrating these skills within physiatry encounters. Resources to support physiatrists in applying basic palliative skills are provided throughout.

Musculoskeletal ultrasonography: ninety-nine reasons for physiatrists.

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