The History of the Specialty of Physical Medicine and Rehabilitation

Author(s): AAPMR History Preservation Committee

Originally published:11/03/2012

Last updated:11/03/2012

One of the true pioneers of Physical Medicine and Rehabilitation (PM&R) was Frank H. Krusen, MD. Having undergone treatment for his own tuberculosis, Dr. Krusen later scientifically investigated the uses of physical medicine and soon made it his career. After initiating a program in physical therapy at Temple University in Philadelphia, Dr. Krusen moved to the Mayo Clinic in 1936 where he developed a Department of Physical Medicine. His training program there evolved into the first three-year residency in physical medicine in the United States.

Starting in 1936, Dr. Krusen along with 14 other “physical therapy physicians” (as physiatrists were known at the time) found themselves with distinct interests and concerns, that were different from their contemporary colleagues who were physical therapists and radiologists. They initiated a decade of work to establish physical medicine and rehabilitation as a distinct medical entity. During those years, many meetings and letters written among the first generation of physiatrists, and documentation from the American Medical Association, the American Board of Medical Specialties,, and medical specialty boards already in existence, explicitly supported the development of PM&R as a distinct approach to the practice of medicine. Concurrently, other groups supported its development including the War Department and the United States (US) Navy. Converging support and approval ultimately supported that PM&R would become a medical specialty with board certification. However, early in the evolution of PM&R, some still regarded that physical medicine would be better based and funded as a division within another already existing medical specialty.

In 1938, Dr. Krusen proposed the term “physiatrist” to identify the physician specializing in physical medicine. To avoid confusion with psychiatry, he proposed a different pronunciation, with emphasis on the third syllable.

On September 12, 1938, the Society of Physical Therapy Physicians was founded during the annual meeting of the American Congress of Physical Medicine at the Palmer House in Chicago. The group elected Walter Zeiter, MD, as executive director, a position he held for twenty-two years. John S. Coulter, MD was elected as the first president.

Membership was limited to physicians with at least five years’ experience in full time practice of physical therapy, with a teaching appointment in a medical school or the directorship of a department. Membership was by invitation only and was limited (until 1944) to 100 doctors.

With US involvement in World War II in 1941, the focus of physical medicine broadened to become a comprehensive restoration of a patient’s capabilities as injured soldiers returned home for treatment.

In 1943, the Baruch committee was established. After three-month survey, it recommended establishment of teaching and research centers in PM&R; establishment of fellowships and residencies in PM&R; promotion of PM&R in medical schools; promotion of wartime and post-war physical rehabilitation; and development of an American Board of Physical Medicine and Rehabilitation.

In 1945, a section on PM&R was established by the American Medical Association. The next year, the Council on Physical Medicine voted to sponsor the term “physiatrist” as designation for physicians specializing in physical medicine. Residency and fellowship training programs in PM&R were established in 25 hospitals.

In early 1947, Drs. Krusen, Zeiter, and Coulter presented a revamped plan for the organization and financing of an American Board of Physical Medicine and Rehabilitation to the American Board of Medical Specialties. This time they succeeded. On February 27, the American Board of Physical Medicine was incorporated. It was officially recognized by the America Board of Medical specialties and the American Medical Association,,and Dr. Krusen was named its first chairman. That year, almost 80 physicians sat for the first board examination in Minneapolis. Written exams were given on the first day and oral exams were given on the second day. Later that month, 91 physiatrists were approved as charter diplomates in PM&R. Thirty of the physical medicine “pioneers” received certification without having to take the exam.

Another key event in the development of the specialty was the polio epidemic. In 1952, more than 21,200 cases of polio were reported. The polio epidemic dominated the attention of PM&R physicians until 1955 when the Salk vaccine was invented.

The Vocational Rehabilitation Act passed in 1958 added training funds for resident stipends in PM&R.

In 1987, American Board of PM&R voted to limit board certification to 10 years that began with 1993 board examinations. Board re-certification, then, was mandated for all physiatrists who became board eligible in 1993 and thereafter.

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