Tackling gender disparities in academic physiatry

By Allison Bean, MD, PhD

Tackling gender disparities in academic physiatry

September was “Women in Medicine” month, with many organizations taking the opportunity to highlight the contributions of their women members. As an academic physiatrist-in-training, I am excited to be entering a field where women have comprised approximately 40% of faculty for more than 20 years. However, I remain concerned about the lack of recognition women continue to receive in both PM&R and academic medicine in general.

Recent publications by Dr. Julie Silver and her colleagues at Spaulding Rehabilitation Hospital, found that women are consistently under-recognized in awards given by medical societies. While women comprise approximately 40% of the AAP membership, between 1990 and 2016, only 20% of awards were given to women. Even more striking was that between 2013 and 2016 women did not receive any awards. As a physiatry resident and Vice Chair of the Resident Fellow Council, I was particularly concerned to learn that no women had received the McLean Outstanding Resident/Fellow award since its inception in 2010.

Dr. Silver describes the failure to recognize women in medical society awards as “mentoring against a closed gate”, where it becomes an ethical issue whether to encourage women trainees and early-career faculty to invest time and financial resources into joining societies if there are disparities in inclusion. Indeed, failure to sponsor women, including but not limited to formal recognition of their work, at the early stages of their careers likely contributes to well-documented gaps in reaching professor and chair level promotions. While percentages have been slowly trending upwards, as of 2016 only 28% of PM&R faculty holding the rank of full professor were women.

The AAP has recently acknowledged the importance of actively supporting women members. At the 2017 Annual Meeting , Drs. Felicia Ambrose and Mooyeon Oh-Park organized a “Women in Physiatry” workshop, focusing on the challenges of being a woman in academic physiatry and providing advice on how to successfully navigate the career track. This workshop was well-received and will be held again during the 2018 Annual Meeting. Also at the 2017 Annual Meeting, outgoing AAP President Dr. Gerard Francisco announced the creation of a Women’s Task Force chaired by Dr. Sara Cuccurullo and Dr. Silver, to further investigate gender disparities within the organization. The work of this group is ongoing.

I am encouraged by the AAP leadership’s willingness to transparently investigate workforce gender issues in our field, and I am hopeful that this will lead to ongoing dialogue, education, and strategic metrics-driven efforts to close these gaps, ensuring that women as well as men from underrepresented groups receive equal support from the organization.

Throughout my residency, I have been continually impressed with intelligence, talent, and drive of many of my fellow women physiatrists. It is time to ensure they receive the recognition they deserve. All trainees deserve equitable support, and women in PM&R must seek out not only mentors but sponsors — individuals who will actively promote us in specific ways that lead to career advancement. Leaders in PM&R, regardless of gender, have many opportunities to provide sponsorship and ensure that our entire future workforce is supported. These efforts are crucial to the future of academic physiatry and the diverse patients we care for in our practices.

Allison Bean, MD, PhD

Allison Bean, MD, PhD is the 2017–2018 Vice Chair of the AAP Residents Fellows Council and a PGY-3 resident in the Department of Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai. Follow her on Twitter: @DrAlliBean.

  1. Silver JK, Slocum CS, Bank AM, et al. Where Are the Women? The Underrepresentation of Women Physicians Among Recognition Award Recipients From Medical Specialty Societies. PM R. 2017;9(8):804–815. doi:10.1016/j.pmrj.2017.06.001.
  2. Silver JK, Blauwet CA, Bhatnagar S, et al. Women Physicians Are Underrepresented in Recognition Awards From the Association of Academic Physiatrists. Am J Phys Med Rehabil. July 2017:1. doi:10.1097/PHM.0000000000000792.
  3. Silver JK, Bhatnagar S, Blauwet CA, et al. Female Physicians Are Underrepresented in Recognition Awards from the American Academy of Physical Medicine and Rehabilitation. PM R. 2016:1–9. doi:10.1016/j.pmrj.2017.02.016.
  4. Hwang J, Byrd K, Nguyen MO, Liu M, Huang Y, Bae GH. Gender and Ethnic Diversity in Academic PM&R Faculty: National Trend Analysis of Two Decades. Am J Phys Med Rehabil. 2017;96(8):593–595. doi:10.1097/PHM.0000000000000716.
  5. Association of American Medical Colleges. Faculty Roster: U.S.Medical School Faculty, 2016. https://www.aamc.org/data/facultyroster/reports/475478/usmsf16.html. Published 2016.
  6. Silver J. Diversity and inclusion are core leadership competencies: A primer for busy leaders. Becker’s Hosp Rev. 2017. https://www.beckershospitalreview.com/hospital-management-administration/diversity-and-inclusion-are-core-leadership-competencies-a-primer-for-busy-leaders.html.
Remembering your reasons: Reflections from a physiatry resident

Remembering your reasons: Reflections from a physiatry resident

By Melissa Kirk, MD

Over four years ago, you took an Oath. You made a commitment when you swore, “I solemnly pledge to consecrate my life to the service of humanity.” That was an amazing day when you stood proud as a medical student reciting the Hippocratic Oath. You were one step closer to fulfilling your passion of making a difference in your patients’ lives. It was going to be the best journey of your life, full of smiling patients and daily gratification. Everything was perfect, absolutely perfect!

In present day, your eyes blink while yawning, and your body is fighting to stay alert. You look at the clock and realize you have successfully exceeded 24 hours of no sleep. Your bedtime consists of napping in the hospital break room with dinners composed of cafeteria cuisine. You struggle to remember why you took that leap so many years ago.

I share your experiences and your emotions. According to the Journal of Graduate Medical education, we are not alone. In the December 2009 issue, burnout is described as a state of mental and physical exhaustion related to work or caregiving activities. This is especially high among residents, where prevalence rates may range from 27–75%.

With statistics against us, how does one fuel the passion to practice the art of medicine? I have learned one remedy to overcome the plague of mental and physical exhaustion. The solution is simple, serve your patients and find inspiration through their victories.

On Monday September 25th 2016, I was reminded of my motivation. I vividly remember the morning like it was yesterday. I started my rotation on the Spinal Cord Injury service at the University of Utah. Greeting my patients for the first time and I was particularly looking forward to meeting William Goldman.

William, a delightful 32-year-old male, had a history of achondroplasia resulting in L1-L5 stenosis. He was initially planned for scheduled decompression surgery, but acutely developed worsening leg weakness and bladder incontinence at which point there was concern for cauda equina syndrome. He was taken for emergent L1-L5 decompression with T12-L4 posterior spinal fusion on September 21st. Postoperatively he did well, was extremely motivated to participate in therapy, and was admitted to inpatient rehab three days following surgery.

I knew William’s drive and positive demeanor would take him far with recovery. He gave me daily high fives and cheered on other patients. He uplifted everyone’s spirits on the unit, including the staff. Regardless of long hours, William’s smile brightened my spirit each morning and evening. On October 18th he was discharged to his apartment in a wheelchair, but he had the ability to walk short distances with a four-wheeled walker. Thinking that would be the last time I would see William, I kept the memory of his warmth and infectious happy energy inside me as a fuel to push forward.

Ten months later, following intense inpatient rotations through the winter and an exhausting call schedule, I fell back into fatigue. With sleep becoming a distant memory, taking on extracurricular activities was definitely a low priority. However, a camping trip to East Canyon, through our incredible TRAILS (Technology Recreation Access Independence Lifestyle Sports) program, persuaded me otherwise. I was compelled to attend knowing the event is designed to help patients with a history of spinal cord injury achieve their sports goals.

Despite coming off post call, I arrived at 7am on Saturday morning shivering in the chilly canyon breeze. While setting up canopies and flipping over kayaks, sudden warmth came over me. The warmth was not from the sun, but from seeing William Goldman. This time, without a wheelchair, instead he took long strides down the canyon to the water with a single forearm crutch. Joy instantly overwhelmed me, removing any thoughts of fatigue, as I was reminded of the time I first met him and the progress he had achieved. Flashbacks to my first acceptance into medical school came flooding back. I was reminded of the rewards of medicine. I took an Oath and when fulfilling that promise I am reminded of the joy felt when serving others.

William now lives as my permanent reminder of my passion for the medical field. I challenge each of you to find your William. Seek out opportunities to serve your patients and celebrate in their victories to overcome burnout. As the famous Gandhi once said “The best way to find yourself is to lose yourself in the service of others.”

Melissa Kirk, MD

Melissa Kirk, MD, is a third year resident in the department of Physical Medicine and Rehabilitation at the University of Utah. She also serves as the Secretary for the AAP Resident Fellow Council.

Uncovering PM&R: An engaging elective experience

Uncovering PM&R: An engaging elective experience: A collaboration between Case Western and MetroHeath introduces PM&R to first year medical students

By Helen Sun

As a first-year medical student with little more than a month of school under my belt, my background in bioengineering drove many of my interests. When I first heard about Dr. Greg Nemunaitis’ spinal cord injury (SCI) elective, I thought of force vectors, exoskeletons, and tricked-out wheelchairs.

One thing that had not been advertised was that this elective was also a gateway to an entire specialty unbeknownst to most first and second year medical students. Over the course of ten sessions, my appreciation for engineering grew. Even more inspiring was the way that PM&R specialists, orphysiatrists, straddle a line between coach, innovator, and confidante. They help those with spinal cord injury — congenital or acquired — engineer their lives to achieve the things they want to accomplish.

Dr. Nemunaitis and Mary Jo Roach, PhD directed the elective at the MetroHealth Medical Center. From the start, we learned that there is more to SCI medicine than neurology and orthopedics. The course introduced students to therapies ranging from nerve stimulation for regaining muscle tone to treatment of erectile dysfunction for patients who wanted to start a family. Students met guest speakers who spoke about their own experiences as SCI patients, and highlighted some of the ways their lives had changed post-injury. One young woman I met was several weeks pregnant with her first child, and during our conversation I learned more about the dangers of autonomic dysreflexia than obstetrics. My classmates also experienced what it was like to navigate through an obstacle course using a wheelchair. As expected, it was a real arm workout!

An uphill battle
Everyday situations that are not designed for wheelchair users

We learned that not all spinal cord injuries are created equal, and not all people with a similar injury experience a similar recovery. Some adaptations are more psychological than they are physical. A good support system, access to knowledgeable physiatrists, tailored physical therapy, and patience are crucial to overcoming the psychological and physical effects of an SCI. I realized that during my time as an undergraduate student, I had taken part in this network of support by volunteering as a swimming teacher for children with cerebral palsy and other special needs. Not only was I teaching a valuable life skill, I was also teaching children and families that movement and play are still possible with limited mobility.

Students learn about electromyography (EMG) and nerve conduction testing

A good physiatrist coordinates the physical, occupational, recreational, and psychological aspects of patient care. Spinal cord injury medicine is a field that will continue to require imagination and adaptation because every patient’s path to recovery is different. I am excited that the next round of this elective will offer students even more opportunities to create custom devices for SCI patients using 3D-printing to rapidly prototype objects. This interactive model of education is instrumental in spurring student learning and engagement in PM&R. It is my hope that more students are able to take courses like this, explore SCI medicine, and have the opportunity to work with some of the inspirational patients and physicians in this field.

Helen Sun is a third-year medical student at Case Western Reserve University School of Medicine with interests in spinal cord injury medicine, engineering, and writing.

RFC developments: Starting the first AAP National Medical Student Council

RFC developments: Starting the first AAP National Medical Student Council

By Brittany Snider, DO

The Resident/Fellow Council (RFC) is excited to announce the initiation of the AAP National Medical Student Council! We have been working closely with the Medical Student Educators Council to develop this initiative and move it forward to fruition.

A medical student council will enable the next generation of physiatrists to gain experience in leadership and collaboration as they prepare for their future careers in PM&R. We expect this council to be a strong driving force for increased student membership and active involvement in AAP. Student leaders will be invaluable advocates for the specialty, helping to increase its visibility and supporting advocacy efforts within their institutions and communities.

The reasons for starting this council are best explained by AAP’s three tenets: mentorship, discovery, and leadership. The Medical Student Council will consist of seven positions: Chair, Vice-Chair, Secretary, Education/Mentorship Representative, Membership/Recruitment Representative, Social Media/Technology Representative, and Research Representative. Each position was created to align with AAP’s mission and strategic plan. Read more about the positions at the AAP website.

The inaugural medical student council will serve from January 2018 through the AAP Annual Meeting in February 2019. AAP will begin accepting online applications for the student council during the week of October 30, 2017. The application deadline is December 1, 2017. Candidates must be an MS1-MS3 in an LCME, COCA, or NCFMEA accredited medical school. Students must also be active AAP members at the time of application. For additional details regarding eligibility, council positions, and the application process, please visit here. You may also contact the RFC with any questions (residentfellowcouncil@gmail.com ).

To all medical students pursing PM&R, we welcome you to the specialty and encourage you to apply to this leadership council. We are eager to work with you and look forward to receiving your applications.

Brittany Snider, DO

Brittany Snider, DO, is a third year PM&R resident at Mayo Clinic and the Medical Student Affairs Representative of the Resident Fellow Council of the AAP.

Call for applications for Association of Academic Physiatry Medical Student Council positions

Call for applications for Association of Academic Physiatry Medical Student Council positions

The AAP leadership and the Residents/Fellows Council (RFC) are excited to announce the establishment of the first national PM&R Medical Student Council. We are seeking applications from highly motivated medical students interested in PM&R for leadership positions to represent medical student members of the AAP and promote the field of PM&R to medical students throughout the country.

A description of available positions and requirements can be found here. Inaugural council members will serve in their positions until the AAP Annual Meeting in February 2019.

Please submit your application here. Applications are due December 1, 2017. Results of the selection process will be announced in early January 2018.

Join the Resident Fellow Council of the AAP

Join the Resident Fellow Council of the AAP

2017 (back) and 2016 (front) Resident Fellow Councils

As we ready ourselves for Physiatry ’18, to be held February 13–17, 2018 in Atlanta, GA, the Residents/Fellows Council (RFC) will also be preparing to pass the baton to next year’s council.

The 2017–2018 RFC is very proud of our accomplishments over the past year, and we look forward to ushering in a new set of council members.

We will soon begin soliciting applications for the 2018–2019 RFC council. Applications for the Vice Chair position will be due on January 1, 2018 and applications for all other positions will be due on January 15, 2018.

Elections will be held at the AAP annual meeting on Friday, February 16 from 3:30–5:00pm. Residents/fellows must be present at the election in order to run for a position. A description of available positions and application requirements will be available soon at (http://www.physiatry.org/?RFC_Elections).

We encourage all residents to apply for these leadership positions to ensure that resident and fellow interests are well-represented within the AAP and to work together on initiatives that will have a broad and meaningful impact on the specialty of PM&R.

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