Pediatric Rehabilitation Medicine in the USA

Physiatrists have been taking care of children with disabilities since the beginning of the field. Yet, pediatric rehabilitation medicine is still young; its official recognition commenced in 2003 with the initiation of a certificate of special qualifications. Pediatric physiatrists have enjoyed increasing recognition during the past few years, including greater visibility within the American Academy of Physical Medicine and Rehabilitation (referred to herein as the Academy) with the establishment of the Pediatric Rehabilitation and Developmental Disabilities Council, as well as nationally with greater involvement in organizations such as the American Academy of Cerebral Palsy. A number of challenges remain to the growth of pediatric rehabilitation. Dr. Amy Houtrow, in her report on the survey results of the Council [1], identifies some of these and provides important information that will be useful for planning, as well as a metric to determine growth and improvement in the field. These problems include limited geographic dispersion, slow academic progress, and the lack of federally funded investigators. She also raises interesting questions about gender inequity in compensation. Children with disabilities are spread throughout the nation, and pediatric rehabilitation medicine specialists provide important care and services for these children. Yet, the survey results revealed a significant concentration of such physicians in the Midwest compared with other regions of the country. The most likely reason for this is the strong pediatric rehabilitation training programs found in the Midwest in cities such as Chicago, Ann Arbor, Detroit, Minnesota, Cincinnati, Kansas City, and others, combined with the strong tendency of trainees to end up practicing not far from where they trained. Furthermore, in wellestablished centers, this value and contribution is highly recognized, creating a greater demand and a need for a larger physician group. However, in many areas of the country, pediatric physiatrists often need to demonstrate the value that they bring to a team caring for pediatric onset disability. The Academy, and especially the Pediatric Rehabilitation and Developmental Disabilities Council, can help by promoting knowledge about the field to our pediatric colleagues. Dr. Houtrow notes that pediatric rehabilitation medicine physicians may be less academically competitive or academically inclined. The reported academic ranks were: 7% instructor, 40.7% assistant professor, 27.9% associate professor, and 8.1% professor. An additional 16.3% reported no academic rank. Of most interest were the facts that 30% of the assistant professors had been practicing for more than 10 years, and 18% of the associate professors had been practicing more than 20 years. The possible explanations for this academic stagnation are inadequate mentoring and guidance for promotion, and less individual physician interest in pursuing an academic career. We hypothesize that both are probable factors. Most (71%) of the respondents to Dr. Houtrow’s survey were women. Previous investigators [2,3] have noted that women in academia face many significant challenges and issues, including balancing work with family, time management, adequate mentors or role models, and gaining credibility from peers and administrators. This latter issue suggests that the departmental chairs should foster and facilitate academic advancement for those female faculty members inclined to advance their careers. The department leaders should develop family-friendly policies and practices, including flexible work hours, tenure stops, shared positions, modified duties, and clinical activity. They must work to minimize the gender biases in promotion and tenure and especially to increase the reward for clinical service and teaching, assist junior faculty to identify gaps and offer suggestions for strengthening their portfolio, and encourage the faculty to attend their