One of the specialty’s true pioneers was Frank H. Krusen, MD. Having undergone treatment for his own tuberculosis, Dr. Krusen later researched the uses of physical medicine and soon made it his career. After initiating a program in physical therapy at Temple University, Dr. Krusen moved to Mayo Clinic in 1936 where he developed a Department of Physical Medicine. His training program there developed into the first three-year residency in physical medicine in the United States.
Dr. Krusen along with fourteen other “physical therapy physicians” (as physiatrists were known at the time) found themselves with different interests and concerns than their colleagues the physical therapists and radiologists. They began to promote physical medicine as a specialty. They asked the American Medical Association (AMA) for specialty status and an examining board for physical medicine.
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. However, it wasn’t until 1946 that the AMA sponsored the term.
The American Board of Physical Medicine
Starting in 1936, Dr. Krusen and 13 other pioneering physiatrists began a decade of work to establish physical medicine and rehabilitation as a specialty. During those years there were many meetings and letters between physiatrists, the AMA, the American Board of Medical Specialties (ABMS), and specialty boards already in existence. Many supported the idea, including the War Department and the US Navy. Everyone agreed there should be certification, but opinions differed on how it should be based and financed. Some thought physical medicine should have its own specialty status, while others thought certification should be a division of another existing specialty board. Academy members also considered forming an autonomous board on their own with the hope that it might later be recognized by ABMS.
In early 1947, Drs. Krusen, Walter Zeiter, and John Coulter presented yet another revamped plan for the organization and financing of an American Board of Physical Medicine and Rehabilitation to ABMS. This time they succeeded. On February 27, the American Board of Physical Medicine was incorporated. It was officially recognized by ABMS and the AMA, and Dr. Krusen was named the first chairman.
That year, almost 80 physicians took the first Board exam 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 physical medicine. Around 30 of the physical medicine “pioneers” received certification without having to take the exam.
Notable dates in the history of PM&R:
1941: US involvement in WWII begins, which broadened the focus of physical medicine to now become a comprehensive restoration of a patient’s capabilities as injured soldiers returned home for treatment.
1943: Baruch committee established which, after three-month survey, 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.
1945: Section on PM&R established in AMA
1946: The Council on Physical Medicine voted to sponsor the term “physiatrist” as designation for physicians specializing in physical medicine; residencies or fellowships in PM&R established in 25 hospitals.
1952: More than 21,200 cases of polio are reported. The polio epidemic dominated the attention of PM&R physicians until 1955 when the Salk vaccine was invented.
1958: Vocational Rehabilitation Act adds training funds for resident stipends in PM&R
1965: Enactment of Medicare and Medicaid
1972: Medicare coverage expands to include disabled and inpatient rehabilitation
1987: ABPMR votes to issue only 10-year certificates beginning in 1993.