November 2007

President's Editorial

Since the beginning of the Global War on Terrorism (GWOT) in 2001, there have been an increasing number of US servicemen (active duty, reservists, National Guardsmen) with disabling injuries, ranging from severe polytrauma to mild musculoskeletal. The Department of Defense (DoD) and the Veterans Health Administration (VHA) have spent significant time, effort, and resources developing a system of health care to meet the needs of these individuals, in particular their PM&R needs. While far from perfect, this system represents the largest, integrated rehabilitation network in the world. Some highlights include standardized screening for mild traumatic brain injury on the battlefields of Iraq and Afghanistan, state-of-the art prosthetics care at Walter Reed Army Medical Center, and centers of excellence in moderate and severe TBI rehabilitation at four VA medical centers in Richmond, Tampa, Minneapolis, and Palo Alto. Along with tremendous growth in clinical capacity and quality in the past six years, the DoD and VHA have grown residency and fellowship training programs in PM&R, pain management, and spinal cord injury medicine across the country; have sponsored more than $150 million in research in the areas of polytrauma-related PM&R; and have produced a series of educational products (DVDs, pamphlets, lecture slides) and presentation in the PM&R arena. While the reasons behind the need for all of this growth is not something to be celebrated, the response to this need is.

So why should our AAPM&R members care about all of this? Aren’t you doing enough already by paying your taxes, giving to your local veterans charity, and adhering a magnetic ribbon to your car? Maybe your clinic or hospital has already reached out to the local or national VA to offer your services. Maybe you already work in the VA and are seeing these injured warriors. Isn’t that enough? Americans need to step up and make a sacrifice to support the efforts of our military in a way that directly affects their everyday lives, so that we can all better comprehend the sacrifices our troops are making for us. Feeling the drain of these wars on all of our lives (other than on television or in the movies) is an important way for us to better understand what we are fighting for and to help decide how you feel about those sacrifices. Regardless of how you align yourself politically, getting involved is important.

So what can you do? AAPM&R members can best serve the needs of the war effort by using their clinical skills! The VHA is actively seeking skilled PM&R clinicians to help provide expert care for active duty servicemen and women and veterans with acute and chronic disabilities. This care can be optimally delivered within the VA system (as a part- or full-time employee or a contract physician) using the nation-wide EMR, but there are also options available to provide the care directly in your office or rehabilitation program (as a “fee basis” service from the VA or under Tricare from the DoD). There is tremendous need for individuals with musculoskeletal disability and pain and mild TBI with post-concussion symptoms. Programs that focus on return to work/active duty and community reintegration are especially relevant. The best way to find out what services are needed in your area is to contact either your local VA medical center (either the PM&R chief or chief of staff) or the Polytrauma Network Site within your geographic region (for contact info, visit: www.polytrauma.va.gov).

The Academy has also launched a grassroots effort through the PM&R state society presidents network. See the sidebar at right for more information.

The Academy is in a unique position to directly help out in our country’s efforts. I implore each of you to get involved.

David X. Cifu, MD

AAPM&R President

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