March 2008

Members Pursue Ways to Care for Returning Servicemen and Women

In Brief: The Academy is making strides in connecting returning servicemen and women to physiatric care. The Injured Soldier Work Group and the state societies are taking the lead in collabor­ating with the Veterans Administration and encouraging Academy members to offer and provide care.

The conflicts in Iraq and Afghanistan do not appear to be ending anytime soon – and neither does the need for care for returning servicemen and women. As part of AAPM&R’s desire to do its part to enhance their access to physiatric care, the Academy formed the Injured Soldier Work Group in 2007. The work group, along with PM&R state societies, is working to identify physiatrists who can provide needed care for servicemen who can benefit from PM&R services; the Academy views this as an opportunity for members of the specialty to step into the forefront in providing care for these deserving patients.

“It’s always been about getting the right care for returning service­men and women,” said Stuart Glassman, MD, chair of the work group and medical director at Granite Physiatry in Concord, New Hampshire. “It was thought that our specialty is very well suited for being the quarter­back for that treatment team, given the kinds of injuries we’ve been seeing.”

Indeed, servicemen and women return with everything from traumatic brain injuries and amputations to pain and musculo­skeletal conditions. The work group hopes to help meet these PM&R needs by connecting servicemen and women with those physiatrists who can help them. Specifically, the work group seeks to provide access to non-governmental physiatrists if any perceived gaps in care occur between the time active-duty servicemen and women and veterans (of the recent wars in Iraq and Afghanistan) return from service and when they return to their communities.

To organize and provide this access, they’ve collaborated with the Veterans Administration (VA), explored relationships with the Department of Defense, appeared before Congress, and met with a number of veteran service organizations. In addition to these collaborations, the group began partnering with PM&R state societies as a means of getting individual members involved with their local VAs.

Getting physiatrists involved

Academy members can get involved with this cause in one of two ways: Physiatrists in any form of practice can contract themselves out to their local VA and provide services on the premises of the VA; or physiatrists can offer their services to the VA and the VA can recom­mend those services to servicemen and women and who can then be treated within the physiatrists’ own facilities. According to Dr. Glassman, the ability to offer services in both directions is ideal. He also noted that this kind of work can usually be performed in a clinic once or twice a month.

“The question becomes, how are you as a physiatrist going to get your name out to [the VA and injured service members] and get people to come your way?” Glassman said.

Dr. Glassman suggested that members agree to accept and enroll in TRICARE insurance and, importantly, call the nearest VA. When making that connection, physiatrists can offer contractual services to the VA or ask the VA to recommend their services and facilities to servicemen. If members have trouble connecting with a VA, they can then approach their state society. State society presidents can ease the transition by approaching VA facilities themselves.

“It takes making that connection with the medical director at the local VA,” Glassman said, “but once you do that, you can start opening doors. You can help create a network of specialties that can serve our service member.”

Connections in rural comm­unities will be the key to creating a better system, Glassman said. If a service member is not near a VA facility or their state is large and only a few VAs are available to them, physiatrists can offer care to fill that geographic void – either individually or through their state society. One group that has excelled in its connections with the VA is the PM&R state society in Washington, led by society president Daniel Brzusek, DO.

Setting an example: Washington State

In a state like Washington, where there is a lot of territory and only a few VA facilities, the need for more options for and access to care is obvious.

“When people are required to travel three or four hours to see a physician, we need to do something better for our vets,” said Dr. Brzusek, a physiatrist at the North­west Rehabilitation Associ­ation in Bellevue, Washington. Dr. Brzusek spent two years in active duty in the Air Force and three years in the Reserves. He has been treating wounded servicemen and women for 30 years and has seen every­thing from shrapnel wounds to chronic ankle, back, and knee problems.

Dr. Brzusek said Washington has significant barriers to transportation and noted that, when the state is hammered with snowstorms, it can sometimes take four hours to make a half-hour trip. This year in particular has been extremely bad with most and sometimes all of our mountain passes closed for days at a time. Even when not closed, the trip across the mountains can be extremely hazardous. To alleviate this problem, the state society connects servicemen and women to transportation or finds a physiatrist closer to their homes in order to eliminate the travel barrier and care for the servicemen and women.

To maintain this network of available physiatrists, Dr. Brzusek created an e-mail listserv housed at the Department of Rehabilatation Medicine at the University of Washington. He tries to ensure e-mail addresses for every physiatrist in every part of the state are included on the listserv each year. In this way, he can help the VA find physiatric assistance in any geographic location on a moment’s notice.

“If the VA has a patient having a hard time finding a physician close to their home, they identify that patient to us and we get a physiatrist to connect with that vet, and vice versa,” he explained. “We’re all connected to the listserv, so if someone needs care in Bellevue and we have eight physiatrists in Bellevue, we e-mail the listserv and ask which one will pick up the patient’s request for service.”

Though the state society in Washington helps connect servicemen and women to physia­trists, Dr. Brzusek also strongly recommends that physiatrists contact local VAs themselves to offer their services. He said it’s important to make that grassroots effort and to let the VA know that there are individual physiatrists out there who can help when needed.

“The overall goal is continuity of care for these vets,” he said. “These are the people who protected our country. They’re the silent, neglected people out there. The best voice we can give them is good, quality health care – locally, so they’re not traveling five hours to get it.”

Are you involved in helping returning servicemen and women? Tell us how! Contact the Academy office at 847-737-6038 or jwalker@aapmr.org.

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