Profile of a Staff Physiatrist at the Rehabilitation Institute of Chicago

Mark E. Huang, MD, is a staff physiatrist on the general rehabilitation unit at the Rehabilitation Institute of Chicago (RIC). He started his medical career in a six-year medicine program at Pennsylvania State University and Jefferson Medical College. It was at Jefferson that he was first exposed to the field of PM&R. He was attracted to the dynamic speaking skills of Gerald J. Herbison, MD, who gave a lecture to the medical students about electrodiagnostics and the field of PM&R that described its holistic focus on quality of life and function. Dr. Huang chose to train at RIC for his residency. After completing his residency training, he then moved to the Medical College of Virginia, Virginia Commonwealth University, where he served as associate medical director of the rehabilitation and research center and director of general rehabilitation program. After five years, he moved back to Chicago and has been a staff physiatrist at RIC ever since. At RIC, he is the medical director of medical records, a member of the medical information replacement core team, and assistant professor in the department of PM&R, Northwestern University Feinberg School of Medicine. Dr. Huang has won numerous teaching awards and has consistently been one of the most popular and well-regarded faculty members at RIC. His areas of clinical interest include cancer, amputee, and stroke rehabilitation. The following is an edited transcript.

How did you get interested in amputee care and cancer rehabilitation?

I became interested in cancer rehabilitation through my experiences with my father during residency. My father had lung cancer that resulted in paraplegia secondary to spinal cord involvement. Through my experiences with his medical care, I saw a striking lack of awareness about rehabilitation for impairments resulting from cancer and its treatment in general oncologic community. As a result I have remained committed to the rehabilitation of patients with cancer through teaching, research, and clinical care. I have always liked prosthetics and orthotics and find amputee care to be very rewarding. Amputation is a complex condition that is well suited to the comprehensive approach of a physiatrist. There is something primal about replacing something that is missing. In addition, amputee rehabilitation is a great blend of latest technology with traditional rehabilitation interventions. Rehabilitation of these patients has medical, psychologic, biomechanical, and technological considerations that make this a rewarding field. Interestingly, both fields tend to be under-represented in our specialty, which makes them all the more enjoyable to practice from my standpoint.

You are one of the key people involved in the transition of the medical records system at RIC. What are your thoughts on technology and medicine?

Electronic medical records are the future of medicine whether we like it or not. There are numerous advantages to having an electronic record, such as easy online access to a patient’s chart for patient care and decision making and faster access to view test and lab results. The concern is making technology an aid and not a hindrance in day-to-day activities. There is potential to be more efficient, but typically, the actual application of technology results in less clinical efficiency. It’s much like what has happened with e-mail. E-mail was supposed to facilitate efficient communication, but now most people are just drowning in e-mail. How much time are we spending answering e-mail, most of which is simply junk? E-mail has been a cop-out for people to send less than relevant information to people who don’t need to hear about it. In addition, it is sometimes easier to call someone than peck away at a long e-mail thread. The electronic medical record has a similar danger of drowning us in information overload. Easy access to pertinent and critical medical information, as opposed to endless “scrolling” through the medical record, is vital. With electronic notes, there’s a danger of too much duplication and not enough updating in the medical record. The main challenge with electronic notes is finding what clinicians actually need on a day-to-day basis. The goal is to provide the most up-to-date patient information in the medical record with an efficient means of retrieving that information and acting on it with orders and communication to others.

How do you see the future of the field of PM&R?

The field has many bright spots for the future. With the aging population and better disease management, we are seeing patients live longer. As a result, our specialty will play an increasingly important role in maintaining fitness in patients and addressing disabling impairments that the aging adults we will encounter. In addition there are many potential medical breakthroughs, such as biologic agents, stem cells, and electrical stimulation that may change how we manage certain disabled individuals. These advances may enhance the recovery of patients from previously irreversible events, such as stroke and spinal cord injury. These patients would benefit from rehabilitation to enhance their functional abilities.

There will also be challenges to face. As in much of the medical profession, there is increasing financial pressures on institutions for physicians to have increased clinical production potential and researchers to get grant funding at the expense of other areas, such as medical education. Clinicians and researchers have less time to work on non-revenue generating areas, such as teaching and program development. In terms of the rehabilitation side of specialty, I think there will be continued pressure to reduce lengths of stay for patients receiving inpatient rehabilitation. Obviously, the Medicare rules are going to have an impact on the types of patients coming to inpatient rehabilitation, specifically, increased medical acuity. I have already seen that these reduced lengths of stay result in patients feeling less prepared for discharge and leaving with lower functional abilities at the time of discharge. Finally, we need more outcomes research to prove that what we do is effective.

What words of advice do you have for residents and young attending physicians?

Approach your education and career with an open mind. Too many people come into training close-minded about what they want to do. You may end up doing something different from what you anticipated when you started. On the flip side, don’t fret if your senior year has arrived and you don’t exactly know what you want to practice as an attending. Just because you’ve finished residency doesn’t mean your decision has to be made. If there are several areas of PM&R that you like, try to get more in-depth experience in all of them. Gradually, you will find your niche. It may be an unexpected opportunity that drives your career choice.

You also participate in resident selection and work closely with our program director. What kinds of qualities do you look for in applicants and residents?

I think most residency programs in PM&R look for similar attributes. Since rehabilitation tends to be team oriented, it is critical for future physiatrists to be able to really thrive as a leader of a rehabilitation team, whether it be in an inpatient rehabilitation or an outpatient clinic setting. It is important to learn how to be a leader who listens well and values input from others as opposed to being autocratic. It is also important to know how to communicate effectively with others. Finally, know your limitations. From my perspective, what I look for in an applicant is someone with excellence in these areas: fund of knowledge, ability to apply medical knowledge to clinical applications, documentation skills, work ethic, initiative, “coachability,” and interpersonal, and communication skills. Residents who possess these attributes are the most successful during and after residency.

Ai Mukai, MD
Rehabilitation Institute of Chicago
amukai355@gmail.com