A Brief History of the Establishment of the Specialty of PM&R
Dr. Frank Krusen, a Philadelphia physician who began his training with a surgical career in mind, contracted tuberculosis during medical school at Jefferson Medical College in 1922. After his recovery, he began to research the uses of physical medicine and soon made it his career. Krusen established a program in physical therapy and an inpatient rehabilitation unit at Temple University in 1929. In 1936, Dr. Krusen moved to the Mayo Clinic and developed a department of physical medicine and the field’s first United States residency training program.
The American College of Radiology and Physiotherapy, later the American Congress of Rehabilitation Medicine (ACRM), was founded in 1923. The membership included physical therapy physicians (the term for physiatrists at that time), physiotherapists, and radiologists. But the physical therapy physicians found themselves with different interests and concerns than their colleagues and eventually began to promote physical medicine as a medical specialty.
The American Society of Physical Therapy Physicians, the organization that became the American Academy of Physical Medicine and Rehabilitation (AAPM&R), was founded in 1938. The same year, Dr. Frank Krusen proposed the term “physiatrist” to identify a physician specializing in physical medicine. To avoid confusion with psychiatry, he proposed a pronunciation with emphasis on the third syllable. (Today, physiatrists use both pronunciations.) The organization appointed Mayo Clinic physiatrist Walter Zeiter, MD, the executive director, and Northwestern University physiatrist John Coulter, MD, the first president.
The United States entered the Second World War in 1941. Physical and rehabilitation medicine treatments had already been established in the First World War, and even before. However, as injured soldiers returned home, veterans and civilian hospitals and clinics began using these same wartime techniques and practices. Rehabilitation medicine utilized not just physical medicine approaches, but also multidisciplinary interventions and medications with the goal of restoration of a person’s function after injury or illness. Rehabilitation teams treated patients in inpatient and outpatient settings, and physiatrists further developed their leadership roles.
Established in 1944, the Baruch Committee’s mission was to further develop the field of PM&R. It issued recommendations for the establishment of PM&R teaching and research centers in medical schools, fellowships, and residency programs, and advocated for wartime and post-war clinical rehabilitation programs. The Baruch Committee also strongly argued for the establishment of a certifying board for the then new medical specialty. The Baruch awards given at 12 universities bolstered PM&R programs with training and research funding for physiatrists, such as Arthur Watkins (Harvard University), Robert Darling (Columbia University), and Frances Hellebrandt (Virginia Commonwealth University).
Bernard Baruch’s philanthropy and advocacy work was substantial and integral to the development and survival of PM&R in its early years as a medical specialty. Bernard Baruch was motivated by a desire to honor his father, a physician who promoted the use of physical medicine techniques and researched hydrology before the inception of PM&R. The specialty was significantly aided by the generosity and support of Bernard Baruch.
Though we recognize the Baruch family’s role in helping to establish PM&R as a medical specialty, their legacy is entangled with the stain of their historic participation in, and financial gain from, the slave trade and Confederacy. PM&R’s history, like other specialties, unfortunately includes contributions from those who benefitted from the forced labor and exploitation of marginalized groups and the systemic disenfranchisement of minorities. It is important to acknowledge and raise awareness of this aspect of the specialty’s history in the spirit of advancement and growth.
As the Second World War was ending, organized medicine began to accept the field of PM&R as a medical specialty. The AMA established the Section on PM&R in 1945. Baruch’s philanthropy and the work of early pioneering physiatrists were crucial ingredients for the birth and development of PM&R as a respected academic field of medicine. By 1946, 25 hospitals had residency and fellowship training programs in PM&R. The Baruch awards at 12 universities bolstered the PM&R with training and research funding for physiatrists such as Arthur Watkins (Harvard University), Robert Darling (Columbia University), and Frances Hellebrandt (Virginia Commonwealth University).
Drs. Howard Rusk and John Coulter were among a group of prominent physiatrists who served in leadership positions during World War II. The Rusk Institute at New York University became a model for the field’s expansion across the nation after the War. Rusk achieved international recognition not only as a physician but as a journalist, radio broadcaster, and a public health advocate. His international work, including for the United Nations, helped to advance the field beyond the U.S. borders. Before the War, Coulter had established a physical therapy program in the orthopedics department at Northwestern University’s school of medicine. After the War, Coulter continued his work with other physicians in industrial medicine and orthopedics in Chicago, laying the foundation for the development of the field in the Midwest.
The American Board of Physical Medicine and Rehabilitation
Beginning in the late 1930s, Dr. Krusen and other pioneering physiatrists held many meetings with the AMA, the ABMS, and other medical specialty boards to gain recognition of the field and to promote the establishment of a separate certifying board. In the early years, physiatric leaders considered forming an autonomous board on their own with hopes that the American Board of Medical Specialties (ABMS) might later recognize it. However, additional support came from the War Department and the U.S. Navy after 1945. Opinions did differ about how such a board should be established and financed. Some thought physical medicine should have specialty status, while others thought physical medicine certification should be a subspecialty of an existing medical specialty.
In early 1947, physiatrists Krusen, Zeiter, and Coulter presented yet another plan to the ABMS for the organization and financing of a specialty board for the field. This time they succeeded, and with support from the AMA, the American Board of Physical Medicine became incorporated on February 27, 1947. Dr. Krusen was named the first chairman. That year, almost 80 physicians took the first board examination in Minneapolis, Minnesota. The Board established written exams on the first day and oral exams on the second day, and 91 physiatrists became charter diplomates in physical medicine. Approximately 30 physical medicine “pioneers” received certification without having to take an examination.
Other notable dates in the history of PM&R and the Academy
1945: The Archives of Physical Medicine and Rehabilitation becomes a joint publication of the American Congress of Rehabilitation Medicine and AAPM&R.
1950: The American Society of Physical Therapy Physicians is renamed the American Society of PM&R. The American Board of Physical Medicine is renamed the American Board of PM&R.
1951: Frank Krusen publishes the first textbook for the field: Physical Medicine and Rehabilitation for the Clinician.
1952: Close to 58,000 cases of polio are reported in the U.S. Thousands of people survive, only to have disabling conditions that require medical care from physiatrists.
1954: The Vocational Rehabilitation Act adds training funds for residency programs in PM&R.
1955: The American Society of PM&R is renamed the American Academy of PM&R.
1958: AAPM&R begins offering continuing medical education (CME) credit for educational sessions.
1961: The AAPM&R establishes the Walter J. Zeiter Lectureship. Considered a pioneer in the formation of the specialty of physical medicine and rehabilitation, Dr. Zeiter served as executive director of AAPM&R from its founding in 1938 (as the Society of Physical Therapy Physicians) until 1960.
1965: The U.S. government establishes Medicare and Medicaid, providing health care for the elderly, people with disabilities, and citizens with low income.
1971: AAPM&R establishes the Krusen Lifetime Achievement Award and Frank Krusen is the first awardee.
1972: Medicare coverage expands to include more services for the disabled and funds for inpatient rehabilitation facilities. AAPM&R administers the first self-assessment exams.
1978: AAPM&R membership reaches the 1,000 mark.
1985: AAPM&R launches The Physiatrist, a monthly print newsletter to its membership.
1987: ABPMR votes to issue 10-year certificates beginning in 1993.
1989: The Archives of PM&R publishes the “Gold Issue” in celebration of AAPM&R’s 50th Anniversary.
1993: The Physiatric Association of Spine, Sports and Occupational Rehabilitation (PASSOR) is established as an organization within AAPM&R, with its own dues and governance structure.
1996: AAPM&R launches a website: www.aapmr.org.
2001: A pre-course on “Entering Physiatric Practice,” scheduled before the AAPM&R Annual Assembly from September 10 to 11 takes place in New Orleans. The Annual Assembly is cancelled on the morning of September 11, and approximately 100 attendees of the precourse rent cars to travel home.
2002: The Foundation for PM&R is established.
2008: The PASSOR Legacy Award and Lectureship is established to recognize a mid-career physiatrist who has advanced musculoskeletal care.
2009: AAPM&R launches PM&R, “the purple journal.” AAPM&R introduces the Member Council model and Community Networks, and restructures the Board of Governors.
2010: AAPM&R introduces PhyzForum, an online peer networking tool and www.me.aapmr.org, an online educational repository. AAPM&R also launches Maintenance of Certification resources, including review courses, a MOC|3 Online Mock Exam, and a Practice Improvement Project. The number of board-certified physiatrists reaches 10,000.
2012: The AAPM&R establishes the Future Leaders Program (formerly the Academy Leadership Program) to identify young member leaders and prepare them for specialty leadership and volunteerism.
2013: The AAPM&R celebrates its 75th anniversary. PM&R receives its first Impact Factor and is ranked in the top half of all journals in the rehabilitation and sports science categories.
2016: The AAPM&R launches PM&R BOLD, an initiative to advance a new mission and vision for the specialty and to help position physiatrists for success across key practice areas. The organization also begins development of a PM&R-focused data registry to improve patient care and to demonstrate physiatrists’ value as providers of the highest quality of care.
2018: The Academy introduces Member Communities, i.e., self-identified, organically-established communities where members can connect with each other, share experiences, and advance the specialty.
2020: The Academy responds to the COVID-19 pandemic by providing resources and guidance through its Physiatrist Member Support and Resource Center (www.aapmr.org/covid19) to support the physiatric community.
See the following resources for more history about the specialty: