ADOLESCENCE AND MATURATION: A PERIOD OF TRANSITION,1982-1991
James S. Lieberman, M.D., became the second Chair of the Department of Physical Medicine and Rehabilitation in July 1982. He had been at UC Davis since 1972 in the Department of Neurology with a joint appointment in Physical Medicine and Rehabilitation. He transferred his primary appointment to Physical Medicine and Rehabilitation in 1974 where he first completed an In Residence PM&R Fellowship and then continued on the faculty. Hibbard E. Williams, M.D. continued as Dean, School of Medicine, and the sixth UC Davis Medical Center administrator, Frank Loge, became hospital director in 1984. Between 1980 and 1992, there was a 50% increase in medical school faculty and more than doubling of staff. Revenues from grants and contracts grew from $12 to $48 million per year, bringing the School of Medicine into the top 30% of all United States medical schools for total research revenue, while 60% of the other schools had more faculty.
UC Davis Medical Center became a major regional referral center for all inland Northern California and a true health science center with 57 separate facilities situated on or near a 100-acre central site in Sacramento. Hospital staff tripled. Outreach clinic centers and a consortium of UC Davis-affiliated hospitals in the East Bay were developed. A new inpatient tower was completed in 1982. By 1990, more than 70% of all Sacramento area physicians had trained or worked at UC Davis Medical Center.
The entering class size at the medical school was reduced from 100 to 93, as medical schools throughout the country started to adjust to the oversupply of physicians. For the medical school and hospital, 1982–1991 was a period of rapid growth and transition to the era of managed care.
For the Department of Physical Medicine and Rehabilitation, this was also a period of consolidation of facilities and programs and a failed venture into the world of corporate medicine. While the department administration moved from the UCD to the Sacramento campus in mid-1982, offices and support space for most of the faculty were not available until the next year in the Professional Building. The temporary buildings on the UCD campus were then used primarily for research activities. When the new tower was completed in 1982, the physical medicine and rehabilitation acute care rehabilitation unit moved to a remodeled ward with a dining area, day room, nursing, and therapy support facilities. Shortly thereafter an electrodiagnostic laboratory was established freeing up clinic space.
As the medical center expanded and the number of patients increased, staff more than doubled in the therapy services. Specialty programs in areas such as Orthopaedics, hand surgery, and children's rehabilitation were developed. A major impact on both the therapy and PM&R services was the establishment of regional burn and trauma centers. By 1991, it was clear that the existing facilities for the therapy services, like the ambulatory clinic, had become inadequate. Section Chiefs during this period were Robert Davison and Diane Von Burg (Physical Therapy), Mary Lou Burke (Occupational Therapy), Robert Buchanan (Orthotics), Jo Mays, Jenni Moser, and Nancy Borroum (Clinic Nurses), Bart Billings, John Wicks, and Rick Wanlass (Psychology), and Deborah Ross, Larry Boles, and Christine Davis (Speech Pathology). Department managers included Linda Beaulieu, Carl Oxendine, Sigrid Owyang and Robert Taylor (Hospital), and Jerri Wright and Karen Lehman (School of Medicine). Barbra Lord succeeded Lynn Macintosh as Clinical Rehabilitation Nurse Specialist in 1983.
Clinic patient programs at the medical center remained about the same as during the late 1970s with an emphasis on neuromuscular diseases, childhood rehabilitation, amputees, spinal cord injury, and musculoskeletal disorders. The number of beds on the new Inpatient Nursing Unit were reduced from 30 to 20, and most of the patients had spinal cord injury, traumatic brain injury, and strokes. Patients with decubitus ulcers were also housed on the ward in a joint program with Plastic Surgery.
The number of physical medicine and rehabilitation housestaff positions increased from 9 to 12 in 1983–84, and PGY I positions were permitted by the medical center for the first time. While qualified resident candidates were hard to find in the 1970s, there were an over-abundance in the 1980s as an increasing number of American trained medical students became interested in PM&R. The department developed a reputation from its graduating residents for having an outstanding training program, and this reputation became an advertisement for attracting even more candidates.
"The most important part of my training that I take with me daily is the depth and breadth of the exposure to primary care at UC Davis Medical Center. The training has left me with medical skills that periodically convince the Medical Staff Office that I am double boarded in Internal Medicine and PM&R. The quality of clinical care expected, taught and practiced at UC Davis Medical Center is the standard for internal medicine."V.E. Garrett, 1983
"Thanks to all of you. The physical medicine and rehabilitation residency, 1981-84 at UCD, was really a great life experience. I have a very rewarding profession as a physiatrist and I look forward to going to work every single day."O.K. Hunter, 1985
"I was grateful to the Physical Medicine and Rehabilitation Department for allowing me to be one of the first PM&R residents to make arrangements for an out of town, four-week independent sports medicine rotation, as part of my residency training program. The Physical Medicine and Rehabilitation Department staff and faculty were invaluable in helping to organize for me the call coverage, malpractice coverage, receiving academic credits, etc. This rotation eventually led to acquisition of my first job in the "real world," with a sports medicine medical group. This in turn lead to one of my professional goals in that I was the recipient of two Super Bowl rings as a member of the medical staff for the San Francisco 49ers."J.J. Wiens, 1985
"Finally, fantastic reunions at Academy meetings, seeing old friends, and realizing what a special program we have. Old residents are very loyal to this place."D.D. Kilmer, 1989
"Most importantly, I feel grateful for how excellent and thorough my education and training during residency was in the areas of neuromuscular diseases, pediatric rehabilitation, and spinal cord injury care. These are areas that seem to be weak in residencies of some of my current colleagues, but were very strong in our program. A lot of my teaching was done by other residents, and much of it occurred by what seemed to be osmosis by spending so much time one-on-one with very knowledgeable faculty members. We had perhaps fewer formal classroom teaching sessions than some residencies might, but this more personal and continuous form of teaching and learning served me well."V. Moise, 1986
"Some interesting and significant events during my time at UCD, were my medical school required rotations. These rotations increased my awareness and interest in PM&R,Caring for a singing (rapping) quadriplegic patient performing a song he wrote called "Disability Blues",Specialty clinics in NMD, spina bifida, amputee, and EMG,Running and skiing with attendings and residents,sharing in the feeling of success and achievement when a depressed disabled patient starts to make gains and enjoy his progress one triple amputee and a TBI patient went on to be a water skier." R.R. Sloan, 1991.
Twenty-nine residents graduated between June 1983 and July 1991: Oscar B. DePaz, Virginia E. Garrett, Stephen I. Mann, Scott F. Recker, Robert R. Haining, James A. Scott, Esperanza Guillermety, Oregon K. Hunter, Alicia M. Abels, Jeryl J. Wiens, Conrad E. Hartsell, Vivian M. Moise, Mary-Nell Anderson, Christopher B. Ryan, Raymond D. Pierson, Jose A. Santos, John J. Aschberger, David R. Cooper, Barbara J. Kolack, David D. Kilmer, Anthony J. Margherita, Lee E. Vranna, James L. Boyd, Jr., Gregory T. Carter, Michael S. Felix, Douglas W. Kindall, Michael L. Kravetz, Barbara J. Sigford, and Robert R. Sloan. Unlike their predecessors in the 1970s, most spent four years in training at UC Davis Medical Center. Two became PM&R faculty, D. D. Kilmer and G. T. Carter.
In 1983, the medical student curriculum returned to a traditional department-oriented program. Some organ system cores, markedly reduced in size, remained, and the department continued to participate in the musculoskeletal course. PM&R electives were replaced by a one-month required clerkship which was reduced to two weeks in 1986. Student reviews have consistently ranked the PM&R clerkship as one of the best in the medical school.
From 1982 through 1991, was probably the most productive research period in the department history. Pre-clinical animal studies were expanded to include electrophysiologic investigations of the spinal cord in cats and of skeletal muscle in rodents with neuromuscular diseases; investigations of drug interventions in dystrophic mice, and studies of the effect of exercise training in normal and dystrophic animals. A comprehensive research study was developed to evaluate the impairment and disability profiles of individuals with neuromuscular diseases and the effect of exercise on these individuals. Research grant support increased to an average of about $860,000 per year. This included a federal research training grant that supported four postdoctoral fellows, one of whom, Mark A. Wineinger, went on to become a member of the faculty. About nine papers were published each year.
The faculty during 1982 -1991 included one non-physician, Richard E. Entrikin, and 13 physiatrists: William M. Fowler, Jr., James S. Lieberman, Robert G. Taylor, Nirmala Nayak, Margaret Portwood, Paul Bach-y-rita, Janet Lord, Paul Willis, E. Ralph Johnson, Charles Yang, Brenda Mallory, David D. Kilmer, and Gregory T. Carter. Bob Taylor, one of the founders of the department and its Director of Residency Training and Vice Chair, died in 1988.
"Robert G. Taylor was one of the last "triple threat" academic physicians; distinctive and caring clinician, outstanding teacher, and excellent researcher. He was a gentle and thoughtful person who often served as the department's conscience, frequently reminding us that we were physicians first of all and that our primary responsibility was to our patients.
Bob never forgot that he started out in medicine as a general practitioner for 10 years. In an age of medical specialization, he somehow became a specialist in just about everything. At one time or another, he was responsible for every specialty clinic in the department as well as for establishing the department's patient service program. His wealth of experience as a primary care physician encouraged him to continuously keep up to date on all aspects of medical diagnosis and care. His knowledge of the medical literature, both clinical and scientific, was formidable especially to students and residents who spent a great deal of time in the library when he was on the ward service. His patients, of course, also benefited from his extensive experience and global clinical interests. He was indeed a physicians' physician, and the department faculty and staff, past and present, often considered him to be their unofficial consultant.
The broad nature and variety of his interests and activities also resulted in his becoming the department's most well-liked and respected teacher. To Bob, patient care, research and teaching were not separate compartmentalized entities, and he was always encouraging the residents to develop research projects to answer their many questions. Teaching was his major interest, and he was available to the housestaff day and night. Long after graduation, former residents continued to contact him regarding his opinion about patient problems. His faculty colleagues will always remember his constant pleas to revise and improve the department's teaching programs.
While his research interests and accomplishments were as global as his clinical interests, his major emphasis was on neuromuscular diseases and muscle biology. He had the rare ability to carry out both clinical and basic investigations, and to link the two together in a comprehensive approach to a research problem.
While an accomplished clinician, teacher and researcher, Bob will be best remembered for his major concern for others and the department, and not for himself. Physical Medicine and Rehabilitation is a discipline, which focuses on the team approach. Bob was the consummate team player."William Fowler, Andrew Gabor, James Lieberman: In Memoriam, University of California, 1988
"I still enjoy performing EMG/NCS due to all the time Bob Taylor spent explaining where the signals were coming from and how to make sense of it all. They remain very interesting, the Sherlock Holmes part of the practice and I hope is helpful to the referring physicians."V.E. Garrett, 1983
"Bob Taylor was really a great teacher. I remember my first EMGs. He simply sent me in to do EMG/NCS and I simply had no idea what I was doing. When I went to ask him some questions to try to figure out what to do, he just gave me obscure answers or just responded with questions. Of course, his Socratic method ultimately helped me to learn to do excellent electrodiagnostic evaluations, but the early learning process was somewhat painful and frustrating."O.K. Hunter, 1985
"Bob Taylor's tie clip with the 3x5 card attached. We used to call him "scratch and sniff Bob" for the way he would closely examine skin lesions to determine the causative pathogens. I remember going into his office and barely being able to see him through the smoke haze."D.D. Kilmer, 1989
"The Bob Taylor Bodybuilder Story: Early in my EMG experience (back in the days of the TB 20), I had the opportunity to work with Bob Taylor. He knew that I had an interest in sports medicine and called me to assist him in evaluating a bodybuilder with neck and shoulder pain. To prove a point, Bob asked the bodybuilder to hold out his affected arm. Bob promptly did a chin-up on the man's arm. He asked me to grade the fellow's strength at which time I responded "5 of 5 of course." Suffice it to say the EMG demonstrated 3+fibs and sharp waves indicative of acute denervation of the deltoid. "Bob Taylor – May he rest in peace: Bob Taylor became ill and died during my tenure as a resident at UCD. I probably did not get the chance to work with him as much as those who preceded me, but will nonetheless remember him with great fondness. At the time, I had a great deal of difficulty dealing with his passing, and remember the tears flowing easily at the incredible memorial service, that was held in his remembrance. He is the man that gave me the opportunity to do an EMG on Greg Lamond, just because he knew I was a cyclist and sports medicine enthusiast. He had an understanding of our specialty that few have duplicated, and empathy for all patients, no matter who they were or how bad off they might be." A.J. Margherita, 1989>
By 1991, the department had grown to over 75 staff and 7 full-time faculty with a national reputation in residency training and research in muscle physiology and neuromuscular diseases. An Association of Academic Physiatrists survey in 1983 ranked the department 3rd of 69 academic departments or divisions of PM&R. In Inland Northern California, there were over 35 community physiatrists and 10 community hospital PM&R programs. About 50% of the community physiatrists where graduates of the UCD residency program or former UCD faculty.
Dr. Lieberman resigned as the second UCD Department Chair, May 1991, to become the third Chair of the Department of Rehabilitation Medicine, College of Physicians & Surgeons, Columbia University. While Chair at UCD, he was also Chief of Staff, UC Davis Medical Center, Chair of the Medical School Faculty Group, Assistant Director of Clinical Resources, UC Davis Medical Center, and in his position as Assistant Director, UC Davis Medical Center, he was one of those responsible for bringing Shriners Hospital to Sacramento.
"Before I even dreamed of becoming a physical medicine and rehabilitation resident, when I attended medical school at UC Davis 72-76, Jim Lieberman really got me excited about neurology, particularly performing a complete and thorough neurological examination. I remember a little blue booklet he referred to, something about the Queen's Neurological Examination (sp?). I learned to do such a through exam routinely, that when patients finally arrive in my practice, I often pick up diagnostic clues that everyone else including neurologists has missed. Thanks Jim."O.K. Hunter, 1985
"Jim Lieberman was "larger than life," "a huge presence" (no pun intended). Everyone at the UCD Medical Center seemed to know Jim. He is also one of the smartest men I have ever encountered. After appearing in his office, post ICU call, unshaven, in bloodied greens, and begging, he gave me a PM&R slot. I owe him my life for that."G.T. Carter, 1990
"Our fearless Jim Lieberman used to say that EMGs filled one of three functions and on some rare occasions, all three at the same time. EMGs were a) diagnostic, b) therapeutic, and c) punitive."W.S. Rosen, 1992