Future of Physical Medicine and Rehabilitation Department
David D. Kilmer, M.D. became Acting Chair, October 1999, and was then appointed the fourth Chair of the Department of Physical Medicine and Rehabilitation in July 2000.
Changes associated with managed care along with reduced support from the State and Federal Government for teaching and research have made the Department of PM&R increasingly reliant on clinical income to fund our programs. Although this creates new challenges, we are optimistic that we will be able to prosper in the future as we adapt to the changes in academic medicine.
From the clinical standpoint, we are adapting to shorter length of inpatient rehabilitation stays with many services now being provided on an outpatient basis. We can no longer afford the inefficiency of transporting patients for therapy between the fifth floor of the hospital and the basement therapy areas. A proposal is being put forth to hospital administration to create a unified rehabilitation unit with contiguous therapy and patient care areas. The location for this new unit within the medical center has not yet been finalized and we will be determining the appropriate number of beds to meet residency training requirements and the inpatient rehabilitation needs of the health system.
Outpatient PM&R at UC Davis is transitioning from a traditional emphasis on rehabilitation diagnoses to burgeoning growth in musculoskeletal and sports rehabilitation. There is a close collaboration between PM&R and Orthopaedics to manage musculoskeletal and spine patients in a way optimally suited to both departments. In addition, collaboration with the Division of Pain Medicine in the Department of Anesthesiology is creating opportunities for resident training in spinal interventional techniques as well as formation of a multidisciplinary pain treatment program at UC Davis. The department is also exploring greater collaborative opportunities with the Northern California VA system, anticipating a greater need for physical medicine and rehabilitation services with the opening of the Mather VA Hospital in 2002.
The residency program is also adapting to the changes in the nature of employment for PM&R physicians. The majority of our recent graduates have been taking positions in musculoskeletal and occupational rehabilitation, and the training program now reflects these changes in the needs of our graduates. We have instituted rotations in the Employee Health Clinic, at the Kaiser Occupational Medicine Clinic, and the Anesthesia Pain Clinic to increase training in these areas. In addition, the recent addition of Dr. Brian Davis, with his expertise in musculoskeletal physical medicine and rehabilitation, will enhance the training of our residents. The residents continue to obtain an outstanding experience in EMG training, attested by the near 100% pass rate of our graduates on the American Board of Electrodiagnostic Medicine certifying exam.
The department continues with its required fourth-year, two-week rotation for the medical students at UC Davis. We are dedicated to teaching our medical students the principles of managing patients with chronic disease and disability, important regardless of their future medical specialty. The rotation continues to garner excellent evaluations, and we are currently undergoing a revision of the didactic curriculum to utilize unique teaching methods and case-based discussions.
In terms of research, the department continues with its national reputation in the rehabilitation of persons with neuromuscular diseases, a longstanding strength of the department begun by Dr. Bill Fowler. There has been consistent funding from NIDRR for this work for over 20 years. We are currently negotiating for space within the medical center for creation of an exercise physiology laboratory to focus on the functional performance of persons with disabilities, as well as to assess the effect of interventions on physical performance. This laboratory should allow us to utilize techniques developed in studying neuromuscular disease patients, expanding in other areas of disability such as survivors of trauma and persons with musculoskeletal disabilities. Finally, research proposals are being forwarded by our faculty involved with Shriner's Hospital to capitalize on our close affiliation with this outstanding clinical institution at our doorstep.
The future of the PM&R Department at UC Davis is bright, and we anticipate continued recognition as a national leader in the training of outstanding PM&R residents, receiving a high amount of extramural funding per faculty, and providing scientifically based and cutting-edge rehabilitative medical care for our patients."….D.D. Kilmer