In 40 years, the UC Davis Medical School and Hospital have gone from several temporary buildings on the UC Davis campus, a small county hospital in Sacramento, and a few faculty, housestaff and medical students, to a large integrated UC Davis Health System with a national reputation. This was accomplished in spite of marked adversity, especially during its formative years.
In 1968, the Department of Physical Medicine and Rehabilitation had three faculty, less than ten staff, a Physical Therapy unit, and severely restricted clinical and research facilities. By the start of the 21st century, the department had grown to include seven physiatrists, over 90 university and grant supported staff, five therapy sections, ten patient service programs, several focused research investigations, a residency program, a required medical student clerkship, and well-designed spacious facilities.
Many of the characteristics of the department today are similar to those at the time it was founded and reflect the department's original objectives. The department is relatively small if only evaluated by the number of faculty and the size of its clinical services and programs such as the Acute Care Inpatient Unit. Objectives in 1968 were to develop a modest size but high quality comprehensive academic and clinical services and patient programs in neuromuscular diseases, children's rehabilitation, amputees, spinal cord injury, and musculoskeletal disorders. Significant growth has occurred in the rehabilitation therapy services due to the marked increase in the number of hospital and clinic patients. In addition, PM&R clinical services have expanded beyond the medical center campus, and there has been increased participation in multidisciplinary medical center programs. This has significantly increased the growth of the pediatric rehabilitation and musculoskeletal programs. The basic philosophy has been that a small or moderate sized department can only develop and maintain excellence in two or three clinical and/or academic areas.
Original objectives were also to develop a small but high quality residency program, extensive participation in the medical student curriculum, a research program of academic excellence and extramural grant support for these programs. These objectives have been met and maintained. Involvement with the medical students evolved from an elective program to a required clerkship. Seventy-four residents have graduated since 1972. Of these, 86 percent went into community or institutional practice, and 14 percent into academic medicine. Most of the latter became faculty at UCD.
Fifty-six percent of the resident graduates remained in California, and most went into practice in Inland Northern California. There continues to be focused organized research investigations in neuromuscular diseases, but with expansion in the 1990's into other areas associated with pediatric rehabilitation and musculoskeletal disorders. Faculty have received over $15 million in extramural grants and contracts and generated over 250 publications.
Some of the original departmental objectives have been modified, and the major effect of managed care and reduced state funding has been on the characteristics of the faculty. Through about the early 1980's, patient service, while required to be of good quality, was considered as a means towards the ends of research and teaching. Patient service quantity and revenues were of secondary importance. In order to be promoted and obtain tenure in a "publish or perish" system, faculty were expected to do focused research, especially preclinical investigations, with extramural grant support. With managed care and decreased state support, the quantity of patient service and patient care revenues has become of primary importance. The emphasis is now on physician faculty who are productive clinicians. This has resulted in a change in the type of research towards clinical investigations. This change, however, has not had any impact on extramural grant support, and the number of publications per year has actually increased.
There are several departmental characteristics that probably distinguish it from other academic departments of PM&R. The residency program is far less structured than at most other institutions with a minimum of didactic instruction. Since there is a high faculty-to-resident ratio, the program is conducted on the preceptor model. The required PM&R clerkship for medical students is unusual in other medical schools. It is also unusual for most other PM&R departments to have a major emphasis on clinical and research programs in pediatric rehabilitation, and especially in neuromuscular diseases.
The department's major impact has probably been in the development of PM&R in Inland Northern California. There was only one community physiatrist in the region in 1968, and UCD had the only PM&R hospital program. Now there are at least 55 physiatrists and 15 community hospital PM&R departments of which ten have inpatient units. About 40 percent of the community physiatrists are graduates of the UCD residency program or former UCD faculty.
The department also has a state reputation based on its medical student and residency training programs and faculty and resident state awards and positions of leadership. Two individuals have been Executive Director and two others President of the California Society of PM&R. Another member of the faculty has received the Physician of the Year Award from the California Governor's Committee for Employment of Disabled Persons. Others have been members of major committees of the California Medical Association.
The department has also obtained a national reputation in its clinical and research programs in pediatric rehabilitation and especially in neuromuscular diseases, as well as national faculty awards and positions of leadership. Examples of the latter are:
American Academy of Physical Medicine and Rehabilitation
- Krusen Award
American Congress of Rehabilitation Medicine
- Vice President
Association of Academic Physiatrists
- Young Academician Award
- Best Paper Award
PM&R Education and Research Foundation
- Vice President
- Best Paper Award
- New Investigator Awards (2)
- Archives of PM&R
- Editorial Board (2)
National Association of Rehabilitation Research and Training Center
- Certificate of Commendation
To the founders of the Department, this history has been a walk back to a different time and place.
"History is the witness that testifies to the passing of time; it illumines reality, vitalizes memory, provides guidance in daily life, and brings us tidings of antiquity" --- Cicero