Raddatz, Mikaela M.

Purpose: In 2022, the American Board of Physical Medicine and Rehabilitation (ABPMR) contracted with Professional Services Industries LLC to complete a Pediatric Rehabilitation Medicine (PRM) practice analysis. The goal was to develop an updated examination content outline that accurately depicts the knowledge and skills expected for a competent PRM physician following completion of training. The purpose of this paper is to describe the process of practice analysis and to present candidate perceptions of scope of practice and relevancy of content from the first two examinations in which the new outline was applied. Methods: The practice analysis process was undertaken in four distinct stages: subject matter expert meetings to determine the tasks and knowledge areas; the development, issuance and analysis of a national survey; development of exam specifications; and results verification. Results were analyzed by a psychometrician and team to determine mean relative importance of task and knowledge items. A new outline was then created and used for the administration of the 2023 and 2024 ABPMR PRM Certification Examinations. Results: All active board certified PRM physicians identified were sent surveys via e-mail. One hundred ninety six (61.1%) respondents completed the survey. The top five task statements in order of perceived importance were performing history and physical examinations, managing muscle and tone abnormalities, prescribing orthoses and equipment, prescribing therapy services, and making appropriate specialty care referrals. The top five knowledge statements in order of perceived importance were cerebral palsy, spinal cord injury, abnormal growth and development, neuromuscular disorders, and musculoskeletal conditions. The new PRM Examination content outline created included six domains and 22 subdomains of knowledge content areas. A higher percentage of initial certification candidates sitting for the 2023 and 2024 ABPMR PRM Certification Examinations selected “Strongly Agree” or “Agree” when responding to the examination content reflecting both scope of training and relevancy. Conclusion: A practice analysis process was undertaken resulting in a new content outline for the ABPMR PRM Certification Examination. Following the implementation of the new content outline, initial certification candidate survey responses showed improved favorability regarding content reflecting scope of training and relevancy.

Abstract Background Physical medicine and rehabilitation (PM&R) is a diverse specialty, growing and evolving over a variety of subspecialty and practice focus areas. Accurate data regarding practice patterns of physiatrists are essential for updating requirements in training and certification, particularly as the Accreditation Council for Graduate Medical Education begins its process to update of the PM&R core residency training requirements. This study analyzes practice trends for nearly 98% of physiatrists in active practice, the largest study to date. Objective To update current demographics of physicians specializing in PM&R, including current areas of practice focus, to analyze the alignment of practice focus with subspecialty certification, and to determine the extent that electromyography is a component of current physiatric practice. Design Retrospective analysis of deidentified responses from American Board of Physical Medicine and Rehabilitation (ABPMR) board‐certified PM&R physicians (diplomates) on annual enrollment in the ABPMR Continuing Certification program. Participants A total of 9543 ABPMR diplomates. Main Outcome Measures Demographics – age, gender, years in practice, practice setting(s) and area(s). Practice focus, subspecialty certifications. Results The majority of practicing physiatrists are men (62%) although the percentage of women in the field is growing (38%). Nearly 80% of physiatrists report more than one practice focus area, with pain medicine and sports medicine/musculoskeletal practices most commonly reported. Conclusions This study confirms the growth trends in PM&R in pain and sports medicine but also highlights the substantial number of physiatrists focusing their practices in areas related to neurorehabilitation and medical rehabilitation. The large majority of physiatrists incorporate multiple focus areas into their practices. Electromyography is a focus for a declining percentage of practicing physiatrists.

Background Physician burnout is of growing concern. Burnout among physical medicine and rehabilitation (PM&R) physicians has shown a significant increase, positioning PM&R as one of the most “burned out” of specialties. Little has been written about potential factors contributing to physiatrist burnout or potential interventions. Objective To determine the prevalence of burnout among physiatrists and identify risk factors for burnout and potential strategies to decrease burnout among physiatrists. Design Prospective cross‐sectional survey. Setting National survey of board certified physiatrists. Participants: One thousand five hundred thirty‐six physiatrists certified by the American Board of PM&R. Outcome The Mini‐Z Burnout Survey, 1 question from the Maslach Burnout Scale on callousness toward patients, and several potential drivers of burnout. The probability of burnout, identified by question 3 on the Mini‐Z, was the dependent variable. Other questions on the Mini‐Z were explored as independent variables using logistic regression. Results Seven hundred seventy physiatrists (50.7%) fulfilled the definition of burnout. Only 38% of physiatrists reported not becoming more callous toward patients. The top 3 causes of burnout identified by physiatrists were increasing regulatory demands, workload and job demands, and practice inefficiency and lack of resources. Higher burnout rate was associated with high levels of job stress and working more hours per week. Lower burnout rates were associated with higher job satisfaction, control over workload, professional values aligned with those of department leaders, and sufficient time for documentation. There was no significant association between burnout and sex, years in practice, practice focus, or practice area. Conclusion Burnout is a significant problem among PM&R physicians and is pervasive throughout the specialty. Opportunities exist to address major contributing drivers of burnout relating to practice patterns and efficiency of care within PM&R. These opportunities are, to varying degrees, under the control of hospital leaders, practice administrators, and practitioners.

AbstractBackgroundThere is a need to better understand the overall state of sub‐specialization in physical medicine and rehabilitation (PM&R).ObjectiveTo examine the status and trends in subspecialty certification for each of the seven subspecialties approved for American Board of Physical Medicine and Rehabilitation (ABPMR) diplomates.Design/SettingRetrospective analysis of deidentified information from the ABPMR database.ParticipantsPhysicians certified by ABPMR through 2019.InterventionsNot applicable.Main Outcome MeasuresFor each subspecialty, we examined: (1) the number of certificates issued to ABPMR diplomates; (2) the recertification rate; (3) the yearly trends for total active, new, and expired certificates; and (4) for ABPMR‐administered subspecialties, recertification rates for those entering the subspecialty through fellowship completion versus a “grandfathered” practice pathway.ResultsOf 11,421 ABPMR diplomates in the United States in 2019, a total of 3560 (31.2%) had 3985 active subspecialty certificates. Pain Medicine (PM) was the most common subspecialty certification (15.5% of all ABPMR diplomates) followed by Sports Medicine (SM, 6.6%), Brain Injury Medicine (BIM, 4.8%), Spinal Cord Injury Medicine (SCIM, 4.2%), Pediatric Rehabilitation Medicine (PRM, 2.5%), Neuromuscular Medicine (NMM, 0.7%), and Hospice and Palliative Medicine (HPM, 0.5%). For diplomates with more than one subspecialty certification, PM and SM was the most frequent combination. Both the recertification rate and the end of practice track eligibility influenced certification trends differently for individual subspecialties. The average number of new certificates added annually for every subspecialty was higher before than after the temporary practice track‐based eligibility ended; the difference was statistically significant (p < .05) for SCIM, PM, SM, and NMM. The recertification rate for all subspecialties combined was 73.4%. For the subspecialties (SCIM, PRM) for which these data were available, fellowship candidates had higher recertification rates than those grandfathered through a practice track.ConclusionThis report informs stakeholders about the state and evolution of subspecialty certification in PM&R over time.

BackgroundOsteopathic physicians (DOs) represent over 30% of residents in allopathic (MD) Accreditation Council for Graduate Medical Education (ACGME) accredited physical medicine and rehabilitation (PM&R) training programs. However, some have questioned the quality of osteopathic medical school training and the graduates of osteopathic medical schools. The performance of osteopathic physicians in allopathic PM&R training programs has not been assessed.ObjectiveTo compare allopathic (MD) and osteopathic (DO) physician performance on American Board of Physical Medicine and Rehabilitation (ABPMR) initial certifying examinations.DesignRetrospective cross‐sectional study.SettingBoard‐eligible PM&R physicians.ParticipantsMDs and DOs who completed an allopathic ACGME‐accredited PM&R residency training program.MethodsMD and DO pass rates and mean scaled scores on the ABPMR initial certifying examinations were compared. MD versus DO degrees and training program 6 years aggregate board pass rates were independent variables.InterventionsNot applicable.Main Outcome MeasureMD and DO pass rates and mean scaled scores on the ABPMR initial certifying examinations.ResultsOf the 2187 physicians who were first‐time ABPMR initial certifying examination takers, there were 1596 MDs (73%) and 591 DOs (27%). No statistically significant difference was found in pass rates between MDs and DOs on Part I (94.9% vs. 93.9%, P = .35) or Part II (87.8% vs. 88%, P = .83) of the ABPMR certifying examination. Analysis of mean scaled scores demonstrated higher MD scores on both Part I ( 526, SD = 31, vs. 516, SD = 67, P = .002) and Part II ( 6.73, SD = .83 vs. 6.62, SD = .77, P = .005), significant only in programs with a 90%‐100% pass rate. These differences, however, were of very small magnitude and likely not meaningful from a clinical or educational perspective.ConclusionThis study did not find meaningful differences in performance on the ABPMR certifying examinations between MDs and DOs.

BackgroundCertification by the American Board of Physical Medicine and Rehabilitation (ABPMR) requires passing both a written multiple choice examination (Part I) and an oral examination (Part II), but it has been unclear whether the two examinations measure the same or different dimensions of knowledge.ObjectiveTo evaluate the concordance between the Part I and Part II examinations for ABPMR initial certification with regard to candidate performance on the examinations and their subsets. Our question is whether the Part II examination provides additional assessment of a candidate beyond what Part I provides.DesignRetrospective psychometric evaluation of deidentified board examination scores.SettingABPMR database of Part I and Part II examination scores.ParticipantsCandidates for the ABPMR Part I and Part II examinations after 2005, with a more detailed analysis of candidates for the Part I examination from 2014 to 2016. Examination scores of candidates who took the Part II examination both before and after the examination was standardized in 2005 were also used for an additional analysis.MethodsCorrelations, simple linear regressions, and principal components analysis.Main Outcome MeasurementsCorrelation coefficients, variance analysis, and unexplained variance in the principal components analysis.ResultsThere is a weak to moderate correlation between performance on the Part I and Part II examinations: r = 0.33, P < .001. There is an additional dimension of assessment that is demonstrated on the Part II examination, with this being primarily in the domains of systems‐based practice and interpersonal communication skills.ConclusionThe Part I and Part II examinations, although with some overlap, contribute different and meaningful components to the overall evaluation of candidates for board certification in PM&R.Level of EvidenceIII.