Demonstrating the vital role of physiatry throughout the health care continuum: Lessons learned from the impacts of the COVID‐19 pandemic from a national academy perspective

Abstract

Speculators, fortune tellers, and psychics have flourished during prior periods of unprecedented and unnerving national calamity. Our current situation is no different, although the players have been polished up as they make bold predictions regarding the implications of the worldwide COVID-19 pandemic on our future society and health care system. Management consultants are feverishly publishing and offering their premium services to share prophecies around the consequences and fundamental change that will result from our current crisis. Many variables across our society, including social and political unrest, are in simultaneous state of change making detailed predictions about the future more speculative than ever. Although it may be too early to accurately predict the future, we can and should look to the broader trends that existed before the pandemic that are now under more scrutiny and pressure in today’s environment. The pandemic has accelerated many existing precrisis trends and has dramatically uncovered the fragility of our health care system. The inequities and social implications of our fragmented delivery system and national health care funding strategies have been undeniably exposed. Future analysis will surely document the outcome variances between communities that were able to respond to the pandemic with an integrated health care response compared to those communities that lacked the system integration and cooperation to marshal a comprehensive response. The instability of our existing health care finance and reimbursement system, which necessitates and prioritizes specialized procedures that must subsidize general and intensive medical care, has brought many of our largest and most prestigious health care systems to their brink with implications that will last much longer than the pandemic itself. The vulnerability of private and group medical practices with limited financial reserves and access to capital has resulted in long-term uncertainty for many practices. Positively and appropriately, front-line physicians and health care workers have been praised and their professional reputations elevated for heroic actions and personal sacrifices responding to the COVID-19 pandemic. So too have physiatrists been deployed to the front line and have converted rehabilitation units and innovatively reengineered practices to maintain crucial continuity of care for the most vulnerable patients. The rapid response and inspiring achievements of medical science and research have moved from scientific journals to front-page news. Yet these merited accolades for the medical community are coming during a time of great hardship and disruption in the profession. Temporary practice closures and the ongoing significant reductions in patient volume, combined with higher practice expenses (e.g., personal protective equipment [PPE] and other safety investments) threaten the stability of physician practices and are creating profound fiscal and emotional stress on practitioners at the very time they are being asked to step forward. Surveying by the American Academy of Physical Medicine and Rehabilitation (AAPM&R), as well as the American Medical Association, Received: 15 April 2021 Accepted: 15 April 2021