Physiatry Forward: Medical Missions in PM&R Programs
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Incorporating Medical Missions into a PM&R Residency Program

Author: Stephanie Rand, DO
Associate Program Director at Montefiore Medical Center

Much of the burden of living with a disability is concentrated among those populations least financially able to bear the burden. The World Health Organization estimates that while 10% of the worldwide population has a disability, 80% of these individuals live in developing countries with limited access to health care and rehabilitation services. Although as physiatrists we are in a unique position to provide care to this under-served global population, historically medical missions have been primarily comprised of surgeons and primary care providers.

Physiatry residents need exposure to medical mission work in their residency programs to develop necessary skills and understand the challenges these populations face. Medical mission work during residency can strengthen a trainee’s competence in systems-based practice, provide an opportunity for creatively providing patient care in challenged environments, and help with prospective resident recruitment.

But, how can that be done in the context of the ACGME-accredited residency?

Barrier 1: Unlike surgical care, physiatric care is rarely a “one and done” approach. Much like treating persons with disabilities at home, persons with disabilities in developing countries best benefit from ongoing access to physiatric care or knowledge.

Solution 1: Develop long-term relations with target countries, particularly in collaboration with their local hospitals.

Barrier 2: Financial cost. Direct costs may include airfare, hotel, work permit/visa, meals, medications and medical equipment.

Solution 2: Alternative funding sources for global health include institutional grant funds, secular non-profit and religious organizations, and private donors.

Barrier 3: Administrative guidelines (aka “red tape”). Indirect costs include loss of home-institution productivity, or loss of vacation time.

Solution 3: Pairing residents with faculty on department-funded missions can accommodate medical mission work within ACGME guidelines, without requiring participants to use personal time. Including academic time in calculating faculty contribution at the home institution may ensure the time spent with residents abroad does not detract from their productivity goals.