Dear Editor,

On witnessing the management of orthopedic or neurologic problems in hospital wards, one becomes aware of the growing problem of the physiatrist. Patients undergoing surgery by an orthopedist or those with a neurological stroke are often sent to a physiatrist without a therapy plan to which both parties have mutually agreed. Increasingly, we are witnessing an overlap of competences. Patients and colleagues from other fields often see physiatrists as useless middle professionals who insert themselves between them and the physiotherapist. The physiatrist is often requested to follow only guidelines imposed by good medical practice.

This situation often results from physiatrists themselves prescribing therapies that are exactly the same as those prescribed by other specialists, without adding anything new or unique. Physiatrists interpret patients’ disabilities and evaluate them by debatable criteria based on patient and professional subjectivity. Indeed, a visual analog or a Constant scale or an International Classification of Functioning test can be given or completed by other professionals with equal efficacy as the physiatrist. If the prescribed therapy for arthrosis is often infiltration or if for post-stroke spasticity botulinum toxin is mainly used, why should a neurologist or an orthopaedist consult a physiatrist?

We do not proclaim that these therapies are not effective or that the physiatrist should not prescribe them. However, we raise the issue of the overlapping of specialties without a strong argument for the need for physiatrists.

During physical medicine conferences or at several medical schools, it is often noted that physiatrists are the only specialists who interpret a disability from a functional standpoint, placing the disability in the patient’s subjective viewpoint. Is this statement really true? Could this be the real argument for the need for physiatrists?

For the 2 previous examples, arthrosis and post-stroke spasticity, several studies have highlighted the effectiveness of new therapeutic techniques, especially when classical therapies have limitations. In orthopaedics, baclofen was found to limit a good response to therapeutic exercise in patients with knee osteoarthritis, and laser therapy could be used to treat degenerative diseases and joint inflammation . For post-stroke spasticity, shock waves or transcranial magnetic stimulation could allow the operator to avoid the long-term use of botulinum toxin with reduced side effects of the toxin .

We need to remember that the physiatrist is an expert specialized in evaluating, implementing and designing a future of functionality for the patient, and this kind of specialist has as their first aim not just labeling a disability by the diagnosis but also exploring functional alternatives and new balances for the quality of the life of the patient. This is the real need for the physiatrist.

Finally, it is important to mention that since the name of our specialty is “physical and rehabilitation medicine”, the prescribed therapy should be mainly represented by physical means and therapeutic exercise as well as other important aspects of physical medicine and rehabilitation–speech and language therapy, cognitive rehabilitation, treatment of behavioural disorders, and other closely related domains such as vocational and social re-entry programs or family support.

The training of new physical and rehabilitation specialists (in Spain as we have observed but also in other countries) and the scientific production in the field should focus on equipping physiatrists with these specific and unique tools.