Dr. John Gilmer wants to help patients recover after trauma injuries or strokes, so he’s training in that specialty through a new Spokane residency program. Gilmer is among the first six resident doctors here who plan to become physiatrists, or specialists in physical medicine and rehabilitation for spinal cord injury, stroke, brain injury, amputee care and pediatric work.
The inaugural group began in July to train in what will be a three-year program based at Providence St. Luke’s Rehabilitation Medical Center. Next year there will be 12 first-year residents, and the program plans to reach its full capacity of 18 doctors per cohort in the third year.
“I think the interesting part of physical medicine and rehabilitation to me as a specialty is I really appreciated the functional aspect of it, that you really get to work with your patients to help them do something that they weren’t previously able to do,” Gilmer said.
“We deal with a lot of patients who have had strokes, brain injuries or spinal cord injuries. These are devastating injuries that changed what they were able to do, and you really have just the bravest patients who are willing to work to overcome that.”
The program hopes to attract and retain such doctors to serve in this region. Gilmer spent his first two years of medical school in Spokane as a University of Washington School of Medicine student. He was raised in McCall, Idaho, and by age 8 followed a doctor around a hospital where his mom worked as a respiratory therapist. After graduating from UWSOM, Gilmer did an intern year in Spokane in internal medicine at Sacred Heart.
Now, he and the other residents at St. Luke’s will work with rehabilitation patients alongside attending physiatrists and others in a caregiver team, including physical and occupational therapists. As specialists, physiatrists understand and oversee all aspects of recovery past the acute stage along with managing any medication required such as for stroke patients.
“Physiatry is a unique speciality,” Gilmer added. “I think the textbook answer would be that we’re kind of the specialists of nerves and muscles. What I tell my parents to explain it is we are the best at helping people regain function or regain the ability to do something after they’ve lost that from a stroke or a spinal cord injury.”
Among physiatrist training programs, the only other one in the Northwest is at the University of Washington in Seattle. The next closest is in Salt Lake City, said Dr. Kenneth Isaacs, regional medical director at Providence Spokane Neuroscience Institute.
Isaacs said St. Luke’s offers one of the largest free-standing physiatry rehabilitation programs in the Western U.S. and has state-of-the-art equipment and facilities. The rehabilitation hospital has 12 physiatrists who also will be attending physicians in the training program, Isaacs said. The residents will work with patients from a broad regional area, including the Inland Northwest, Montana and Alaska.
“Physiatry is important because after a person sustains – for example – a stroke or traumatic brain injury or spinal cord injury, they need to be not only treated by cardiologists, neurologists or surgeons, (but) to then have restorative care from physiatrists to build upon that to achieve their maximum potential recovery,” Isaacs said.
“Physiatry is t hat portion of medicine that takes you from an acute episode through the restoration to reach your maximum capabilities.” He said the physiatrist training program here also builds on the Spokane medical community’s growth that includes two medical schools and an increasing biomedical presence.
“Frankly, Spokane is transforming into a major medical hub and biomedical center. This is one of those components.” He said Spokane has other existing doctor residency programs that include ones for internal medicine, family practice, psychiatry and radiology.
In the physiatrists’ training, the residents will work the first year in inpatient service. The second year involves a mix of outpatient clinics, also working with attending physicians. The residents complete such training in the third year until taking examinations to become board-certified. While in the program, residents also will do research work.
Additionally, Isaacs said the program will collaborate with Spokane’s medical schools while inviting students to visit or participate from UWSOM with classes on the Gonzaga University campus and from Washington State University’s Elson S. Floyd College of Medicine. Gilmer said all the residents plan to do research. He’s also enjoying the collaborative work.
“I started on the brain injury unit,” Gilmer said. “I’m usually one of the first people at the hospital, and I get everything ready, and when the attending gets in, we go on rounds. We see patients and assess them, put a plan in place, then in the afternoon, we follow through with what we came up with on rounds, and we admit new patients.”
“In the afternoons, I can go to the therapy sessions with my patients, which is a pretty unique experience to (physical medicine and rehabilitation). I can actually work with them on how they can learn to walk again.
“We work with a multidisciplinary team, so on a daily basis, I’m working with the occupational therapist, the physical therapist, the speech therapist, the recreational therapist,” he said. Psychiatry also can be involved. “A big part of PM&R is coordinating everybody on the team and making sure everyone is aware of what is going on, what our goals are and how we’re going to get there.”
He also sees a need for more physiatrists because St. Luke’s serves a large regional area, people are living longer, and more patients are recovering after a trauma. “We have more and more patients who are surviving strokes now, spinal cord injuries and brain injuries. As they survive long-term, they work with PM&R doctors to maintain function throughout the rest of their lives.
“As we get better at keeping people alive through that acute phase, there is an increased need for PM&R doctors to care for them for the rest of their lives.” And St. Luke’s site offers such services with state-of-the-art facilities and equipment to help those patients, he added.
Planning to develop such physiatrist training locally started about 10 years ago with the arrival of Dr. Greg Carter, chief medical officer at Providence St. Luke’s Rehabilitation Medical Center. Isaacs said other physicians also worked to launch the new program, including Dr. Ross Bogey, now director of St. Luke’s PM&R Residency Program.
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