Dr. Andrew Haig: Vermont needs to train specialists in rehabilitation medicine

This commentary is by Andrew J. Haig, MD, Full Professor Emeritus of Physical Medicine and Rehabilitation at the University of Michigan and recipient of numerous international awards, most recently the 2022 Distinguished Advocate Award from the American Academy of Physical Medicine and Rehabilitation. He practices in Middlebury and Williston.

I’m the local rehab doctor here in Middlebury. On Friday morning, I listened to a woman unable to see or hear me talk about her misfortunes.

Haben Girma was in Geneva, Switzerland at the time. She was on stage to host the Friday launch of the World Health Organization’s Global Report on Health Equity for People with Disabilities. His misfortunes were related to the inequality of health care for people with disabilities.

I was there practically as the president of the International Rehabilitation Forum, www.rehabforum.org, an organization that builds rehabilitation around the world. At the end of that meeting, I felt compelled to take a message home to Vermont.

Let’s go back to Ms. Girma. Her doctor told her she was unable to go to school. Thus, a few years after this bad medical opinion, she graduated from Harvard Law School. From Geneva with a Braille computer, she spoke eloquently of the facts: 16%, or 1.25 billion people worldwide, have a significant disability. They face discrimination, are underemployed, have less social interaction and have less access to basic services. When they seek healthcare, they are often ignored, misdiagnosed, undertreated and looked down upon.

His colleagues provided more details. It’s not “those people” with disabilities. It’s “we the people”. Right now, we’re all handicapped in something, whether it’s slamming a basketball or explaining the Goldman-Hotchkiss-Katz equation. Almost every person will have a significant physical disability in their lifetime. But disability only matters if a specific disability interferes with a specific activity that a person wants to do or needs to do – or if other people feel that it interferes.

The report also tells us that every dollar spent on rehabilitation of people with disabilities returns $10 to society. So it is a smart strategy for countries and states to have strong medical rehabilitation. The World Health Organization report concluded that health care systems need to have experts in disability management.

Here in Vermont, Ms. Girma wouldn’t hear much about rehabilitation medicine, even with a voice-Braille computer interface. The specialty is almost non-existent. The UVM has four specialists instead of six. Dartmouth has one, the same symbolic number it has had for decades. We are a handful in private practice.

What happens if there are not enough rehabilitation doctors?

Disabled people from spinal cord injury, brain injury, cancer, Covid, stroke, nerve diseases and other issues don’t have specialists trained in their rehabilitation. Family doctors, surgeons, physiotherapists and others have no one to take charge when they have failed to treat back pain, sports injuries or geriatric frailty.

So they undergo more surgery, injection drugs and therapies, often to no avail, sometimes with more complications. Best example: In Michigan, when we required patients referred by primary care physicians for back surgery to have only one visit to a rehabilitation physician, the surgery rate dropped by one thirds and millions of dollars have been saved.

An award-winning study we presented this summer found that states with fewer rehab physicians have more opioid-related deaths. So here in Vermont, we are literally dying because there are not enough rehabilitation medicine specialists.

We need to train specialists in rehabilitation medicine. Currently UVM does not have any trained physicians in the field. Dartmouth has zero. UMass, Brown, and Yale — all our weird isolated New England university monopolies — have none.

The thing is, the only doctors trained in my specialty in Vermont are trained virtually in Ghana, Ethiopia, Cameroon, and South Africa on my laptop.

I find it baffling that the medical centers in our small state find the money to train spine surgeons, but not the doctors who prevent spine surgery. We train neurologists but not doctors who deal with the consequences of strokes. We train anesthesiologists to put needles in the back of suffering people, but not doctors to help these suffering people return to work.

We train general pediatricians, but not the specialists who ensure that children with cerebral palsy, spina bifida and other disorders can grow up to be accountants, counselors or even lawyers like Ms. Girma.

Yet our medical students are passionate about rehabilitation. This Saturday, I’m going out for pizza with my half-dozen adopted medical students from UVM and Dartmouth who want to get into the specialty. Like the others I have supported before them, these young doctors will “correspond” to Miami or Des Moines, train there for four years, get married, get offered a job and never come back to take care of people. with disabilities in Vermont.

It’s time for Dartmouth and UVM to catch up with universities in these low-resource countries, not to mention almost every other US state. They need to restructure the financial, political and physical space where rehabilitation lives in their institutions. Then they must recruit visionary young leaders with the skills to build.

They also need money. So they need to ask if OneCare really cares and instruct their development offices to seek out grants, corporate sponsorships, and individual donors.

It has already been done. Everywhere else in America. Someone in Vermont just needs to listen to this woman who can’t hear.