This commentary is by Andrew J. Haig, M.D., a tenured professor emeritus of physical medicine and rehabilitation at the University of Michigan and recipient of numerous international awards, most recently the American Academy of Physical Medicine and Rehabilitation’s 2022 Distinguished Advocate award. He practices in Middlebury and Williston.
I’m the local rehabilitation doctor here in Middlebury. Friday morning I listened to a woman who was unable to see or hear tell me all about her woes.
Haben Girma was in Geneva, Switzerland, at the time. She was on the stage to moderate Friday’s launch of the World Health Organization’s Global Report on Health Equity for Persons with Disabilities. Her woes had to do with inequity in health care for people with disability.
I was there virtually as president of the International Rehabilitation Forum, www.rehabforum.org, an organization that builds rehabilitation around the world. By the end of that meeting, I felt compelled to bring a message back home to Vermont.
Back to Ms. Girma. Her doctor told her she was incapable of going to school. So a few years after that bad medical advice, she graduated from Harvard Law School. From Geneva with a Braille-interfaced computer, she spoke eloquently about the facts: Sixteen percent, or 1.25 billion people in the world, have a significant disability. They’re discriminated against, underemployed, have less social interaction and less access to basic services. When they seek health care, they are often ignored, misdiagnosed, undertreated and disrespected.
Her colleagues filled in more details. It’s not “those people” with disability. It’s “us people.” Right now all of us are disabled from something, whether its slam-dunking a basketball or explaining the Goldman-Hotchkiss-Katz equation. Just about every person will have a significant physical disability during their lifetimes. But disability only matters if a specific disability interferes with a specific activity a person wants to do or needs to do — or if other people judge that it interferes.
The report also tells us that every dollar spent on rehabilitation of people with disability yields 10 bucks to society. So it’s a smart strategy for countries and states to have strong medical rehabilitation. The World Health Organization report concluded that health care systems need to get expert in dealing with disability.
Here in Vermont, Ms. Girma would not hear much about rehabilitation medicine, even with a voice-to-Braille computer interface. The specialty is almost nonexistent. UVM has four specialists, down from six. Dartmouth has one, the same token number it’s had for decades. There are a handful of us in private practice.
So what happens if there aren’t enough rehab doctors?
Persons with disability from spinal cord injury, brain injury, cancer, Covid, stroke, nerve diseases, and other problems don’t have specialists trained in their rehabilitation. Family doctors, surgeons, physical therapists and others have no one to pick up the case when they’ve failed to cure back pain, sports injury or geriatric frailty.
So they flail through more surgery, injection drugs and therapies, often to no avail, sometimes with more complications. Best example: In Michigan, when we required that patients referred by primary care doctors for back surgery have just one visit with a rehab doctor, the rate of operation dropped by a third and millions of dollars were saved.
An award-winning study we presented this summer found that states with fewer rehab doctors have more opioid deaths. So here in Vermont, we’re literally dying because there are not enough rehabilitation medicine specialists.
We need to train rehabilitation medicine specialists. Right now, UVM has zero doctors training in the field. Dartmouth has zero. UMass, Brown, and Yale — all of our odd New England isolated academic monopolies — have none.
The fact is that the only doctors trained in my specialty in Vermont are trained virtually in Ghana, Ethiopia, Cameroon and South Africa on my laptop computer.
I find it disconcerting that the medical centers in our little state find money to train spine surgeons but not the doctors who prevent spine surgery. We train neurologists but not the doctors who deal with the consequences of strokes. We train anesthesiologists to put needles in the backs of people with pain, but not doctors to help these people with pain return to work.
We train general pediatricians, but not the specialists who ensure that kids with cerebral palsy, spina bifida and other disorders can grow up and become accountants, counselors or even lawyers like Ms. Girma.
Yet our medical students are passionate about rehabilitation. This Saturday, I’m headed out for pizza with my half-dozen adopted UVM and Dartmouth medical students who want to get into the specialty. Like the others I’ve supported before them, these young doctors will “match” to Miami or Des Moines, train there for four years, get married, get offered a job, and never return to care for Vermont’s people with disabilities.
It’s time for Dartmouth and UVM to catch up with universities in these low-resource countries — let alone almost every other state in America. They need to restructure the financial, political and physical space where rehabilitation lives in their institutions. Then they need to recruit visionary young leaders with the skill to build.
They need money, too. So they need to ask if OneCare really cares, and task their development offices to seek grants, corporate sponsorships and individual donors.
It’s been done before. Everywhere else in America. Someone in Vermont just needs to listen to that woman who can’t hear.