Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And thank you for joining us on part two of our series, highlighting women in physiatry. Today, we're discussing the evolution of women in physiatry. Joining me is Dr. Larissa Pavone, she's a pediatric physiatrist and Chief Medical Officer at Marianjoy Rehabilitation Hospital; and Dr. Mary Keen, she's a Pediatric Physical Medicine and Rehabilitation Specialist at Northwestern Medicine Marianjoy Rehabilitation Hospital. Doctors, thank you so much for joining us.

Dr. Keen, starting with you, as we were talking off the air a little, I asked you, and you've been in this field quite a long time, how has the field of physiatry evolved since you began practicing? What changes have stood out the most to you?

Mary Keen, MD: There have been so many changes. One is that the duration of training has changed. When I did my residency from '80 to '83, we had six months of an internship and two and a half years of PM&R training. It's crazy when I think back that anybody would've thought that was enough time for the complicated patients that we see.

 Also, back then, patients were in the hospital typically for three months or longer for a stroke, six months or longer with a spinal cord injury. So, there was an opportunity to really get to know patients and their families very well. There was opportunity for our patients and their families to learn new roles, trial out new roles, because oftentimes that had to change. For example, if a man working as a telephone pole worker broke their neck or broke their back in a fall, they're not going to get back to their old job. But all of these tremendous changes take time for the patients and their families to accommodate to, to adjust to.

Other changes include technology. The internet wasn't up then. There were no such thing as computerized medical records. One hospital stay would've been three volumes of charts for a typical rehab patient. And access to knowledge was also so limited. We had to go to a library and use something called Index Medicus to try to find journals that had something to do with the topic that we were studying. It was a difficult process to access scientific information. So, those are just a couple of little changes. There are many more that I'm sure we'll touch on as our conversation progresses.

Melanie Cole, MS: Dr. Keen, do you feel it's more demanding now that this technology you're mentioning and the electronic medical records and the fact that while it used to be sort of a silo, now the share information is global, really? Do you feel that it's a more demanding profession now or it was then?

Mary Keen, MD: Yes, I agree that it is a more demanding profession now than it was. With all of these changes, the expectation is that we treat more patients faster. And that in particular is a challenge when we're dealing with patients who are experiencing such changes in their lives.

Melanie Cole, MS: That's such an interesting observation. And Dr. Pavone, can you share a moment or experience that reflects how the role of women in physiatry has grown or shifted over time? As we're talking with Dr. Keen about the more challenging and demanding situations and the change to electronic records and all of these changes, can you give us some reflections on progress and current challenges?

Larissa Pavone, MD: Absolutely. I can say that, when Dr. Keen and I have spoken before about mentorship, she talked about that she didn't really have many women mentors, and I think the changing in how much representation there is for women has changed over time. I've been really fortunate to have wonderful female mentors.

My medical school mentor introduced me to my residency mentor who really pushed me to achieve so many wonderful things. And that mentor introduced me to Dr. Keen. And I've had other mentors in different aspects who have actually all been very strong women who I think have taken me outside of my comfort zone and pushed me to achieve more than I thought I could really ever achieve.

So, I think that experience for me shows that how it has changed over time. And I could even say from, when I joined the Marianjoy group back in I think it was 2012, there were a few female attendings at the time, probably just a couple years ago. We have transitioned to where, at that time, every medical director was a female. And most of our new hires were women physicians. And so we've seen it shift and change over time.

As a residency program director, I have also seen that within PM&R, there's fewer women applying. I don't know what the trends have looked like prior to my current career. But when I'm recruiting for our residency program, there's definitely not quite as many women applying to physical medicine and rehab as there are men.

Melanie Cole, MS: Dr. Keen, what aspects of this specialty have improved or expanded in ways that have positively impacted your career or clinical practice? What have you loved to see change?

Mary Keen, MD: Among the things that have improved my patients' lives as well as our work in rehabilitation is technology. Simple robots have made a difference in improving a patient's ability to do repetitive activities with an active assist to help the movements be more precise and exact, which is what we want for training, I believe.

And over time, our ability to access technology like artificial intelligence will give us additional opportunities to shorten the amount of time it might take to find information, shorten amount of time that it takes to complete our medical records. And it has also dramatically improved the lives of some of my patients who have extremely complex communication needs. Patients who can't talk, patients who can't type nowadays have access to communication devices using eye gaze, which allows them the ability to really participate with their families, with their peers in ways that were impossible, really, 10 or 15 years ago.

Melanie Cole, MS: That really is amazing. What an exciting time in your field. Dr. Pavone, what challenges do women in physiatry still face today, do you feel? And how do you personally navigate or support others through these challenges?

Larissa Pavone, MD: I think that I talked about how I've been fortunate to have female mentorship through it. But knowing that there can be decreased numbers of women in the specialty, I think finding the right person to help direct you. And mentorship doesn't always have to be a woman. Obviously, men could be great mentors too.

But I think, when you're looking to your future, sometimes it's nice to have someone you can like emulate or see yourself being like. And so, I think that could be a challenge. Navigating this, as I said, I've been fortunate to have it, but I think leaning on our organizations, our national organizations that have put an emphasis on supporting women I think is a really great resource.

Melanie Cole, MS: This is such a great topic. I really do love to talk to two women in this field that are so knowledgeable and with so much expertise to share. I'd like to give you each a chance for a final thought here. So Dr. Pavone, starting with you, looking ahead, what are you most excited about for the future of physiatry, especially for women that are thinking about this field right now?

Larissa Pavone, MD: There's so many aspects of physiatry that I'm excited about. I think really Dr. Keen touched upon technology, and I think technology is especially important for our population of patients that we work with disability and impairment. So, I think there's such a huge, bright future for incorporation of technology in our specialty and women to be leading that charge. I think that would be really exciting and will be a really exciting advancement for physiatry.

Melanie Cole, MS: And Dr. Keen, with your incredible expertise, looking ahead, what are you most excited about for the future of physiatry, especially for women entering the field, but for really anyone looking for this very unique and specialized field?

Mary Keen, MD: What I find most exciting is access to continuing medical education. Our American Academy of PM&R has put together incredible resources to give us access to experts with so many different subspecialties within PM&R and within pediatric PM&R. We used to have to study and travel great distances to try to get expertise of other people, and now we can access it online from our offices or our homes. I'd like to encourage other women physiatrists to participate in these sorts of training programs, both as a provider of information, but take advantage of the resources that are available to us.

Melanie Cole, MS: Thank you both so much for joining us for this series. It's been fascinating to hear and I hope you'll both join us again. So thank you again. And in case you missed it, please be sure to check out part one, where we discuss women in mentorship roles. Great podcast there. To refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/rehabilitation to get connected with one of our providers. And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole.