I first came across physiatry through a rather comical situation. As a high school student, I had arranged to volunteer at a medical clinic during the summer as a learning experience, with my father — a career psychiatrist — arranging it. He mentioned that the opportunity was at a friend’s office, where a friend practiced physiatry. I understandably took it that I was going to a psychiatry practice. And I thought one of two things from this assignment. Either my father wants me to follow in his footsteps, or he has some concerns about me that he wants his friend to evaluate! Instead, I found myself in a physiatrist’s office, staring at equipment I couldn’t identify and listening to conversations about function, gait, and mobility. I remember thinking, “This is a strange psychiatry clinic.” Ironically, as I write this essay, autocorrect keeps trying to change “physiatry” to “psychiatry,” as if even my computer refuses to believe the specialty exists. Yet that accidental detour — one that neither my dad nor my spell-checker could have predicted — became the moment that shaped my entire career.
Physiatry’s evolution mirrors the way it entered my life: quietly, unexpectedly, and with a sense of purpose that only becomes clear in hindsight. Long before it had a formal name, the specialty grew out of necessity. Early 20th century physicians caring for patients with polio and industrial injuries began to realize that mere survival was not enough. People needed to regain movement, independence, and dignity. The polio epidemics created an urgent demand for structured rehabilitation, and World War II amplified that need dramatically. Thousands of injured service members required long-term recovery, and medicine had to confront the reality that healing did not end when the acute crisis resolved.
Visionaries like Dr. Frank Krusen and Dr. Howard Rusk recognized that restoring function required a new discipline — one that blended musculoskeletal medicine, neurology, physical modalities, and long-term recovery strategies. Their work led to the establishment of the American Board of Physical Medicine in 1947, which was later expanded to include rehabilitation as the field matured. Over the decades, physiatry transformed from a misunderstood niche into a specialty defined by diagnostic precision and targeted interventions. Electrodiagnostic testing, ultrasound-guided procedures, fluoroscopic spine interventions, and biomechanical analysis became central tools. Rehabilitation hospitals and interdisciplinary teams emerged, giving the specialty a voice and identity it had long lacked.
By the time I entered medical school, physiatry had already begun to claim its rightful place in modern medicine. But its ethos — the belief that restoring function is as essential as treating disease — remained unchanged. That philosophy was what drew me in before I even knew what the specialty was called.
My training in Puerto Rico solidified that early intuition. Unlike many places in the mainland U.S., Puerto Rico had long embraced physiatry as a core component of medical care. At the San Juan VA Hospital, rehabilitation medicine was not an afterthought but a respected, integrated discipline. The environment validated what I had felt since high school: Physiatry was not only meaningful but necessary. It bridged care gaps, brought teams together, and restored lives in ways that traditional medical silos often overlooked.
Under the guidance of Dr. Herman Flax — a visionary who championed the specialty long before it was fashionable — I learned that physiatry’s evolution was driven not by glamour but by conviction. Dr. Flax trained generations of physiatrists, believing that restoring function was central to medicine, not peripheral. His persistence helped build a strong foundation for rehabilitation across Puerto Rico and the broader Caribbean, and his influence shaped my understanding of what it means to fully and unapologetically commit to a specialty.
That commitment brings me to a belief I’ve held for years: Physicians who choose their specialty early often become more successful, more content, and more stable in their careers. When a specialty resonates deeply — before the pressures of training, competition, or prestige distort the decision — it tends to reflect something authentic about a person’s values and temperament. Early deciders often enter residency with clarity and purpose. They are less likely to feel mismatched, less likely to burn out from identity dissonance, and more likely to grow roots in their field.
But the literature tells a more complicated story. Studies on specialty choice suggest that early selection does not necessarily predict long-term satisfaction. Many physicians who choose later — after broad exposure to clinical rotations — report equal or greater fulfillment. Some research even argues that early commitment can limit exploration, leading students to overlook specialties that might have suited them better. The data also show that career satisfaction is influenced more by the work environment, autonomy, and support systems than by the timing of the decision.
And yet, despite what the literature says, I remain convinced that there is something uniquely grounding about discovering your specialty early — especially when that discovery is organic rather than strategic. For me, physiatry was not a calculated choice. It was a recognition. A sense of alignment. A feeling that the way this specialty treated patients was how I wanted to practice medicine.
Physiatry has grown tremendously since the day I wandered into that clinic with mistaken expectations. It has become a field defined by diagnostic rigor, targeted interventions, and a holistic understanding of human function. It has earned its place in the medical landscape not through flash but through impact. And I have grown alongside it, shaped by its philosophy and sustained by its purpose.
When a specialty calls you early, it becomes more than a career. It becomes a lens through which you understand patients, healing, and your own place in medicine. That is why I stayed.
When did you know your specialty was the right fit for you? Share in the comments.
Dr. Francisco M. Torres is an interventional physiatrist who specializes in pain medicine. He is also an avid writer, enjoys playing the violin, and has a deep affection for his seven grandchildren. Dr. Torres was a 2024–2025 Doximity Op-Med Fellow and continues as a 2025–2026 Doximity Op-Med Fellow. He can be reached on Instagram at Dr.tdropthefat.
Image by GoodStudio / Shutterstock
