New leader focuses on building physical medicine, rehab expertise at MUSC

The Medical University of South Carolina recently welcomed Ameet Nagpal, M.D., as chief of the Physical Medicine and Rehabilitation Division. The division falls under the Department of Orthopaedics and Physical Medicine, and Nagpal has big plans in mind.

In the following Q&A, Nagpal explains this area of medicine as well as his plans to shore up the clinical team and build bridges to other areas of the institution.

Q: What is Physical Medicine and Rehabilitation? 

A: Physical Medicine and Rehabilitation, also known as PM&R, is a medical specialty that is designed to improve the lives of people with chronic illnesses and chronic debilitating diseases that range from complex musculoskeletal diseases like osteoarthritis all the way to complex neurologic disorders like strokes, traumatic brain injuries or spinal cord injuries that could be traumatic or atraumatic. And improving the function of people with these debilitating diseases or injuries is the hallmark of what PM&R does.

Q: You came from University of Texas Health San Antonio. How does your role here differ from your role at UT Health?

A: At UT Health San Antonio, I was the division chief of Pain Medicine, so I very much focused on the treatment of patients with chronic pain, which is also my clinical expertise and what I'm doing when I see patients on a daily basis. But here, as the division chief of the entirety of Physical Medicine and Rehabilitation, it's a much larger specialty of medicine. And I hope that by venturing into this realm of administrative medicine, of running an entire division that eventually we’ll have a residency for, we will be able to affect more lives and touch more patients with a wide variety of illnesses and diseases. 

Q: What do you hope to accomplish in this role here at MUSC? 

A: The people of the Lowcountry have not really had high levels of access to true PM&R care over the last several decades. And because PM&R hasn't existed at MUSC, many people of this area who have had traumatic brain injuries or strokes or amputations, or so on and so forth, have not had access to the type of care that we can deliver. But while there has been excellent care provided at another local hospital and at Encompass in North Charleston, now known as MUSC Health Rehabilitation Hospital, this is a small footprint for such a large catchment area. So, it is my goal and my responsibility to develop a robust PM&R clinical program and eventually a teaching program and research program to augment the great care that people are already getting from their neurosurgeons and orthopedic surgeons and neurologists, and so on and so forth, by helping them restore their function and get them reintegrated into society and in an immediately meaningful way. 

Q: Will you be doing any research in this role? 

A: Absolutely. We have a small group of physicians right now, and all of us practice in the same subspecialty niche of interventional spine care and sports medicine and nonsurgical sports medicine for people who have musculoskeletal diseases. We are about to start a research study on the use of a novel injectable nerve blocking medication for treating chronic osteoarthritis pain of the knee. But we haven't hired the people who do so much more, like taking care of the neurorehabilitation side. I'm in the process of recruiting for those positions, and, hopefully, 18 to 24 months from now, we'll have the full gamut of everything that PM&R does – maybe even sooner than that. And at that time, once we've really developed the clinical programs out to the point where we're taking care of these people that haven't had the care that they've needed or deserved for quite a long time, then we'll really delve into making sure that we're doing high level research to improve the outcomes of the care that we provide. 

Q: How are you prepared to work with the colleges in terms of both students and residents?

A: Right now, we're going to be working with medical students as much as we can. We already have had orthopedic surgery residents work with us. We have family medicine residents that will be working with us in the near future. And in the future, after that, we're going to have sports medicine fellows and pain medicine fellows who will work with us as well. But ultimately, the plan is to have a PM&R residency up and running here at MUSC so that we can work with more students and residents. The basis upon that is that we're an academic organization. We want to grow and foster the careers of other people who want to do what we do so that they can give back to the community, and eventually, perhaps, join the medical community of MUSC or private practice, so that we can continue to expand the offerings that are available to people in Charleston. 

Q: What is your outlook for the next three months? 

A: In the next three months, we're still going to continue to try to offer more clinical services for those patients with musculoskeletal injuries and diseases. That's sort of where our bread and butter is right now.

Q: Where would you like to see the division in a year from now? 

A: A year from now, I want to be in the hospital, offering care to patients with polytrauma and related diseases, like the things I've mentioned already – traumatic brain injury, spinal cord injury, amputation, stroke, orthopedic fractures, things of this nature and, eventually, out into the community as well. And also to take care of those patients in an inpatient rehabilitation setting –for those patients who leave their hospital stays but need acute rehabilitation in an inpatient setting. I want to be able to offer that. We also already have an affiliation with Encompass at the MUSC Health Rehabilitation Hospital in North Charleston, and we want to develop a presence there, as well, to help our patients who are suffering from these maladies and then help those people in an ambulatory setting subsequently.

Q: What are your five-year goals? 

A: Five years from now, I want to have a comprehensive research program for treating these illnesses and diseases and have a really robust, top-of-the line residency that is well-respected nationally and have a clinical program that's humming. We should be able to take care of patients efficiently, with high levels of access. The care we will be providing should be low cost and the highest of quality.