Chinenye Christa Nnoromele and Chloe Slocum are physicians from Massachusetts General Hospital and Brigham & Women’s Hospital.
Christa Nnoromele is currently a senior Physical Medicine and Rehabilitation resident at Spaulding Rehabilitation Hospital within the Mass General Brigham network. Upon completing her residency this June, she will be moving on to complete a fellowship in Spinal Cord Injury Medicine at Shirley Ryan Ability Lab at Northwestern in Chicago.
Dr. Slocum MPH is a practicing spinal cord injury physician, Associate Director of Quality at Mass General Brigham Spaulding Rehabilitation Network, and Director of Health Policy at Harvard Medical School’s Department of Physical Medicine and Rehabilitation. Her clinical work centers around optimizing long-term health for individuals with paralysis and her research is focused on assessing functional outcomes following rehabilitation, access to high-quality primary and specialty care, and systems of health care delivery across the post-acute care continuum for individuals with disabilities. Dr. Slocum has published research on functional outcomes following traumatic spinal cord injury and has lectured nationally on topics ranging from spinal cord injury outcomes to health policy and payment reform to clinician well-being.
They recently presented their research at the American Academy of Physical Medicine and Rehabilitation assembly, looking at women’s health in spinal cord injury.
SSN: What drove you to choose physical medicine as a career – and rehabilitation in particular?
Dr Nnoromele (pictured left): I actually found out about physical medicine and rehabilitation (PM&R) pretty late into my med school career. When I was finally exposed to the field, I pretty much changed everything around last minute to pursue PM&R. In this field, I found physicians that were both caring for the medical needs of their patients, but these were doctors who also cared about how these patients were going to thrive and function after a diagnosis. Physiatrists are clinicians who treat the whole patient, and look into ways to better assist their everyday life goals. Once I saw this in practice, I knew I couldn’t pursue any other field in medicine.
Dr. Slocum (pictured right: I enjoyed many of my rotations as a medical student – pediatrics, obstetrics, neurology – but I liked the focus on the whole patient and the importance of getting people back to activities they enjoy in the community in physical medicine and rehabilitation (PM&R).
SSN: It is clear that the healthcare industry has been greatly impacted by the pandemic, what has been the greatest impact for you within your research and industry?
Dr. Nnoromele: In a way, the pandemic has almost improved accessibility for research and interacting with our patients during the pandemic. Prior to Covid-19, telemedicine was not nearly as mainstream as it is now. With spinal cord injury patients, often times they have difficulty attending their appointments because of the travel needs and assistance they need. With the use of telemedicine, we have gained access to seeing patients in their home; seeing how they are functioning at home, what resources they have. It has been beneficial from that regard.
In addition, there have been benefits from the standpoint of research. It has been great to collaborate with physicians and clinicians from various organizations to work together on a common research interest. During the pandemic, the expansion of online meeting software has helped significantly with the collaboration.
There obviously have been negative impacts due to the pandemic. Supply chain issues have made it extremely difficult to obtain equipment and timely services for many of our patients. Psychology and Psychiatry care waitlists are so long that it has made mental health services very difficult to obtain. Similarly, equipment to help with daily life can often times take months to receive which can negatively affect our patients.
Dr. Slocum: I think the transition to virtual care and meetings has been transformative. It has really helped make our services more accessible to a greater population. This is true for non-medical services and access to peer support, research briefings, and other information. It has been a big benefit and I think helped shift norms in a positive way. On the other hand, I think the pandemic has also caused a lot of patients and caregivers to forego care and sometimes we are seeing folks who have put off routine or needed care and identifying problems later because people may have been hesitant to go to the hospital.
SSN: What’s the best part of your job?
Dr. Nnoromele: Being a resident, I am still in the training aspect of my career, but the best part of my job thus far has been all of the collaboration it takes to take care of our patient population. I am constantly working with social workers, case management, therapists, nursing, other physicians. I love working with and meeting people with different expertise than me and coming together to solve problems.
Dr. Slocum: The best part of my job is helping patients get back to activities that they enjoy and support them through recovery from catastrophic illness or injury. It is a privilege to be able to witness the amazing work that our patients and families do and phenomenal to be able to collaborate with them and see they progress.
SSN: … and the worst?
Dr. Nnoromele: Our patients have a lot of needs and not everyone has the best outcome or prognosis for their care. The difficult cases are always difficult and require a lot of empathy and patience. No matter how many times you see it, it doesn’t get easier.
Dr. Slocum: I answer a lot of questions about community resources and sometimes people have questions about their insurance coverage, which I can’t always answer! I have learned to try and help in areas where I’m confident of my knowledge – say, maybe resources for adaptive exercise or peer support groups – but to collaborate with our outpatient case management team when patients’ questions are in areas outside of my expertise. But earlier in my career, it could be exasperating to field so many questions and feel inadequate sometimes to meet the needs of the person in front of me. I’ve grown much more comfortable about working in a team and acknowledging the strengths of my teammates when we are working together on a complex case.
SSN: What has been the highlight of your career so far?
Dr. Nnoromele: The greatest honour was being able to give a presentation to our local congresswoman (Ayanna Pressley) about the need for government research funding for neurorehabilitation and the impact of health insurance plans on the accessibility of equipment and services for our neurorehabilitation patients. It was amazing to have the opportunity to talk to her about the work we do at Spaulding and the need for continued work in this area for our patients.
Dr. Slocum: The highlight of my career has been mentoring our amazing residents. They are inspiring and amazing. I also trained as a peer coach for physicians and have found that work to be really eye-opening and transformative to my personal practice and outlook.
SSN: You recently spoke at the American Academy of Physical Medicine and Rehabilitation assembly about your research on women’s health and spinal cord injury. Could you tell us more about your research and findings.
Dr. Nnoromele and Dr. Slocum: We both have an interest in women’s health and spinal cord injury (SCI) and the data out there focusing on the specific needs for women after SCI. Although the majority of patients with SCI are male, there is still a significant amount of the patient population that identify as women and are of childbearing age. Despite this, there is a paucity of research into women specific needs after SCI. We both wanted to create a presentation that discussed the general consensus and guidelines for women’s health in SCI. In addition, we wanted to create a resource that would help close the knowledge gap amongst providers who will care for women after SCI.
SSN: How important is educating providers and their patients to ensure preventative care is encouraged to improve overall good health care? How can this be managed?
Dr. Nnoromele and Dr. Slocum: Discussing and addressing preventative care is very important, especially in the SCI community. In general, often SCI physicians are managing patients in alignment with their primary care doctor. Although there is some overlap, it is also important to have open lines of communication open with their primary care physician to ensure that both their addressing the general and specific SCI preventative medicine factors.
SSN: Do you currently work with emerging technologies and how can they effect the patient experience?
Dr. Nnoromele: I personally do not work with many emerging technologies on a personal level as a resident, but I am hopeful to gain more exposure as I continue with my training.
Dr. Slocum: I often work with patients who are interested in clinical experimental trials for spinal cord injury and discuss their questions about becoming a study participant. Some of my patients have had great experiences being involved in clinical research but it is important for us to discuss any questions they have up front so they understand the focus of the research and the potential benefits and risks involved before proceeding.
SSN: Are you planning to attend any orthopaedic or spinal events this year?
Dr. Nnoromele: I am hoping to attend Academy of Spinal Cord Injury Professionals (ASCIP) in addition to American Academy of Physical Medicine and Rehabilitation (AAPM&R) in the Fall of 2023, and hoping to attend more conferences after my fellowship.
Dr. Slocum: I am part of the Future Leaders Program (FPL) with the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and will be attending this meeting in 2023.
SSN: If you weren’t a physician, what would you be?
Dr. Nnoromele: Most likely I would be a teacher. I come from a long line of both high school and collegiate teachers and professors, and it was also a path I thought about pursuing until I committed to medicine. Likely high school science if I had to pick a subject. In a pipe dream I would also be a peloton instructor, but I doubt that would actually be able to achieve that.
Dr. Slocum: My undergraduate major was in public health and so I imagine that I would still be involved in community health and health promotion but maybe not in a clinical role. I would love to do something that involves cooking and travel in an alternate universe, too.
SSN: What would you tell your 21-year-old self?
Dr. Nnoromele: Enjoy the ride and keep going. You are just at the beginning of a long path where you will continue to hone who you are and your passions. You will be so proud of the person you become.
Dr. Slocum: It will all work out! You are starting out and are going to meet a lot of new people and see a lot of different ways to work. You will be able to choose and figure out what ways work best for you and which line of work you find most fulfilling.
SSN: If you were Health Minister for the day, what changes would you implement?
Dr. Nnoromele: I would expand health care coverage for rehabilitation essentials. Both lengthen the amount of time that is allotted for inpatient rehabilitation, but also increase benefits to cover goal-directed therapy and equipment. There are many equipment needs that are considered standard of care in the rehabilitation community that is not current covered by insurance, making it significantly more difficult for patients without means to make the amount of progress they could make with this equipment. I would try to remedy this so that socioeconomic status less affects outcomes.
Dr. Slocum: I would change financial performance benchmarks to incorporate long-term perspectives rather than relying on annual reporting and would advocate for universal access to basic health care services. I think short-term financial incentives are a barrier to helping our patients with spinal cord return to the community most effectively and a long-term lens could spur much more innovation in care delivery models by payers.
SSN: Away from the clinic and operating theatre – what do you do to relax?
Dr. Nnoromele: I am a huge fan of the peloton work out system (yes it is a cult, and I am a proud member!). Cycling/working out is a big way that I relax. Otherwise, I am kind of an introvert. Nothing is better than sitting at home and watching a new show with my husband and dog.
Dr. Slocum: I love to cook, read, watch movies, exercise, and spend time with my family. I have a one-year old and a two-and-a-half year-old at home, so I watch a lot of Cocomelon mostly nowadays but I like a good thriller or mystery otherwise.
SSN: How do you think the future looks in the field of orthopaedic and spinal surgery and rehabilitation and what are your predictions for 2023 and the next decade?
Dr. Nnoromele: I think the future is very bright. There are constant breakthroughs and ground-breaking research that is being conducted that will continue to push our fields forward. I think in the next year and beyond, there will be increased collaboration amongst our fields to allow for maximum benefits to our patients.
Dr. Slocum: I think the future is bright and I am constantly amazed by the wonderful work that I see being done across the field in our institution and by national peers. I predict that PM&R will continue to be central to innovative collaborations to help people with injuries and/or disability recover and return to maximum function wherever they live.
