Treating Our Future – Part 3: Resolving the Bane of the New Professional

This is Part 3 of our series, “Treating Our Future,” exploring employment issues with new graduates.

 Links to Treating our Future Series
Part 1: The Bane of the New Professional 
Part 2: New Grads, An Asset for Clinics
Part 3: Resolving the Bane of the New Professional

Resolving the Bane of the New Professional

Here’s an anecdote that fully describes the thing that really gets me about PT business owners not hiring new grads readily:

New professional Elizabeth was hired after a long, long job search and all of the crummy hoops to jump through described in Part 1. Elizabeth gets the job after some high-profile referenced speak on her behalf and the owner decides to, “really go out on a limb and hire a new grad.” Fine, done. Job achieved. Elizabeth begins her job and spends her day setting up treatments, observing patient sessions and offering to take patients, but not being allowed to. Instead, one of her main chores becomes setting up ultrasound treatments for the patients, as they almost all get that particular modality at said clinic.

What?! What was all this fuss about? Why did you even hire a PT? Didn’t you just need a tech? Let them dive in!

Yet another tale:

Bob, a student at a clinic in town, completing his final clinical training experience. I ask how it’s going? “Well my CI knows a lot of manual stuff and they do most of the treatments. They say I’m not allowed to do manual, I should just watch and then do exercises.” Clinic in question later offers Bob a position. He refuses based on life circumstances, but I wonder how they possibly could after not thinking him capable of doing hand-on treatment for patients as a student.

Still another tale, this one from the comments section of Part 1:

“I felt that there was a lot of questioning of my skill set when I first got into the job market as well. I felt as though I was overly scrutinized because I was young in the profession. Lucky for me I was at a clinic that had some great people who were there to help me learn. There unfortunately are too many places out there who do take advantage of young grads. Terrible hours, poor pay, and little support. I have been there before. It was very discouraging and made me doubt my decision to become a PT at all.” Ouch. 
 

What is the Role of Expertise in Patient Outcomes?

Underlying these tales, and perhaps the aspect I find so troubling, is the idea that expertise is required to perform any treatment. The first tale takes that a step further and makes a laugh out of the purported “expertise” as the guru clinic owner uses an overwhelming amount of a poorly supported intervention in ultrasound. It also sounds a little cook-book to me.

An idea that had plagued physical therapy for many years, especially in the realm of orthopaedic manual therapy is that a particular set of expertise is required to perform it in a manner than benefits patients. This idea, born out of the “guru” continuing education model, but not supported by evidence, has probably prevented more good therapy than it created. Large paradigm shifts related to this have occurred, perhaps most notably illustrated by CAPTE’s identification of spinal manipulation as an entry-level skill. All new professionals are instructed to perform this competently. No evidence exists that supports that only experts can use manual techniques to benefit patients. Why the persistent reluctance for seasoned clinicians to let the new professionals touch their patients?

Are There Business-Related Red Flags with New Grads?

Another commenter on Part 1, Nick, was kind enough to share his perspective, as an 8-year PT and clinic owner. He brought up several red flags regarding new grads that could prevent his hiring of said new professional:

-“New grads inexperience w billing/coding. The insurance world is very dynamic and definitely not black & white. My experience has been new grads are very resistant to learn the intricacies of 3 party payers and delivering treatment that respects the insurance guidelines.
 
-Lack of real world experience. Experience does not need to be related to PT, but if this will be your first “real” job, I have a concern.
 
-During the interview, many new grads reference “taking a break” after graduation & the boards. Not meaning time off but implying taking a break from studying and the stresses of school. Employment, especially as a new grad, will bring new stresses (challenging cases requiring off the clock studying, documentation over lunch & after last pt leave, learning the company culture, finding your niche, seeing pts over lunch because a MD calls you up asks if you can “squeeze” this pt into your schedule, etc.). I want clinicians that want to work hard, not “take a break”.”

What do you think about these as potential red flags? I think there’s validity in these comments, although from my perspective, PT school today is pretty much a 9-5 job, perhaps more. My PT school in the 1990’s wasn’t really that way, but today students are held to extremely high standards and are present on campus for entire days, meeting many deadlines in rapid succession. They know how to work. That said, I enjoyed the insight for how an employer might interpret the “take some time off” comment…even though the time off might be forced upon them!

Clinic owners time and time again point to trouble with the business side of PT in new professionals. On one side, I can see that it’s difficult to learn this without being submersed in the “doing” of the job. On the other hand, this is one area where PT educational programs can certainly improve dramatically, which could help the concerns of PT business professionals everywhere. Programs like Evidence in Motion’s, Executive Program in Private Practice Management can bridge the gap, but can also serve as a model for what entry-level programs should be targeting in their curricula. Emory University offers a DPT-MBA degree, which is intriguing to say the least! APTA’s Private Practice Section, however, often criticized for lack of student membership and high dues costs, is one of, if not the only section to not have a student special interest group. As a member of that section, I can report that there are initiatives underway to help mitigate the student involvement process beyond simply contests for conference attendance. These initiatives are critical, as is the development of education initiatives in our universities.

Embracing the New Professional

Some clinic systems have learned to love the new professional. David Browder from south Texas, yet another commenter on Part 1 had this to say about new grads:

“Employers should be working from the beginning of the interview to retain people and set the tone for their practice… even if they don’t hire the applicant. What you describe is symptomatic of practices that probably don’t treat their existing employees all that well, either. In our practice, those hired as new graduates and mentored by us have become our leaders and the catalyst for our growth.”

Following up with David, his clinic system, Texas Physical Therapy Specialists, an award winning practice, incorporates residency and fellowship training into the developmental process. Hiring new graduates has positioned them to be a growing practice. In David’s statement, mentorship seems integrated tightly with hires. For those clinics without this type of mentorship support, I’d urge them to take a close look at their company culture and see how this can be improved. One example of how this can be done is seen in the Mercer University Residency Model, where clinics partner with a university and in turn have access to new professionals, and mentorship that is world class.

The Resolution

It seems the path forward is not a burden owned by any one group. Improvements on the part of educational systems, clinic owners and managers, and even the new professionals themselves are needed.

While the following steps are complicated, here are my suggestions moving forward:

1. Increase the amount of quality business-related education within entry-level education.

This needs to be real-world, clinically applicable content. Incorporation of billing, electronic medical records, and profit/loss principles inherent in any business should be tightly woven throughout the development of clinical skills. I’ll place improved student outreach by the Private Practice Section here.

2. Improved mentorship programs for new and existing clinicians.

The idea of mentorship is never a bad one. The idea that new professionals can hit the ground running without a developmental plan is not realistic. The idea that experienced clinicians can exist without a developmental plan is unrealistic. Let’s put down our ultrasound wands and take a hard look at how we grow as individuals, as professionals, and as a profession. Let’s throw out this idea that only “experts” can perform manual techniques while we’re at it.

3. Enhanced focus on business and entrepreneurship by students in DPT Programs

I do think many PT students are happy to learn how to be a physical therapist clinically without a care in the world about what it takes to operate a practice, or even how the profits are obtained to pay them at their first job. Decisions made by clinic managers today will affect the employment opportunities for new graduates years down the road. Students need to maintain this perspective and formulate their thoughts, actions, and involvement to help mitigate the business-related concerns of clinic owners. How about getting an MBA on your own, or taking business related MOOC courses. Students can react more quickly than education curricula can. Take advantage, and take ownership.

4. Hire partners, not employees.

Clinic owners want people to help their business grow. DPT students are very high-end individuals who are motivated and engaged. The concept of physical therapists as employees may need to be reconsidered in favor of models of shared ownership as seen in the law and medical communities. In reality, employees will never be properly motivated to be engaged in your business to the degree of engagement of junior partners who can feel the impact of good business in real financial terms. This might have the side-effect of improved interest in legislative advocacy for our profession. I acknowledge that this shift might not be possible for existing business models, but newly forming clinics may have a disruptive advantage here.

The bottom line is that we need to meet in the middle. Students. Employers. Educators. New and existing professionals. Without action, I fear this divide will only grow, and so I hope this series begins a conversation that persists as we continue the ongoing process of optimizing the profession of physical therapy. As always, interested in your comments, opinions, and input. Thanks to Lauren Kealy for helping with the concept and production of this series, as well as all those who checked in and commented on Twitter, Facebook, and the blog itself, as your opinions helped form this final post.

 Links to Treating our Future Series
Part 1: The Bane of the New Professional 
Part 2: New Grads, An Asset for Clinics
Part 3: Resolving the Bane of the New Professional

Transformation Scrutinization: Vison versus Reality

I wonder if academics in medieval universities had their own versions of Twitter debates about the use of the word “doctor.” I wonder if the opponents to its use decried it a foul and unfair title, which should be reserved only for the Apostles and those learned elite of the Catholic church (who had, of course, taken a test and paid the appropriate fee to earn such a prefix). That argument seems ridiculous now, but it’s a worthy perspective for us to consider, especially after a #DPTstudent tweetchat which debated just such a question: should we be called “Doctor” as physical therapists who have earned the Doctor of Physical Therapy degree.

My very intelligent and witty friend, Courtney Kelsch, who happens to be a student of the English language and an academic herself, later joined in the debate. She’s not a PT, nor a healthcare practitioner, but her post on Twitter reminded me of this perspective. She wrote, “…the title Dr comes from the Latin word for “to teach.” Origins in academia, was never tied solely to physicians. Which is to say, arguing that PTs should not be called doctors makes no sense. Doctoral degree = doctor.” Well stated, and for us, quite embarrassingly so. I wonder just what drives someone who is currently paying for, and working hard to obtain a DPT degree, to feel the title is unfitting for them? What is this? Professional insecurity? Something else?

Yet even as individuals entering this profession are reluctant to permit others to refer to them as a doctor of the field, the American Physical Therapy Association’s Board of Directors is proposing a new vision statement to guide us forward, “Transform Society.” Bold! But, it is appropriate?

Points of consideration:

-Things that I’ve considered transformative to society include antibiotics, air travel, mobile communications, the semi-conductor, the cotton gin, and fire. Public health as a collective overall field can perhaps make this list as well. When physicians in Texas embarked on a campaign to stop spitting on the sidewalks, everyone lived an extra year or two. Not quite as profound as the first flight, but yes, the applications of the germ theory of disease was transformative to society. I just don’t see the same effect happening from widespread deployment of movement impairment analysis.

-This past week a physical therapist related to me the following statement: “Since we are PT’s, we can’t eat until 12:45 once all the physicians have eaten.” The worst part is: this was spoken without indignant offense, but rather in passing as part of a separate story.

-In a video spot a few weeks ago, a physical therapist got on a national TV show and purported cutting edge techniques, which were in reality, non-evidence-based banter that most skilled PT’s would never touch. That damage will take a long time to be undone given the scope of the audience.

-In a thoughtful post written by Jay Deragon entitled, “5 Stages of Societal Transformation,” he states, “Those that reach the transformation stages are the groups who create meaningful and significant change that positively impacts the entire human network. These groups are philosophically connected and grounded in a common set of principles that guide everything they think and do.”

And that’s the catch for me.

I know the APTA Board of Directors is a cohesive group tied together by a common vision. In fact most of the physical therapists I interact with on a regular basis whether at work or through conferences would probably fit the definition of a cohesive group philosophically I just worry that this vision doesn’t extend to the reality of the multi-faceted body of physical therapists that ultimately define the profession. There are tens of thousands of physical therapists that don’t go to conferences, don’t engage in professional dialouge, and who use outdated practice patterns. One former student of mine went down the road to work at a clinic in Texas where the clinic’s owner was adamantly against the concept of direct access to physical therapists.

The examples in this post, from reluctance to use an earned degree title, to persistance in old practice patterns, to flat denial of the role of physical therapists as a primary access provider support my notion that perhaps physical therapy as a profession isn’t ready to transform society. Despite how ready my colleagues and I might be to fight and redefine the role physical therapists play in the health of our society, I worry that just as I wage the battle, others in my profession are undermining it.

So I’m left with the question: how do we transform them?

Work hard to improve health and find ways to engage society in new and different ways? I get it. I want it. But I’m afraid the interpretation of the “transform society” vision will be muted by the volume of those scoffing at it. Not all of those people scoffing will be strangers.

 

 

#CSM2013

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#CSM2013 is here! PT Think Tank and it’s contributors are all in attendance. We plan to provide highlights, quick summaries of sessions, and other insights right here on PT Think Tank as well as through the conference hashtag #CSM2013. If you are tweeting do not forget about the other hashtags curated and discussed in the #Physicaltherapy Hash Tag Project 2.0 . Not attending? Follow the hashtags at home and join the conversation.

#CSM2011 Acute Care Lecture: Our Foundation and Our Future?

#CSM2013 has arrived! Pre-conference courses are in full swing and the regular section programming begins tomorrow morning. Acute care practice received press online and discussion here on PT Think Tank. Now, I am going to review an inspirational lecture from 2 years ago at #CSM2011 that I truly enjoyed.

Jim Dunleavy PT, MS gave the inaugural Acute Care Section Lecture at #CSM2011 entitled “Acute Care: Our Foundation and Our Future.” Jim has been instrumental in the Acute Care section as well as served as president of the New York Physical Therapy Association.

Here are some quick facts you may not know about the Acute Care Section:

  • Formed in 1992
  • First section with platform presentations
  • First to share special interest groups across sections
  • Goal of establishing an acute care physical therapy speciality certification
  • APTA’s 2011 Most Outstanding Section award
  • Twitter @AcuteCarePT (ond of the most active sections)
  • Fantastic website with excellent resources

 

Jim discussed the history of our profession in the United States. The physical therapy profession grew out of serving societal need, providing necessary service not otherwise available. Jim urged us to not loose site of what society and patients need, not merely what we desire to accomplish professionally. A focus on need, service, and commitment.

Now, I must say Jim has VISION. Throughout his lecture he kept emphasizing the “courage and will to change.” He even poised the question how could direct access physical therapy be practiced within the hospital? Interational therapists, notably some in Australia, practice in a direct access environment even within intensive care units.

Jim stressed pursuing measurable financial, personal, and patient outcome effects of acute care provided by physical therapists. He presented the necessity for openness to new business relationships with the facilities at which physical therapists are currently employed. Changes in healthcare, payment and hospital care delivery require physical therapist practice to evolve. Can an acute care physical therapist structure their practice like a hospital physician?

As I discussed in so, you think you can walk? Jim maintains that a function only approach may cost a facility more money. It is imperative physical therapists research and present their impact on costs to the patient, hospital, and health care system in addition to patient outcomes (pain, function, morbidity). Across settings, a function only approach results in far too narrow and limiting scope of analysis for our practice. A great example of the profound effect we can have on medical outcomes and complications, regardless of function, was illustrated in a recent PTJ manuscript investigating an early mobility program in a trauma and burn intensive care unit.

No adverse events were reported related to the EMP [early mobility program]. After adjusting for age and injury severity, there was a decrease in airway, pulmonary, and vascular complications (including pneumonia and DVT) post-EMP. Ventilator days, TBICU and hospital lengths of stay were not significantly decreased.

So, regardless of the functional implications of early mobility and a lack of effect on ventilator days and hospital length of stay, there a strong argument for the presence of a physical therapist and early mobility in a TBICU exists. If this investigation focused soley on function, a vital, important outcome of movement would have been overlooked.

But, the Acute Care section needs help and recognition from the other sections. Further, it needs young, motivated individuals to sustain and execute it’s vision and goals. Despite impressive and innovative acute care practice expansion over the years including more complex, acute patient populations and environments ranging from emergency departments to intensive care units, the Acute Care section has struggled for meaningful recognition and collaboration from professional colleagues…

So, what’s next?

Research illustrates the importance, effectiveness, and outcomes when a physical therapist is involved in patient care. Future investigations should focus on specifics of interventions including frequency, duration, intensity, and content which is most efficacious and effective for specific populations. But, global inquiry on the impact of physical therapists on patient, hospital, and healthcare outcomes should not be abandoned. Some of the more profound research is not just what physical therapists can do to improve function and quality of life, but on reducing the risk of adverse medical outcomes and morbidity. ALL students should have some type of acute care rotation or experience prior to graduation. If we truly want to assume our role as direct access providers of choice all students must obtain didactic knowledge and clinical exposure to acute medical conditions.

Dan Malone, PT, PhD, CCS and recently elected president of the cardiopulmonary section states in his editorial The New Demands of Acute Care: Are We Ready?

The articles cited here should inspire us—acute care practitioners, therapy managers, and educators—to examine and evaluate how to provide services as well as how to facilitate the integration of the specialized knowledge, skills, and behaviors that will bring success in acute care. We face many challenges ahead—an aging population; changes in work processes and care delivery; recruitment and retention of high-quality staff; and the imperative to define the value of physical therapy to our many stakeholders, including patients, referral sources, and third-party payers. Are we ready?

Physical therapists in acute care (and beyond) need to step up to the challenge. We need to focus on changing the process and concept of our practice. We need to improve our understanding of pain and musculoskeletal conditions. We need to treat patients within the hospital who have pain complaints. We need to assist in pain management, pain education, and pain understanding for out patients, our colleagues, and other professionals. We need to continue to educate our outpatient colleagues on the physical therapists role in managing medical conditions. We also need to learn from and collaborate with them.

This years Acute Care Lecture is on Wednesday from 6:30PM to 7:30PM in the Hilton Bayfront Indigo GH rooms. Sharon Gorman PT, DPTSc, GCS will discus Leveraging Technology to Advance Acute Care Practice. Even if you do not practice in acute care, please stop by. Interested in attending some Acute Care Section Programming? Here is the #CSM2013 schedule.

Official CSM 2013 iOS App Available

CSM 2013 is quickly approaching, is your itinerary planned? (I know you’ve been networking before the conference)

Here in time to help is the APTA CSM 2013 App. Basically, the app contains most of the information about the schedule, speakers, exhibitors, venues, and San Diego you find be lugging around in the bulky paper directories you get at the registration table.

In lieu of yammering on more about the specific features, I recorded a quick demo of the app using my favorite app of 2012 – Reflector. Enjoy:

Demo of the APTA CSM 2013 Mobile App from Mike Pascoe on Vimeo.

Here is a quick video showing a few things you can do with the APTA CSM 2013 app, which was released on Dec 20, 2012.

Here is the link to the app:
http://itun.es/us/RPXcJ.i

 

Term & Title Protection for the #PhysicalTherapist & #PhysicalTherapy

APTA Term Protection Ad

The American Physical Therapy Association recently constructed a Term and Title Resource Center regarding the use of the terms physical therapy and physiotherapy as well as the titles physical therapist, physiotherapist, PT, DPT, and MPT.

They have even constructed a 1 page advertisement, that I think is actually rather clever. The APTA announces

The full-page color advertisement will run in future editions of State Legislatures magazine, the monthly publication of the National Conference of State Legislatures which is provided to state legislators, legislative staff, and other state policy makers in all US jurisdictions.

I commend the APTA for their efforts and resources, which are no doubt, an important step. And, there have been some victories. Virginia successfully enacted term protection for physical therapy and title protection for physical therapists.

Unfortunately, physical therapists are currently losing this battle on both the legislative (lack of term protection laws), but just as importantly, the judicial level. In 2010, the Washington State Supreme Court issued an impactful ruling that dealt specifically with physician owned physical therapy services (POPTS). But, the ruling also has significant ramifications for the use of the term physical therapy.  Details about the ruling can be found in an APTA released statement. The Kentucky Supreme Court issued a similar opinion.

The Washington State Supreme Court Opinion states:

Physical therapy is one aspect of the practice of medicine. The practice of medicine is defined by RCW 18.71.011(1) as ‘[o]ffer[ing] or undertak[ing] to diagnose, cure, advise, or prescribe for any human disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real or imaginary, by any means or instrumentality.’ This broad definition readily encompasses all the acts constituting the statutory definition of the practice of physical therapy.

Ouch. But, it gets worse. The Washington State Medical Association exclaimed “Big Win in Supreme Court!!!” following the ruling. They continue:

The decision represents a victory for physicians and medical practices, not only because it is now clear they can employ physical therapists, but because an adverse ruling could have outlawed their employment of other licensed health care professionals (such as nurses).

Double ouch. The ruling as well as the medical community’s reaction clearly illustrate that legislators, the judicial system, and physicians do not view physical therapy as a unique profession nor physical therapists as skilled, collaborative, unique members of the healthcare team. It appears physical therapy continues to be viewed as a prescribed or provided modality with physical therapists as mere technicians or employees under the physician umbrella.

We either need to more aggressive with our formal national, state, and local legislative lobbying and education (including legislators,  patients, colleagues, etc), or we we need to seek and secure allies within the medical and healthcare community, including but not limited to physicians. I vote for both.

What are you doing to #SolvePT? What should we do at the grassroots level?

Resources

Term and Title Resources via the American Physical Therapy Association
Term Protection Advertisement/Handout
Physician Owned Physical Therapy Services (POPTS) and Referral for Profit via AAOMPT Student Special Interest Group Blog
APTA Statement on WA Supreme Court Decision
WA Supreme Court Decision and Statement
Virginia Term Protection
Kentucky Court Ruling Information[/list]

Social media & physical therapy: a look back on the 2012 House of Delegates and RC 23

My view from the floor of the APTA House of Delegates

Earlier this month, I attended my very first session of the American Physical Therapy Association’s House of Delegates. There were a couple of large issues – namely governance review and what is now known as Physical Therapist Responsibility and Accountability for the Delivery of Care (formerly discussed as RC 3-11 & RC 2-12) – that dominated House this year, as well they should have. Both of these have to potential to bring large changes to our profession and the APTA itself. I enjoyed these discussions and learned a lot in the process. But, as a researcher with an intense interest in the role of social media in physical therapy practice and education, it was a much smaller motion that I was interested in this year: RC 23-12.

RC 23-12, Standards of Conduct in the use of Social Media, was proposed by the Washington Chapter. Prior to the House, RC 23-12 caught the attention of a group of physical therapists (including myself) who actively use social media for professional and educational purposes. This resulted in a social media discussion of the social media motion, including my post on PT Think Tank, a Google+ Hangout, and an ongoing Twitter conversation using the hashtag #RC23. It was exciting to be a part of those conversations, and I (somewhat naively) thought that it was likely that no one was paying much attention to them besides social media users. My intent, as a delegate, was to get feedback about this motion from physical therapy professionals who actually use social media so that I could take that feedback to the House of Delegates. I learned that not all Delegates viewed my social media use so favorably. Participating in the House of Delegates was an eye-opening experience and, now that the final Post-House packet and House summary documents are posted on the HOD online community (accessible to members), I think it might be time to finally share some of my experiences and lessons learned.

Lesson #1: RC 23-12 was totally unnecessary and – as written – doesn’t really DO anything

The final language of RC 23-12, adopted by the 2012 House of Delegates, is available in the House of Delegates online community (available for APTA members). I’m told it will be “published” (I assume that means public) when it is officially approved in September. I was very involved in modifying the language, and I do think the policy is much more positive now (the first sentence does, after all, recognize that social media offers new “opportunities” for communication). But I still voted no on the motion, because I think the policy is unnecessary (as most social media policies are). The APTA – like most other health care organizations and institutions – has a Code of Ethics and Standards of Conduct. These documents outline expectations for ethical and professional conduct that apply to all forms of communication, including social media. By adopting a social media policy, we followed other health care organizations (most notably the AMA). And I’m sure many thought that having a policy that recognizes professional use of social media was a progressive position. But I would argue that the true progressive position would be to recognize that social media is simply another form of communication and doesn’t warrant any additional policies. That said, I think RC 23-12 is essentially harmless – it isn’t any more restrictive than the existing Code of Ethics, so I don’t think it is a game-changer.

Lesson #2: The APTA, as an organization, is pretty progressive when it comes to social media

As an organization, the APTA takes a lot of heat about being non-responsive to members (and non-members), and that includes criticism about its use of social media. What I learned at the House of Delegates is that APTA staff, as well as the Board of Directors, are actually extremely progressive when it comes to social media, and seem to be excited about its potential. There are two APTA staff members (shout-out to Jason and Amelia!) who are social media experts, and I had many exciting conversations with them about their ideas to continue to expand APTA’s social media presence. I was also approached by several Board of Directors members who said that they followed the Twitter discussions or viewed the Google + video and were excited by what they saw. They saw potential for future social media discussions, and appreciated the opportunity social media provided to educate members on the APTA governance process (how many of you learned how to contact your Delegate?). From the top, the APTA seemed to be very supportive (and even a bit intrigued) by the potential use of social media to discuss association issues and even House motions. It was my fellow APTA members who seemed a bit more uncomfortable with it, which leads me to…

Lesson #3: APTA members (or at least those who are delegates) are very traditional, which results in a lot of hesitation, skepticism, and even fear of/about social media

The only negative reaction to social media use (at least that I heard) came from my fellow Delegates, many of whom seemed to be upset about the use of social media to discuss and share House issues. There were questions about whether the #RC23 Twitter conversations were “appropriate,” and lots of feathers were ruffled when I (and a few other Delegates) tweeted during the candidate interviews. I heard delegates say things like “I’m not a social media kind of person, I never will be,” and there was much grumbling about how many delegates were using devices (laptops, iPads, and smart phones) during the House. All of these comments seemed to come under the guise of concerns about “professionalism,” but I think it’s about something else altogether. The House of Delegates is an extremely traditional environment. Not only does social media have the potential to make House happenings more public and transparent (can someone please tell me why that would be a bad thing?), but it also levels the playing field so that everyone gets a voice. The truth is, many delegations answer to their Chief, vote as a block, and are asked not to post to the discussion boards or discuss motions with other delegations (all that has to go through the Chief). When you understand this, you understand why social media may make some Delegates uncomfortable, and how some (particularly Chief Delegates) may worry that one of their own delegates could go rogue and (gasp!) post their own opinions in a public forum. Don’t get me wrong – there are many progressive, technologically-savvy folks in the House – but there are also many who cling to (and seem to thrive on) tradition and hierarchy, and that doesn’t leave a lot of room for social media. Frustrating, indeed, but an illustration of how far our profession (and health care in general) has to go when it comes to social media and technology.

Lesson #4: Some issues just can’t be discussed in 140 characters or less

One of the biggest lessons I learned on the House floor is that the APTA Staff, Board of Directors, and Delegates work hard to tackle tough, complex issues. I thought I understood “RC 3” (adopted as Physical Therapist Responsibility and Accountability for the Delivery of Care) before I arrived, and quickly realized that I had no idea the breadth and complexity of this issue. The House discussed it for an entire day, and that’s not because we were a “do nothing” House. It’s because changing how we provide physical therapy services is a big deal, and there is much to consider. It may seem simple to a private practice PT that we should have adopted a policy that allows physical therapists total freedom to delegate physical therapy to anyone. But it seems equally simple to a PTA that he/she has a special skill set and should be the only support personnel qualified to provide physical therapy. There is much uncertainty about health care reform. Many members want the alternative payment system to be the priority of the APTA, and have concerns that any profession-altering policy may put that in jeopardy. And there are pediatric physical therapists, like me, who have concerns that the models put forth in RC 2-12 don’t represent pediatric practice (particularly school-based and early intervention therapy). The idea here isn’t to debate this policy, but rather to illustrate how complex these issues really can be when you are trying to represent an organization of over 80,000 members that practice in extremely diverse environments. The truth is, many (most) of these issues just can’t be discussed in 140 characters or less, or we’d conduct House business over Twitter and call it a day. As much as I love social media, I appreciate it for what it is – a place to connect, network, share, educate, and learn. It is a wonderful environment for gathering information and forming relationships – a jumping off point for “real-life” discussion – but isn’t really an effective place for debate. The power of social media – its simplicity – is also the danger sometimes. We can’t have nuanced discussions or solve complex issues facing our profession in 140 characters or less. And so, while it was exciting to tweet news and updates from the House floor, I left the conversation when it turned to debate. And I’ll continue to do that, because it’s not where I want to put my social media energy.

It may sound frustrating, and at times it was. But I’m a glass-half-full kind of gal. So here’s the silver lining… Technology and social media are often referred to as “disruptive innovations” in education an health care. Although social media has been around a few years, I think this year was the tipping point for the APTA. This year, social media was just disruptive (and visible) enough to get everyone’s attention. My hope is that this is the start some real conversations among APTA members, staff, and leadership about how to harness social media and use it to engage members and promote and advance the profession. About how to encourage more participation in the House of Delegates and have broad, transparent discussions about House issues. As in all professions, there is resistance to change. There always will be. But as we move forward, we must recognize that – in a changing world – the biggest risk associated with social media may be not using it at all.

This post was originally published at Kendra’s blog, Kendra Ped PT and is graciously republished here. 

Going social in the APTA House of Delegates: RC 23-12

Next week, the American Physical Therapy Association House of Delegates will convene for the 2012 session.  This year’s House will discuss and vote on a number of motions, but – as a self-proclaimed social media junkie – one motion in particular has caught my attention.  The motion, introduced by the Washington Chapter, is known as RC 23-12 and proposes to set standards of conduct for physical therapists, physical therapist assistants, and physical therapy students who use social media.  The exact language of the motion is as follows:

RC 23-12 ADOPT: STANDARDS OF CONDUCT IN THE USE OF SOCIAL MEDIA

Whereas, Physical therapists (PT), physical therapist assistants (PTA) and physical therapy students (students) must be knowledgeable regarding the principles of patient/client privacy, confidentiality and identifiable patient/client information as it relates to social media;

Whereas, PTs, PTAs, and students should use privacy settings to safeguard personal information. PTs, PTAs and students should monitor their social media presence to make certain that the information on their own pages and content posted about them is in concert with the American Physical Therapy Association (APTA) Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant;

Whereas, PTs, PTAs, and students must be knowledgeable regarding employers’, educational institutions’, or clinical training sites’ published policies on personal social media sites;

Whereas, To uphold appropriate boundaries, PTs, PTAs, and students should consider having separate personal accounts;

Whereas, If a PT, PTA, or student sees content posted by a colleague that appears unprofessional, s/he has a responsibility to bring that content to the attention of the individual, so that the individual can remove or modify the content; and,

Whereas, PTs, PTAs and students can be held personally and legally responsible for their publicly made opinions and comments, even on personally maintained sites and pages;

Resolved, That physical therapists, physical therapist assistants, and physical therapy students should demonstrate appropriate conduct in social media activities.

SS: Physical therapists (PT), physical therapist assistants (PTA), and students are using social media for professional/work/educational purposes, as well as personal interactions. The overlap creates potential conflicts in patient/client management. PTs, PTAs and students must understand that their online actions and content may negatively impact their reputation among patients/clients and colleagues, impact their careers and undermine trust in the profession of physical therapy. Conduct is defined as a verb to behave or manage (oneself); or to direct in action or course; manage. The PT, PTA and student must use appropriate conduct in the use of social media as the professional team. Currently, there are no APTA guidelines available for social media. APTA members are required to maintain patient privacy by following APTA’s Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant, their respective state practice acts, and HIPAA rules at all time, including social media.

Whether you are an APTA member or not (you should be, join here), this motion could have significant implications for those of us who are already using social media, as well as those who may consider communicating using social media in the future.  What are your thoughts?  Is it time for the APTA to formally address professional use of social media?  Does this motion fairly and accurately describe social media and its uses?  If you do not support RC 23-12 as written, what are your suggestions to amend this motion?  What would you add?  What would you remove?

I urge you to share your thoughts on RC 23-12 in the comments below, join the #RC23 conversation on Twitter, and contact your state APTA delegate(s) to let them know how you feel about RC 23-12.  As a Delegate for the Kansas Chapter, I plan to be a vocal participant in this discussion, and I will share your thoughts at the House.  There will be no better way for me to illustrate the power of social media at the House of Delegates than by citing our very own social media discussions of RC 23-12.

Make your voice heard.  Together, we can shape the future of our profession – one status update, tweet, post, or comment at a time.

[icon style=”notice”]Update: A lively Google+ Hangout and Twitter conversation on the #RC23 hashtag has been taking place.[/icon]

RC23-12 Discussion on Google+

Summary of #RC23 discussion on Twitter via Storify.

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Kendra Gagnon is a new contributor to PT Think Tank. A pediatric specialist, she’s on faculty at the University of Kansas Medical Center and shares a common interest among PT Think Tank writers: she is a “self-proclaimed social media “junkie”, and uses technology and social media in the classroom to engage students and prepare them for using these technologies in the professional world.”

She blogs at Kendra Ped PT.

APTA Vision 2020: What’s your grade?

Alan Besselink, blogger and Austinite extraordinaire has written a thoughtful post entitled, “APTA’s Vision 2020: My 12 Year Report Card.” In the post, Alan breaks down the components of Vision 2020 and provides his summary of the progress toward each.

To review, here’s the Vision 2020 statement from the APTA:

“By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, activity limitations, participation restrictions, and environmental barriers related to movement, function, and health.”

I’m sure certain parts of this resonate more with different folks. For Alan, the issue of Direct Access takes center stage. I agree with his critique of the APTA PR machine, which labels 40 something states as having some form of direct access to physical therapists…while in actuality, many of those states are not very gate-keeper free at all. Alan points out that the state we both practice in, Texas, is listed as a Direct Access state by APTA. I consider that false.

Here are Alan’s grades for each section:

  • Autonomous Practice: F
  • Direct Access: F
  • Doctor of Physical Therapy and Lifelong Education: F
  • Evidence-based Practice: F
  • Practitioner of Choice: F
  • Professionalism: A
  • Overall: F

 

Now, I’m not sure I agree with Alan on all of these grades (specifically the EBP and DPT grades), but he makes a good argument for each of his choices in his post. My question to you is, what do you think about the progress we’ve made on Vision 2020. As Alan points out, “As they say, if you do what you’ve done, you will get what you’ve got. Sadly, what we’ve got isn’t much different than what we had 12 years ago.” This may be a good opportunity to take stock and make some changes in strategy before we get too close to 2020 to change!

[icon style=”notice”]I’ll summarize the results of this poll in another post prior to the APTA Annual Conference.[/icon]

How do you Grade APTA Vision 2020 Progress

Physical therapist Blogger, Alan Besselink has already submitted his grade. What's yours?