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

Treating our Future – Part 2: New Grads: An Asset for Clinics

In Part 2 of 3 in our series, Treating Our Future, Lauren Kealy delves into her perspective of the benefits of new professionals. This continues the conversation started in Part 1, “The Bane of the New Professional.”

 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

New Grads: An Asset for Clinics

The job market for any new graduate is rough. The job market for new DPT grads in the state of Colorado takes it to a whole new level. All too often I have heard stories from friends looking for jobs being told, “Sorry, we don’t hire new grads,” without a pause for consideration or even conversation. Part of the rational for the profession’s transition to a doctorate degree was to better prepare new graduates. And, we are more knowledgeable (and more in debt!), yet we are still not seen as ideal hiring material. In fact, in many instances we are seen as a liability. I disagree, and I’m here to tell you why a new grad can be your clinic’s greatest asset.

We are full of passion and energy. Being fresh out of school means that we are very excited to put our knowledge to use. We recognize that we still have a lot to learn (which is a great trait in and of itself!), but we are competent enough to treat patients and get results.

We are innovative. In the business world, new grads are scooped up quickly because they give a fresh energy to the company. We are full of ideas, so give us a shot to present them to you. Sometimes a new set of eyes can find ways to improve profit/outcomes/experience to change the status quo that has become the norm. Some of us even have backgrounds that include other skillsets your clinic might benefit from. Accounting, law, health management, and finance are just a few of my classmates former lives.

We are up to date with current evidence. Ask us! We know the clinical prediction rules based on the latest evidence. If you give us a shot, we may even be able to teach you a thing or two if you are willing to learn from us. Of course, we’re not expert clinicians, but current evidence and clinical expertise seems like a good marriage to me.

We seek outside mentorship. We all recognize that graduating from a great DPT program does NOT make us an expert. We also recognize that most clinics do not have the time to baby us and walk us through constant mentoring. The whole point of the DPT is so that a new grad could hit the ground running (if someone would hire us and give us the chance). Therefore, we see the importance of seeking independent mentorship outside of clinical hours.

We want to continue to learn and grow. With additional certifications, fellowships and residencies available, most of us want to continue to learn and earn specialty certifications. This in turn can help your clinic as we become more advanced. Engage us, and give us a pathway and you might be surprised where we end up.

We are moldable. You want to hire the perfect PT for your clinic. Hire a new grad and mold us into that perfect PT you desire! Where we lack in experience, we make up for in passion and excitement. We are open to criticism and suggestions of how we can be the best possible physical therapist.   

We are the future of this profession. The PT field is growing rapidly and more and more students are applying to PT schools. That means the young PTs that are graduating were picked among tons and tons of applicants. We are a smart and utterly passionate group. WE deserve a fair shake in the applicant pool. If you find a new grad who is well spoken, involved, motivated, and a great fit for your clinic other than the lack of experience, I urge you to give them a shot. In a short while, they may become your best physical therapist.

If new grads are never given the opportunity to shine and grow, how are we as a profession going to move forward? I speak both personally and as the voice of many DPT students and new graduates- treat me like an asset and I will pour every ounce of passion and knowledge I have into becoming the best physical therapist for your clinic.

 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

Treating Our Future – Part 1: The Bane of the New Professional

As a professor in a few entry-level DPT programs over the past several years, I’ve had the privilege of getting to know many students. By and large, the graduates from these programs are some of the smartest, most motivated people I’ve met.  However, they’re not always greeted with the same sentiment by employers. It’s concerning. It’s a situation worthy of not one, but several blog posts and so what follows is the first of a three-part series. I’ll start us off with this post to start a conversation about how the profession treats the people who are it’s future.  In “New Grads: An Asset for Clinics,” Lauren Kealy, a DPT student at Regis University, gives a student perspective on why new grads are excellent assets in the clinic.  In part three, we’ll look at some solutions, and incorporate feedback from the community as the conversation progresses.

Treating Our Future – Part 1: The Bane of the New Professional

My motivation for this blog post, and this series of posts, is not a good one. That said, I hope it sparks a constructive conversation that proves beneficial. Simply put, I’ve seen too many new professionals in physical therapy treated like dung by potential employers.

Here’s a story about how it goes for new grads here up in Colorado:

The new Grad looks for jobs. They don’t find many options, as the positions posted primarily request those with 3-5 years of experience. The newly minted doctor of physical therapy waits patiently for the ad accepting new grads. It never comes. They network, they reach out, they apply to jobs which request 3-5 years of experience anyway. Eventually, they get an interview, only to be told they don’t have enough experience. That’s even if they get a reply at all, as most often they get a polite thank you and never hear from the employer again.

After a while, they find a clinic who’s pressed to hire. Or they have a particularly strong networking connection. They then, to my personal dismay as an instructor, must perform a practical exam as part of the job interview to “test their hands.” I thought we already did that as part of their physical therapy education process? Was it not good enough? Didn’t the new graduate pass the NPTE? Is that not enough? Shouldn’t clinical reasoning be the thing you test instead of “hands,” especially if your clinic’s therapists use ultrasound regularly for patients with back pain? I don’t get it. But, let’s continue the saga of the job-seeking new graduate.

Provided they “pass” their practical exam, they are then sent on their way. If not hired, they still don’t often get a call back to let them know they weren’t hired. Silence is the most common answer. If hired, well, good for them. They’re on their way to greatness, albeit usually without benefits, or with minimal benefits and a salary that soon leads to sticker shock, as they contemplate the grizzly reality of paying off their 7 years of student loan debt and trying to afford a place to live.

At a recent #PTPubNight, I listened to a conversation between two clinicians. When one, the older, found out the person he was conversing with had less than 6 months of experience, he responded with a sneer, a statement, “Oh, you’re fresh!,” and a turn away from the previously strong conversation. Is this how we should be treating our profession’s future?

Dehumanizing our Future

It’s tragic to watch this process. From graduation and all of its ecstatic highs to the low of never even hearing “No,” new professionals in physical therapy can be in for a rough ride. It’s not that each new graduate deserves every job they apply for. However, they deserve the respect of a professional, qualified and ready to work. To not even return their application with a negative response, to question their skill set, to demean them for their lack of work experience is wrong, and unproductive. As the profession works to inspire leaders, innovators, and entrepreneurs to carry us into the future, a first stop characterized by disrespectful professional behavior is not a good strategy.

I know it’s not like this everywhere. In Texas, graduates from Texas State University were gobbled up like delicious pieces of bacon by clinics around the state. Texas is a positive job market, and so employers are happy to see the new graduates arrive. The point is, this happens somewhere. Colorado is not alone. I’ve conversed with many students from around the country and I hear similar themes: “They never even called me back, even after I did a hands-on practical.” “All the jobs want 5 years of experience, how am I supposed to get experience if no one will hire me?” “I had to sit and listen to what a liability I’d be for the clinic since I was a new grad.” “They made me do a practical exam, but the stuff they asked me seemed way out of date compared to what we learned in school.” I’ve spoken with many PT’s who declare, “I’ll never hire a new grad!” without remorse or pause. Many of these are the most respected and seemingly savvy PT’s around, even one’s with a large social media footprint.

It’s time for a conversation.

There are reason’s employers don’t want to hire a new graduate. Some of those are valid, while others are not. Some of the valid reasons, like lack of business skills or billing proficiency, should spark reform in education. Some of the invalid reasons, like assuming new grads can’t possibly manage patients with low back pain, should spark education and discussion. At no times, should the new professional be treated like dog meat as they rush excitedly into their first professional experiences. This issue is closely tied to the often discussed disconnect between education and clinical practice, but it’s more than that. It’s about respect, and a forward thinking strategy for how and where our new professionals go.

I’m very interested in feedback on this post. If you’re a clinic owner who doesn’t hire new grads, tell us why. If you’re a new professional, tell us about some of the hardships. If you just have an opinion, join in!

In part two of this series, Lauren will discuss the benefits of new professionals. Part three will look to solutions, and feature conversations that spawn from our posts, as well as highlighting some very successful practices who have embraced new graduates heavily. I look forward to this conversation.

 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

MedPAC Doubles Down

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In theory, the Medicare Payment Advisory Commission (MedPAC) advises Congress on the best actions to take to ensure both the long term survival of the Medicare program, and that health care needs are met for Medicare beneficiaries. This is a tough task, as tipping too far to one side or another can result in wildly out of control costs, or decisions that harm the public health overall. It’s a tough assignment for MedPAC. Some decisions have been good, such as the overall shift to quality-based reimbursements. Others, like the arbitrary cap on physical therapy services haven’t been so smart. The cap limit has required action by Congress on an annual basis for over a decade to ensure there is an exceptions process.

MedPAC released their report to Congress this month. You can find the June 2013 report here. In the report, there are two recommendations suggested that negatively impact patients with Medicare through burdens placed on physical therapy providers. First, the cap limit has been recommended to be reduced from $1900 per year to $1200 per year. Remember, this is a cap that is shared with Speech and Language Pathologists. Imagine how quickly this goes away if a Medicare beneficiary has a stroke. Unlimited reimbursement can’t be a realistic thing, but minuscule caps on reimbursement demonstrates the continued poor value MedPAC places on physical therapy services.

The second recommendation is one of those curious things in healthcare. The recommendation concerns the multiple procedure payment reduction (MPPR) that went into effect in 2012. The MPPR basically says that if more than one unit of something is billed, the second unit will be billed at some percentage less. For 2013, MedPAC suggests that the MPPR be increased to 50%. Essentially, the first 15 minutes of therapeutic exercise is magically worth more than the second 15 minutes. Since the MPPR’s inception, a decline in payment for therapy services has resulted, further squeezing outpatient therapy services that already have a high administrative burden to treat Medicare beneficiaries. This further reduction will make this much worse.

In a letter from the American Physical Therapy Association (APTA) about the 2013 MedPAC recommendations, president Paul Rockar Jr, PT, DPT, MS, referred to the recommendations as “akin to doubling down on a bad policy.” I have to concur. It seems MedPAC has shifted too far on the mission of “save money” and isn’t considering the affect this has on patients with Medicare.

The APTA has an advocacy page, www.apta.org/Advocacy, where you can learn more about this, and members can take action and let their representatives in Congress know about the negative impact these recommendations have for their constituents with Medicare. The APTA remains in dialogue with policy makes and MedPAC, as well as continuing in advocacy efforts in Congress, but the collective public needs to raise a loud cry against these proposed changes.

Physical Therapy: Technology Update

This is my presentation given at Evidence In Motion's Manipalooza 2013 Symposium held in Aurora, CO.

http://manipalooza.com

I was traveling at the time but the organizers graciously allowed me to submit my talk as a recorded video. Therefore, you will be experiencing the talk just as the symposium participants did!

Forced Unemployment for New Grads

It’s May. That time of year where schools across the country are graduating thousands of new physical therapists that are excited, motivated, and eager to enter the amazing profession they’ve worked 3 hard years towards. These new graduates are searching for and accepting jobs, ready to bring their fresh new knowledge-base to clinics as employees. And, just as importantly, to start digging out of the weight of student loans that have added up over the years. Exciting right? Unfortunately, this isn’t what many new graduates of doctor of physical therapy programs actually experience!

Thanks to recent changes in the administration of the national licensing exam, many graduates have to wait over 2 months from graduation before they will be able to take the exam and begin working. That is already 2 months taken out of the 6-month grace period before student loans have to start being paid off. That’s 2 months that if you try to find jobs you hear “That’s too far in the future, call back when you have a license”. That’s 2 months that the knowledge accrued isn’t being used practically, and well, you know the familiar saying,  “If you don’t use it, you lose it.”

In the past, The Federation of State Boards of Physical Therapy (FSBPT) offered continuous-testing, meaning you could take the National Physical Therapy Exam (NPTE) any day you wanted. In other words, you could technically have your license and begin working within a week of graduation. This flexibility in the exam date reduced the need for states to provide a temporary license to those waiting for an exam date. In fact, from 2008 to 2012 the number of jurisdictions that offer a temporary license decreased from 34 to 26. The temporary license is a license based on the assumption that you have just completed a CAPTE approved program and therefore know enough entry-level information to practice safely under the supervision of a licensed physical therapist. Temporary licenses are provided for a specified length of time (usually 90 days), and/or completion or failure of the National Physical Therapy Exam (NPTE).  Some states elected kept the temp license for those who wanted to work, but delay taking the exam.

Unfortunately, due to a myriad of unfortunate events and compromised exam security, the FSBPT had to switch from continuous to fixed-date testing to preserve the integrity of the exam. This means that instead of taking the exam whenever you wanted, the exam availability was reduced to 4 dates throughout the year: January 29, April 30, July 23-24*, and October 30 (an extra date was added in July due to increased demand). The downfall of this reduced availability is that many, many programs graduate in May, making it difficult, if not impossible to take the April exam. For these May graduates, the only option is to wait over 2 months until the late July test date. This results in high demand for that date and all the scheduling problems associated with high demand at the Prometric testing sites as well as 2 months of forced unemployment for those residing in states without the availability of a temporary license.  A DPT graduate living in Texas can quickly get a temporary license and begin work, but a student in Colorado, for example, has no option but to wait to take the exam and find work doing something other than the degree they just paid thousands of dollars for!

It may seem like 2 months is a short time to wait to work, but the complicating factor lies in the timing of this period of forced unemployment. Students have just come off almost an entire year completing clinical rotations. This is a time where they’re paying tuition to their university, holding down 40+ hour work weeks in a clinic (and generating revenue for the clinic), yet receive no income beyond loan disbursements. Further, they’ve also had to fork over $400+ to apply to take the national license exam. These are students who have been full time students for more than 7 years! The well certainly is quite dry at this point. To add more complicating factors, those without jobs lose eligibility for health insurance from their universities. This is not a pretty 2 month wait.

This hardship could be reduced by more jurisdictions offering a temporary license for new graduates, or offering more dates to take the NPTE sooner after graduation to allow those without the option for a temporary license to seek employment sooner. These options would allow students to get engaged; giving back to their new profession and start climbing out of the student-loan hole they’re in without losing precious time. There’s no more eager professional than the one who just graduated. We need to find a way to let them work!

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.

 

 

The Ultimate Log ‘N Blog for PT app!

Screen Shot of ProtoGeoI wish I had this newly released app last week during CSM 2013! Moves by Protogeo Oy, brings a sweet new movement tracker to the field of personal data monitoring. With no need to purchase a new device, charge it, or risk losing it, Moves is a smart phone app that uses a combination of your phone’s accelerometer and some server-based processing to determine what you are doing and when. Cycling? Got it. Running? Got it. Driving to the next trailhead? Got it covered. (I wouldn’t swim with your phone…but…)

I’d like to see a social component developed on this, but you can share screenshots or summaries of your feats with friends easily enough. This may just be the app every DPT Student needs to track their miles for the Log N’ Blog for PT fundraiser. And, it’s FREE! Enjoy!

#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.

There’s No Such Thing as Bad Press

Succès de scandale!

Well, physical therapy didn’t exactly have a sex tape this week, but over the past several days, two notably large media outlets have featured PT in ways we might not, at first glance, like to be defined. The most prominent of these was physical therapist, Peggy Brill, who appeared on the Dr. Oz show to tout Ultrasound, Tiger Balm patches, and Bumpy Balls as cutting edge treatments for back pain.

Brill, Ultrasound ExpertThe second piece may have been slightly smaller in reach, but not if you’re a regular internet news surfer. An article that originated on the website, Greatist.com, made its way to media juggernaut, The Huffington Post. The article, entitled, “The 8 Best Physical Therapy Methods Explained,” featured “Greatist Experts Dr. Mike Reinold and Dr. Eugene Babenko.” The troubling part about these spots, which drew national attention, is that of the 11 treatments extolled by the PT’s, only 2 were not weakly supported passive modalities. When you take a step back and look at the brand message being delivered, it says ‘Physical Therapy consists of ultrasound, electric stimulation, lasers, traction, heat, ice, smelly patches, something that resembles children’s toys, and oh, exercise and something called manual therapy. Yes, I cringe.

Now, before you hire the lynch mobs to go find these blasphemous physical therapists who soured the public’s view of the profession, pause for a moment and understand how the media works. PT’s do not direct and produce media development. Often, by the time the expert is contacted, the direction of a particular spot is already formed. I will say the Brill Dr. Oz video is difficult to defend, but if you look closer at the Greatist.com article, you’ll see that Mike Reinold did try his best to steer the article.

Statements like, “Ultrasound has also been shown to increase ligament-healing speed in our furry counterparts (read: rats), though more studies are needed to show whether the same holds true for us,” and “Note: Heat is just one tool to help the therapist be more effective, Reinold says, it shouldn’t be the main focus of a treatment plan,” clearly show how Dr. Reinold was trying to steer the article and minimize the message of passive modalities. He even tweeted later on that the author did a great job of taking his feedback on the article. I know Mike well and he’s not a slayer of physical therapy. He’s an advocate, and a powerful one at that, with a large audience who follows his rehab, sports medicine, and performance blog, MikeReinold.com.  Still, the average internet reader and skimmer probably saw, Best PT = Ice, Heat, Ultrasound, Traction, etc. Yes, the article started with Manual Therapy being listed, but I argue that most readers wouldn’t recall that in their skimming compared to the more easily imaged words familiar to them, like heat and ice.

I can relate to this idea of physical therapy by mainstream media. I was interviewed recently for an article being prepared for a national publication. I spent most of the time in the interview trying to convince the writer that their preconceived notions of physical therapy weren’t actually physical therapy. I was moderately, but not fully successful. At a certain point, I had to draw the line or risk the writer moving on to a different “expert” who may have been more passive than I. And that’s the reality of media development. We should accept that the public has a very modality-based view of us and think of strategies to fix this.

Physical Therapist philosophizer, Allan Besselink, responded to the Greatist article, expressing not only his distaste for yet another passive treatment article, but also his idea of the 4 best physical therapy treatments for patient-centered care. He writes,

Here are the four best physical therapy methods for patient-centered care:

1. Mechanical assessment: The best treatment will be a natural progression from a good mechanical assessment based on sound clinical reasoning strategies.

2. Patient education: The patient needs to understand the solutions to their problem, the self care strategies involved, and the self-monitoring and progression of these strategies.

3. Exercise: Patient- and condition-specific exercise programs are critical self care strategies to promote optimal repair and remodeling, along with effective reduction of mechanical derangement if present. Exercise should be evidence-based and supported by the sport sciences research.

4. Mentorship and guidance: Physical therapists have the knowledge base and capacity to act as health mentors, providing instruction, progression, and guidance as necessary.

 Of course, none of these sound quite so fancy or high-tech as laser or ultrasound. But they all depend on the consumer’s active involvement in their care. Isn’t that the message we really want to send to consumers?

 

Allan’s list is excellent, though I would change out the first item for something more recognizable to the patients. The Doctors of Physical Therapy blog developed a similar list. Perhaps my reworked list might look like this:

Eric Robertson’s List of the 5 Best Physical Therapy Treatments for Patient-Centered Care: (stealing some parts directly from Alan)

1. Mentorship and Guidance: Physical therapists have the knowledge base and capacity to act as health mentors, providing instruction, progression, and guidance as necessary. Inherent in this is the fact that physical therapy treatment is continually distilled with excellent patient education about their condition and road to health.

2. Exercise: Exercise is the super power of the human physiology. Patient- and condition-specific exercise programs are critical self care strategies to promote optimal repair and remodeling of all your body’s systems. Exercise should be evidence-based and supported by the sport sciences research.

3. Pain Reduction: Through an integrated strategy that can include hands-on manual treatment, targeted coping strategies, and even the judicious use of passive modalities, physical therapists can have a great impact on acute and chronic pain, either helping patients to overcome the cause of that pain or giving them tools to minimize and cope with their pain.

4. Movement Education: Physical therapists have a unique roll as functional motor control experts. Whether the task is rolling over for the first time as an infant, regaining balance after a stroke, or finding the precise control to play football again after an ACL injury, physical therapists can rise to the challenge. Physical therapists understand how your body moves and can connect the dots between neural control, musculoskeletal strength, and the reality of each individual’s form to maximize human function.

5. Health Optimization: Rarely do paitents or clients of physical therapy make it through an encounter without gaining some benefit to their health apart from the condition or problem that got them there in the first place. It might be improved posture, it might be working out the tight hip that caused the low back pain in the first place, it might be the improved cardiovascular benefit of exercise, it might be a better understanding of how to manage their diabetes, or it might be reduced fear about re-injuring yourself. Physical therapists do much more than just fix body parts. They fix you!

Here’s what we need to remember. Physical Therapy is lucky enough to be a profession that does get mentioned on national press. Inherent in these two spots is something very strong and very important. It’s the idea that ‘Physical Therapists Fix You’. Even if the scholars of our profession squirm when the national media misses the mark on evidence-based treatments, the idea that physical therapists can take care of you is still very present, and very powerful. That is our true brand. And, I can live with that.