Wednesday, May 25, 2011

A time of transitions

Hello All,

     I apologize for the long delay between posts around here!  It has been a very, very busy year.  APTA elections are just around the corner and I've been devoting a good deal of time to my efforts on that front. And of course, with elections come this year's House of Delegates which marks the gathering of the highest governing body of our profession.

I'm very proud to be a part of this year's House.  Just to name a few, we will be tackling issues such the profession's role in end of life care, the possibility that it's time for PTs to bring on additional extenders beyond PTAs, and reflecting on how Vision 2020 is evolving and could be changed.  The House is a place of great passion and enthusiasm.  It is endlessly satisfying to see so many PTs and PTAs lively advocate for what they feel is the right course.

This blog has always been about questioning what is known, be that assumptions regarding new PTs, philosophies about where we are headed as a profession, or even just the present state of health in society.  The microcosm of ideas, musing, and rants here on Move It represent a different way of viewing our profession and reflections on common situations that New Professionals seem to find ourselves in.

So it is with great appreciation and admiration for all of Move It's readers and contributors, that I must make a confession.  My New Professional card has been revoked.  Ten days ago I officially eclipsed the 5 year mark.  From this point on, I hope to serve as a guest author only for the blog.  Fresh perspectives will be coming soon!  Stay tuned and thank you again for your readership!



Wednesday, April 27, 2011

Disrupting something sacred

Tim Richardson has done a nice job of introducing aspects of disruptive innovation to the PT blogsphere.  I read Christensen's book in 2009 and think back to it often.  A big question for me has always been, "How can we do the work we are setting out to do smarter?"

Without a doubt, the need and demand for our services will increase in the coming years.  If we don't seek to disrupt ourselves, someone else will.

Innovation is about capitalizing on areas in which newer, quicker, cheaper, and better options exist.  In many ways, PT evolved to disrupt the western medical model in place for the hundred or so years prior.

If we fail to see that as part of our pedigree, it's a sad state of affairs.  Sad for us because we will lose ground in the next shake up. But it would be great for the next generation of lower cost, more consumer-savvy providers.

If we want to stay on top, here are my suggestions:

Step one: Acknowledge that not every problem requires a PT.  

We have a diverse and widely applicable skill set but we can't be everywhere all the time.  There are some jobs that ATCs, exercise physiologists, health coaches, and nutritionists may do better.  If you can't handle hearing that, okay, but be ready to have our association spread too thin across too many uphill battles...  This means looking at PT-PTA relationships and PT-XYZ relationships as well.  As a profession, and rightly so, we are anti-kick back.  But as demand increases we will need to put the lab back in collaboration.  Which brings me to-

Step two: Forge alliances with the individuals next in line to "disrupt" the system.  

This is no small list. Point of care is moving out of the hospital and out of the Doctor's office.  For us, it's moving out of the clinic...  Nurses were set up to be big winners in Health Care Reform.  That is certainly a strategic alliance that needs our attention.  PTAs, ATCs, SPTs, Massage therapists, and a laundry list of others deserve constructive consideration as well.

Step three: Re-evaluate which jobs we set out to do.  

If an ATC proves they can rehab an ACL better than we can, sigh, maybe we should get out of that business.  Do I expect that to happen? No.  Is it possible?  Perhaps??  If we aren't asking ourselves the question, we open ourselves to being blindsided by unexpected answers.  As I've said in the past, comparative effectiveness studies are exciting opportunities to prove our expertise and rally public support behind endeavors in which we choose to take on a leadership role.  Could the APTA registry in the works be used for the greater good? I certainly hope so.  Why not fund it and fast track it?

Step four: Innovate.  Move "to where the puck is going to be."  

If PTs seek to 'own' just two major areas in the health care arena, they should be obesity and aging related neuromusculoskeletal deterioration.  Soon 80% of Americans would qualify for PT intervention based on one, the other, or both categories. Where are our community based intervention courses for aging and physical therapist interventions?  Where is the hot bed at which PT and Public Health intersect?

  As always, thanks for reading!  There's been a brief hiatus as I've been managing some family issues and gearing up for APTA elections.  This is a cross post with the EIM Blog.  But there will be some Move It exclusives up soon.


Thursday, March 31, 2011

Keeping up with Research

I think we can all agree that RESEARCH ROCKS . . . but how do we keep up with it all?!?! As a physical therapy student, I vowed to myself that I would “always” keep up with the latest research once I entered the working world. Journals, continuing education, conferences . . . I was going to do it all. Once classes, exams, papers and group projects were done, I thought I would have plenty of time to keep up with the research world. How could I possibly be busier than I was as a physical therapy student?!?!

After five years of working as a physical therapist, these thoughts make me laugh :-). I have come to realize that staying up-to-date with the latest research findings is a very personal and challenging journey for each of us. Finding a balance between family, friends, recreational activities and work can be demanding. With so many people, responsibilities, and activities filling each day, finding time to stay in touch with the research world can be difficult. It has taken me a few years of trial and error to figure out what works best for me. Here’s what I do:

· Skimming journal cover pages (JOSPT for example) as soon as I get them and highlighting the articles that are most relevant to the patients I am seeing currently. This helps me prioritize me reading/learning.

· Reading journal articles two days a week during lunch . . . often while riding a recumbent stationary bike. Starting to do this really helped me keep up with my journal reading.

· Attending continuing education courses and PT conferences as regularly as I can given time and $ constraints.

o Looking up journal articles cited by presenters at courses and conferences

o “Open Door” which is available to all APTA members is a great resource for finding journal articles in publications that you don't already receive

· Journal club – I work as one of two physical therapists at a university student health center. Putting together a journal club took some extra planning because our “Sports Medicine” journal club includes physical therapists, an athletic trainer, and primary care physicians. We meet once a month to discuss new articles and to work on our overall system of patient care.

· Talking “shop” with PT friends . . . sharing what we have learned

So fellow NPs, how do you do it? How do you keep up with the latest research while balancing family, friend, work, etc? I'd love some new ideas!

Monday, March 7, 2011

Exploring Our Future

Something is always lost in translation when you summarize a summary.  But I intend to try.  On Saturday I had the honor of attending and presenting in Emory University's "Exploring the Future of Physical Therapy Symposium."  We set out to bridge and contextualize two seminal APTA events, the Physical Therapy and Society Summit(PASS) and the Vitalizing Practice Through Research and Research Through Practice(VRTP) Conference.  The symposium though not officially sanctioned by APTA was certainly peopled with many of its luminaries.  Similarly to PASS, at which I was the youngest PT in attendance, I was surrounded by NIH grantees, journal editors, and progressive thinkers from academia and the clinic.

Emory's event built upon and went beyond past efforts.  PASS imagined the future.  VRTP established strategic goals.  On Saturday, with the help of an APTA lobbyist straight from D.C. and with the Chief Disability and Health Officer from the CDC, we began to compare the current state of affairs with our goals as a profession.  To borrow from Capitol Hill, this was a big "frickin" deal... ahem.  (Not bad for what was initially a simple Alumni weekend and Foundation Fundraiser.)

Exploring the Future was about initiating change in the PT world.  Ivory towers, silos, bloated curricula, exorbitant debt, disconnected scientists, and disinterested clinicians were all on the chopping block.  The audience was engaged and asked to reflect on how change can happen and where change is needed.  Topics ranged from ACOs to regenerative medicine to innovative co-pay incentivization schema.  Comments ranged from "Translational clinicians need to be honored within APTA." to "If you don't donate to the Political Action Committee, at least marry a congress person."  

The seemingly obligatory product of Symposiums these days is the White Paper.  While such a paper is in fact forthcoming, there was a strong call throughout the event to take action beyond the keyboard.  Hopefully bloggers are granted free license in this regard.  No blog of any readable length could do this day long event justice.  So I want to share a personal perspective that grew out of PASS and was strengthened over the weekend.

Physical therapists must come to lead community initiatives.  Our skill set has expanded in many helpful areas but the need for our skill set has exponentially out accelerated that growth.  Patient demographics have become population statistics.  As clinicians, researchers, and just professionals, our reach needs to extend further now than ever.  My personal mission, having attended PASS and presented in Exploring the Future as young leader, is to promote a skill acquisition model for leadership development within APTA.  The sooner we identify the societal needs of 2020 and beyond, the better we will be able to "skate to where the puck will be" by preparing our clinicians and leaders to meet those challenges.  Where do you think the puck is going?


Tuesday, March 1, 2011

Clinical practice is Research (and Research is Practice)

Research is the March theme on ~Move It~

Once upon a time, a time long, long ago, when I was only contemplating sitting for my NCS and not counting down the days until I would take the most expensive and difficult test of my life, I registered for a preconference course at the Combined Sections Meeting. The course was entitled "Laying the Foundation for Expert Practice in Neurological PT". A prominent theme of this course was differentiating between "intuitive" and "systematic" processing. We were taught that experts were able to synthesize information intuitively without investing cognitive resources in differentiating between plausible and implausible hypotheses. This ability was thought to improve efficiency and allow an expert to focus on an individual's complaints.

I'll be honest. I found this distinction frustrating in its over simplicity. Experts will inevitably be more efficient in processing information gathered from their patients. (If they weren't, we'd have a problem.) But in the world of Physical Therapy, everything is data collection, every touch, every question. Saying that something is intuitive makes light of the empirical process going on beneath the surface. New grads think in terms of T-tests, whereas experts conduct ANOVA.

So granted, there is a difference in the way information is processed.  But whether it's an expert clinician performing an evaluation or an NP assessing gait, hypothesis testing is the bread and butter of physical therapy.  Anything that obscures this fact contributes to the unfortunate divide between research and practice in our field.

Researchers assess whether or not a particular practice works.  They are "practicing" to see if it works.  Clinicians test hypotheses with every modification to a treatment plan.  Why, then, is there such an inexplicable divide between clinicians and researchers?  My hypothesis: the methodological family tree split too long ago.  The clinical language is different because there hasn't been an IRB looming in the background.  Standardization wasn't required.  But in the context of the emerging health care paradigm, in which comparative effectiveness and clinician scorecards will evolve, a common bench/bedside language will be indispensable.  Our branches must re-form a central trunk.

Where do you see the Clinic and Lab colliding?  And for the future, if we don't strengthen those connections, how will we survive?


Monday, February 28, 2011

Becoming Component Secretary as a New Professional

Since my first Physical Therapy interview at New York University, being an active member in the American Physical Therapy Association has been an interest of mine.  During the interview is when I first meet Dr. Marilyn Moffat. I was fortunate to have her as a source of knowledge and guidance during my graduate school experience and my continued develop as a new professional. As a student, I regularly attended district and Chapter meetings increasing my interest in the governance process. While I was a student, I was selected to be a student Delegate at New York’s Delegate Assembly which is a smaller version of the APTA House of Delegates (HOD).  This allowed me to attain firsthand experience on how our Chapter makes decisions on important issues.

Our New York Chapter has made it easier for students to get involved at the district and Chapter levels. We recently started a new pilot program called the “Student Interns,” which allows one student from each PT school to attend a Chapter BOD meeting where they are paired with a district director to help mentor them.

My active involvement as a student served to increase my involvement as a New Professional (NP). After graduation, I was asked by my district to attend their Executive committee board meetings, where I got to see more of the deliberating processes. After a year, a vacancy in the position of Vice Chair at the Greater New York District of the NYPTA became available and I was elected to position of Vice Chair of our district. During the same time I submitted my name to our Leadership Committee where I got named to that committee. That same year I also was elected as a NY delegate to the HOD where I got to meet a lot of our influential Chapter delegates and gained more valuable experience.

Last summer our NY Chapter Secretary got elected as Vice President which left a vacancy at that position. Shortly after, I got a call from the NY Chapter President and he was acquiring about my interest in serving on the Executive Committee. With excitement I spoke to a few members of my District to get their insight about me serving as our Secretary. One member whom I valued their opinion informed me I was too young and did not have enough experience to do a good job at the Secretary position. They explained the normal progression was to serve as a district delegate or as a Committee Chair first to get a better understanding of the Board and its structure then persuade an Executive Committee (EC) position. 

After a few lengthy discussions with the President and stating my concerns he ensured me I would do a great job and I was only filling the position for one year. With some hesitation and nervousness I accepted the position not fully understanding what it would entail considering I have never been to a BOD meeting let along serving on the Executive Committee. One of the reasons the president wanted me to become part of the EC was what I could bring to Chapter. Our current President wanted our Chapter to take a new direction and one way to reach this was to get younger members with a fresh perspective. One thing as a NP I can bring to the Chapter is a younger thought and new approach to help bring positive change to our Chapter. Our EC is open to everyone’s’ opinions which allows for discussion because at the end of the day we all want what is best for the Chapter.

Fortunately for me I knew that past Secretary and she continues to mentor me along with the other EC members. This past year has been a little nerve racking yet continues to thrill me as time progress and I gain enough confidence and knowledge. So much so I am running for reelection for the position of Secretary this upcoming April.

Looking back on this past year, I have been very fortunate to have accomplished so much professionally already and hope I can continue to mentor other NPs. I think being involved with a big Chapter like NY offers many advantages because of our size as well as the many opportunities for leadership and involvement. My advice to other NPs would be try to get involved at much as they can commit to; first starting at the district level, then at the Chapter level, and finally at the National level. I was fortunately to bypass the normal progression and go straight to the EC. I am only thankful for the opportunities I have been given so far. As NPs we are the future of the profession and it’s up to us to make the difference.

   Jeremy Crow, DPT, SCS, NYPTA Secretary, NY Delegate to APTA House of Delegates

Sunday, February 20, 2011

4,000 to 1

A little over a week ago I had the chance to speak to a group of PT and PTA students in New Orleans. The Student Assembly leaders held a caucus to give their members a better understanding of involvement, governance, and engagement within APTA. During my talk I brought up the fact that there are about 4,000 Americans for every APTA member. I wanted to make the point that our profession's mission, enhancing societal health and function, requires their generation to be impassioned, involved, and willing to acquire new skill sets.

I single out the up and coming generation for a number of specific reasons. Needless to say, no PT or PTA, regardless of talent as a clinician, is prepared to directly influence thousands of consumers. And yet, that is our goal, an excellent and appropriate goal given our skills and ambition in the emerging health paradigm!

So strategically, how can physical therapy move to meet this challenge head on? Looking back to the ratio, we certainly can't expect the number of Americans to decline (nor would we want it to). However, influencing the right side of the ratio, APTA membership, presents an opportunity to shift things in the profession's favor. Clearly, I'm a big proponent for APTA involvement but it's not out of blind zeal. Upon leaving the bubble of academia, it is essential that PTs and PTAs maintain some line of communication with the professional world. Otherwise, as we do not sit for re-licensure, it's easy to become removed from all but the most local issues. If today's students don't feel a visceral connection between our mission and staying involved, complacency, disinterest, apathy, and a shrinking vision are on the horizon. But with a proper foundation and greater investment in leadership development pathways, this risk can be minimized.

Getting back to our societal goals, soon-to-be clinicians and those with several more decades to practice can and should cultivate some special talents. Community outreach must become a focus! Many of us are comfortable with social media and technology. This is a great place to jump off. How can we hook up groups of clinicians with teams of people seeking improved health? (This speaks to Carpe Sanitas and the "Team Wellness" concept that I should probably devote a whole blog to at some point.) And by extension, how do we pick out the smallest, most effective group of clinicians to assist a given team demographic? Who else will be in the group? Exercise Physiologists? ATCs? Dietitians? Nurses? Chiropractors?

PTs can create a program but for it be consumer-centered we must continue to earn our seat at the table. That will mean disrupting our standard practices, collaborating in new ways, and trying new things. If we don't disrupt ourselves, someone else surely will. (For a great read on this theme try The Innovator's Prescription.) What are your ideas for shaking up the status quo or for getting the benefits of PT to a big audience? I would love to hear them.