Clinical Contemplation on Christmas

Just killing some time between inpatient visits at the hospital on Christmas afternoon and I began envying my private practice friends who are laying comfortably at home, probably enjoying various broiled meats and season-appropriate nogs. The question popped into my head, "When did I stop caring about working exclusively in outpatient?"

The truths are, it doesn't bother me all that much that I'm in the clinic on Christmas Day, I recently realized that the PT in my head that previously thrived on athletic injuries has found joy in a variety of areas, and my vision of my long term career path may be less clear than ever.

My first job out of school was with a private practice, my bread and butter. I never really assessed whether I would be happy in other practice areas. Private practice was what I always envisioned doing, and ultimately someday, I would work for my own private practice. Then, I started as a traveling PT. Originally I took all outpatient assignments but somewhere along the way I fell into assignments in other settings. Now, I haven't had an exclusively outpatient assignment in over 2 years. Somewhere in those two years I learned a lot about myself, here's a list of things I never expected:

-I like home care. Not necessarily the clinical side of it, but I like the lifestyle, the freedom, and being outdoors during the day.
-Prosthetic training is cool. Many of those people are highly motivated and won't reach their fullest potential without intensive physical therapy.
-Urgent Care is a life-changing experience. You will see stuff happen in an ER that you won't see anywhere else on earth.
-Inpatient has taught me a lot about every aspect of surgery, even if I don't do acute care long term, I've learned a lot from it.

I don't have a conclusion. Maybe I have attention deficit issues and what I really like isn't any one thing, but a constant variety. But, through trying different things, I've broadened my own personal scope of practice. Some day I think I'll have to focus a little and put more effort into one portion of the PT spectrum, but for now I like seeing it all.

Time to head back to the floor. Maybe my patient will get to go home for Christmas night because of what I do this afternoon, that's pretty cool.

James

Congrats to 2 of our own

Recently got a promo for this upcoming exciting course down at Emory U. Congrats to Nate and Ben for being speakers. Who better to discuss the future than two guys who will truly be paving the way along with some of the biggest names in the PT world. Wish I could make it down.

https://secure.www.alumniconnections.com/olc/pub/EMR/event/showEventForm.jsp?form_id=65281

Specializing

Firstly, obvious congrats to Ben for the nomination and all things moving forward.

Now my question to all of you... why specialize?

I will be taking my OCS exam, Ben will be taking his NCS and I know a few of the other NP's have already taken one of the specialist exams.
As NP's is it too soon or just the right time to etch out a specialty?
The field that we are in is so broad and diverse it can create a jack of all trades and a master of none situation. For me it was a simple choice because ortho/sports is where my passions lie and are so interspersed (plan to do SCS at some point). I am taking it to force me to sharpen my knowledge base and hopefully serve to make me more marketable in an otherwise saturated NYC market.
I am very curious what all your experiences have been. Has it made you more marketable? Did it actually help sharpen your skill set or was it just an affirmation of what you already knew?
The SCS is the only way a PT can legally (to my knowledge, or also having your ATC) cover sporting events on the sideline, has anyone taken advantage of that? Do other specialties provide you with other 'benefits'?
What was your approach for studying (obviously very personalized question, but good info for us in this boat)?

I apologize for just asking a lot of questions but I feel like this is the right group to ask and hopefully this will stimulate some good convo...
GO!

Ambitious Changes for Move It

Greetings NPs and all others! A new post is once again overdue and I apologize. I've been trying to get all of my ducks in a row for some changes to the blog. The reasons are threefold. One, I need to spend more time in the coming months a) preparing for the upcoming election and b) studying my butt off for the NCS exam. Two, my days as a New Professional are numbered and I need to find a mix of newer grads and experienced voices to carry the torch. And three, during the candidacy phase of the election cycle, it is important that Move It not come across as a campaign vehicle.

To that end, I have contacted a dynamic, diverse group of potential co-authors. Each of these individuals has the potential to contribute meaningfully in a vast number of ways. What I hope to see happen is an enriching of the online community for New Professionals. By expanding the scope of potential topics and by increasing the geographic range of word-of-mouth communication, more authors should lead to a better Move It.

Another change is the introduction of monthly themes. Though still under discussion regarding sequence and details, Practice, Training, Involvement, and Research will be the broad categories for the months of December through March. Posts on other subjects and events will very likely be woven in. But each month will have a theme and there will be weekly posts on some aspect or variation of that concept. For instance, Practice may include posts about Wound Care as an NP, Travelling, or how being an ATC or CSCS influences your clinical skills and decisions.

I would love to hear your feedback on this redesign. And I greatly look forward to seeing the concept behind Move It evolve and grow.

Cheers,
Ben

The Big News: New Professional slated for National Office

... and incidentally, it's me.

With the announcement of the slate today, I can finally, officially divulge that I am a candidate for APTA's Nominating Committee. I've been trying to wrap my head around what that really means for the better part of two weeks. So far I've made it just past "Yippee!" or something to that effect that sounds a bit more appropriate coming for a 29 year-old. I'm thrilled for myself, intimidated and nervous too, yes. But most of all I'm excited at the prospect of an NP (New Professional) serving the Association in a significant role during a time of change and growth. If successful, I may get to set a precedent for how dedicated and progressive the NP crowd can be. While happy for me, I'm pumped for us!

I have lots of thoughts on what the process may hold. Recently I've come to see the NomCom's mission as bringing ideas (specifically people with ideas) and skills (specifically people with skills) to the table. Members of APTA then get to decide which combination will best suit the needs of our profession. It's an exciting, though a bit daunting, opportunity to help facilitate this process. Sink or swim, how I perform in the election cycle will have a bearing on the expectations for and the perceived readiness of the New Professionals as a whole. I'm looking forward to representing our demographic well. Please let me know what you think and please considering participating on Move It!

Cheers,
Ben

The Fountain of Youth

Unfortunately, I have nothing new to report on the election front. Stay tuned! But I have been ruminating on a blog for quite some time. You lucky readers, you.

I was reminded of the idea tonight when suggesting a continuing education course about the impact an overweight population has on the practice of physical therapy. By this, I do not mean "bariatric physical therapy". Bariatric PT is a great specialty, or would be, if the APTA made it one. I could easily digress into why it should be a specialty alongside Prevention, Metabolic Regulation, and Community Centered PT, but that is not what's calling me tonight.

Tonight I just wanted to point out the fountain of youth. We've all seen it. It's the short one, the one next to the taller one that we all tend to drink from. So yes, I'm talking about water fountains. Stay with me here and feel free to point out wheelchair accessibility, biomechanical issues, and the vertically challenged, if you absolutely must. But the point I'm trying to make is that, when given a choice between an easy option and a minutely more difficult one, we tend to take the easier of the two.

I won't argue that you burn more calories by stooping for the lower water fountain. But I will say that a conscious, symbolic dedication to a more effortful why of doing things would help lessen our societal waistband. Am I wrong? It's not that people are lazy necessarily. I think it's the same poetic sensibility inherent to our brain's motor planning ability. We don't think about it. We just see, and take, the path of least resistance. A brilliant strategy for the serengeti, less so for a perpetual office safari. Perhaps there is a time to tell our clients, "Work harder not smarter!"

But exerting more effort will only get our society so far. Many people have dealt with weight related musculoskeletal issues so long, their anatomy no longer responds typically to stressors. And then they have their stroke, COPD diagnosed, diabetic event, heart attack, fall, car crash, or come to Jesus moment. That's where we come in. Except, wouldn't it be great to have prevented it all in the first place? To slap the proverbial Big Gulp out of their hand ages ago? To push for the short fountain while the short fountain was still an option? I think so. Where do you stand and where does your state measure up?


Cheers,
Ben

Why "Move It", why read it, and why now?

So, one thing I think this blog suffers from is a lack of context. You would have to dig pretty far back to learn about its origin or to get a feel for the range of topics it has covered. As such, new readers may find it tricky to figure out what to read and where different topics may be found. To put it more and less succinctly, the better blogs get buried and while Memento was a good set up for a movie, reverse sequenced blog story lines are not very readable. Christopher Nolan I am not.

Who I am is a New Professional, or NP as I like to shorten it. Much of the time this blog has been a font for the random thoughts, experiences, and musings I've had at the beginning of my career. The title, Move It, is a play off of the new APTA slogan Move Forward and is meant to evoke a common PT phrase, "Move It or Lose It." But also, at the risk of being un-PC, it is a message directly to New Professionals, "Move your ass!" No one is going to do it for us. And if we don't move our profession forward, then quite certainly, we will lose it.

I'm one of a cohort of past student leaders that, upon leaving my role within APTA's Student Assembly, found myself in the vacuum of general membership. Luckily, the New Professional moniker had just been created and gradually more attention has been given to getting our demographic involved. Many times over, this fortuitous timing has benefited me greatly.

"But what is this blog about?" Despite being a self-affirmed APTA nerd and often blogging about experiences specific to that avenue of professional involvement, Move It has included universal themes for PTs and PTAs trying to find their calling. I've blogged about career indecision, visionary meetings of forward thinking, physical therapy steering and governance, and often times just my own perspective on where PTs and PTAs can and should be going.

I try to be pointed but fair about the problems that I and we face. Sometimes it's interesting... sometimes it's not. But I think it is important that there is a record of the types of things we go through. And more so, that NPs begin to form an empowered sense of self and direction within our profession. Move It is my idea of what might, in some small way, help kick start that process.

The most recent blogs are about my recent nomination for APTA office at the national level. I'm blogging about the process and, eventually, either the excitement or disappointment this amazing experience will afford. My number one goal, as a blogger and as potentially the youngest person ever slated(fingers crossed) for national office, is to inform and bring together new PTs and PTAs. Follow Move It or just wish me luck but spread the word and tell me what we can do to accomplish this goal.

Cheers and look for more additions and functions on the blog soon,


Ben

It doesn't take long

It's so easy to get busy towards the end of a week and feel rushed before switching to "relax" mode. So I apologize to anyone offended by a less than spiffy blog last night. And tonight, unapologetically, I'm taking the night off to go see some great live music. Work-Life balance people, we could all probably use more of it!

A slightly better designed survey should now be up. Please take the time to fill one out! I was not happy with the formatting from the post last night and couldn't believe I missed that typo. Whether you saw it or not, thank you for visiting the site, reading a bit, and hopefully contributing!

Have a great Saturday night!

Cheers,

Ben

So much to do, so little time, and just as much certainty

I found out today that in order to qualify for election, one must have been a "physical therapist member in good standing for at least five years immediately preceding their election or appointment..." Therefore, student physical therapist membership does not count. will have five years and one month of PT membership on the day of the election! How's that for a close call?!?
While relieved personally, it does bring to my attention, for the first time, the realization that New Professionals are explicitly prohibited from serving on the Nominating Committee, Board of Directors, or other high office. Seems a bit hypocritical from an organization perpetually at odds with "arbitrary limits" placed on us by the likes of CMS and others... This means pushing the New Professional envelope further will necessitate a bylaw amendment down the road. (Note to self)
So here I sit, formally, unequivocally able to be slated, with just nine or ten days before I'll know more and not bound by the rules and code of conduct for candidates. {I would post a link to that document but it's only accessible to Chapter and Component Delegates within APTA. odd.} Well, as the title of this post suggests, there are loads of things I would like to do before anyone can tell me "That's not allowed." Things I'd like to do while juggling a relatively new job and all the expectations and efficiencies expected therein. ... sleep when you're dead? ... meh. We can handle it. If we weren't good at juggling, we wouldn't have made it through school.

Here's what I think I should do. What else would you all suggest?
--Blog Daily on Move It
--Use the NP Facebook group for the evils of shameless self-promotion
--Post Blog link and thoughts to every other NP and PT blog I can think of (here's looking at you Bo)
--Invite other bloggers to comment on the process thus far
--Continue to contact past mentors of mine to solicit suggestions and feedback (3 of 3 are in support of an almost NP on the NomCom so far)

--Don't forget that the benefit to be had of the process, this pre-slate/might-not-ever-be-slated process, is in preparing other emerging leaders to improve upon my performance

Let's be honest, until a critical mass of nontraditionally thinking PTs & PTAs are calling the shots, be that at the House of Delegates level or within the Board of Directors, change will be gradual. I want to be one of the ones that helps to "plug the intersection" and let people through, to usher in new debate and renewed enthusiasm for big, blue sky thinking. To make even the slightest headway there is to succeed!


It's challenging for me to work in all the concepts I would like. Each blog post, much like the multitude of trajectories our career paths might take, could evolve in many different ways. I want to pace myself with the next ten or so days and not grow weary of, or boring with, the blog. Additionally, I want to be realistic about the probability of my being slated. I want to structure my experience to inform the emerging generation of leaders. And as much as all of these, I want to be engaging to all of you and to hear your thoughts, challenges, and the strength of our collective voice!

Cheers for now,
Ben

Opportunities and Inquiry

Well, the process is starting to make a bit more sense, if not the role I am to play. I now understand that a Nominating Committee 1 (NC1) form is mailed by a person or persons, group or groups to the Nominating Committee recommending an individual for a particular office. In my case, the National Assembly, leaders of the PTAs within the association, recommended me. This is interesting, and I really hope I am not committing any faux pas here by blogging about this, because at times I have voiced the opinion that PTAs might best be served by forming an independent, though allied, association. In conversation, this has not always been an endearing argument. My best guess is that they see advantages to having a "non-traditional thinker" on the Nominating Committee(NomCom). I would like to think that is true too.
(A quick aside on the appropriateness or inappropriateness, as the case may be, of blogging about behind the scenes happenings. I'm for it. And hopefully that will not come back to haunt me. I realize that, at times, I toe the line between what should and should not appear on a publicly accessible forum. I always try to let professionalism and learning be my guide. If I cross the line and get burned, at least others will know where the line is. Wish me luck or recommend a good wound specialist.)
Right so, the NC1 form is received by the NomCom and an NC2 form is mailed to the individual. This second form ascertains "Consent to Serve" for the suggested position and all other nationally elected positions. Once returned, the NC2 form and support statements submitted with the NC1 form guides the NomCom as a whole to determine a slate of candidates for all positions to be elected in a given cycle. Of note, the NomCom is not under any obligation to slate you, at all or for the position to which you were directly nominated. Now, I haven't gotten that far yet but, once the NomCom has determined if/where to slate you, you must again consent to serve in that capacity. (I might have to come back and correct that though.)

For me, the whole process raises some interesting questions. In what national position would an NP best serve? We could bring new energy, new ideas, and willingness to be bold to the NomCom. But perhaps the national scope and "contact list" isn't there yet. If it's not, is that a strength or a weakness? NomCom is a committee and each membership benefits from the collaborative effort of the whole. That sounds good for an NP. Would the same thing not also be true of the Board of Directors though? What unique benefit would be instilled in a Board that included an NP? What would be the detriment?

These are all things on my mind and I would love to hear your thoughts! But for now, cheers and have a nice evening. More to come as the process continues...

ben

POPTS/RFP

Thank you Ben for keeping up with this and encouraging participation.

I wanted to touch on a subject that I think lies at the heart of the future of healthcare that possibly we as New Pro's can affect.

In NY there are a lot of mills. Many "PT clinics" that partake in poor ethics with a focus on profit. I know of clinics that pay patients to come in and then submit claims making money this way. The "treatments" (if they are even performed) tend to consist of heat, ice and maybe even massage. Bottom line is these patients are not going to get better. They drain the healthcare resources (money and possible quality clinicians) and patients who have actual pathology will deal with a condition that does not improve correctly because they most likely do not know any better. Long term these patients drain further resources when they need total joint replacements or spine surgeries, etc. It is a vicious cycle with the owners of these clinics having the last laugh. Sometimes they get caught, but is there more we can do?

At the recent National Student Conclave task panel on transitioning from Student to New Pro, where 20% of the GOXV was on the panel, Allen Eshmoili warned the students to avoid the tempting paycheck that may be offered with working in a mill. We certainly need to try to stop it at the source because they cannot run these clinics without a licensed PT. Furthermore, with the idea of branding our profession this is all a step backwards and the image we have to fight to get quality PT to the forefront.

In my experience reporting these clinics does very little becausehttp://www.blogger.com/img/blank.gif a large investigation has to be undertaken. It seems there is some monitorinhttp://www.blogger.com/img/blank.gifg of these clinics and it does take years before they are brought down. Here is an article from my state on how to report misconduct, your respective states likely has a similar process.

Also, be sure to check out the APTA's RFP center.


So I would like to hear what you all think CAN be done and if you have had experiences with these types of clinics.
--
Stay Healthy (personally and professionally :)

It's funny sometimes the way energy cycles around...

Hi Peeps,

Once again there was a longer pause between posts than I would like. Does anyone else find that having a smart phone pushes your visits to an actual, real computer further and further apart? That's been my observation and I definitely think it impacts the blog. Convenience can be a double edged sword at times.

I have some really big news but first the happy news to share is that I was re-elected GA Delegate. I was one of three NPs to be elected, the third being an alternate. Hurray NPs!!! Nearly inconceivable is the fact that by the time the 2011 House rolls around I will no longer be a New Professional. Five years go by quickly when you're trying to take over the world. And to be honest, I've had the thought on more than one occasion recently that I did not play my cards very well in those years. I guess it's human to second guess the course of one's actions. But with the dual disappointments of thinking I had a shot at PTAG President and later thinking that I would be asked to serve as Georgia's Chief Delegate, perhaps the youngest PT in either role, my APTA energy was pretty low. It's not that I begrudge anyone their reasons for withdrawing their support or changing their plan. I choose the word 'disappointed', well, pointedly.

Through a combination of my own experiences, both good (the Physical Therapy and Society Summit, presenting at a CDC symposium on Heart Disease and Stroke Prevention, and being at the House of Delegates with "junior" Chief responsibilities) and bad (discovering my own ineptitude in the Georgia Membership Secretary role, struggling with acceptance of the idea of a Preventative Health specialty at the APTA and University level, and crashing and burning on a post-PASS website initiative), I had begun to question how truly ready our organization was to bring my generation of young leaders out onto the stage. Which is why a recent email caught me completely off guard...

Someone has nominated me for the APTA Nominating Committee. That's a huge honor. I'm not sure where the process will go. I imagine it would take a seriously progressive Nom Com to allow me to be slated. Back when I was a new NP, my plan was to have a certain other NP run for APTA Board of Directors in his first five years. Unfortunately, he went and messed it up by becoming staff. Punk. I never saw myself as the one to try to break through that barrier. I'll have to let everyone know what develops. My thought is, "Why not have a run at it?". If nothing else, what better way to learn about the process and test my 'true readiness' theory, right? I'll definitely be looking for feedback and support from all of you. Let's see if a New Professional can shake up the election process!

Be excellent to each other and cheers,

Ben

Rekindling

To say the least, I've skipped a chapter or two of my 'new job' story. Things are going well and the environment offers a lot of opportunities that I didn't have previously. But as with all busy times, refocusing is a necessity and I've looked forward to turning my attentions back to this project. In the beginning, this blog was an opportunity to espouse my thoughts, spell out some arguments for or against issues facing healthcare and physical therapy, and especially, to give a voice to new professionals looking for their place within a changing health paradigm. I continue to wish my efforts to bring in other opinions had met with greater success. But, the blog continues and things of great interest are on the horizon.

I head later this morning to the Georgia Fall Physical Therapy conference. With programing and meetings today, I hope to make enough of an impression on members to be re-elected as a Georgia Delegate tomorrow. It's very exciting (and intimidating) to see the slate I'm running against. A CEO, a past PTAG president, two past vice-presidents, a nationally experienced PT advocate, an out of state past-delegate, and 3 recently graduated, enthusiastic rock stars. I suppose it becomes a conceit of being a "not so new" New Professional, new faces are good for 'us' but perhaps not for 'me'... It is going to be a tough re-election. It's great to know PTAG has so many great people pursuing the role though. Without a doubt, the association will be in good hands next year. But now I suppose I should go clean myself up a bit and polish my networking skills!

More blogging to come soon! Of particular interest, Emory is putting together an event in March which sets out to shape the future of practice. It will synergize themes from the Physical Therapy and Society Summit and the Vitalizing Practice through Research Conference in a progressive, focused environment. I have the good fortune of being a panelist for the event and will have much to report!

Cheers,

Ben

Accelerando and Decrescendo

As I type from a coffee shop next to the Berklee School of Music, I can't help but inflict a musical theme or two. So for the non-music buffs, that's an increase in tempo with a decrease in volume. I think it's an apt description of the end of the House. Things began to move very, very quickly but then many of the "hot topic" motions were withdrawn prior to a vote. In fact, the House ended hours earlier than expected. Contrast that to last year when there was speed reading and a frenetic pace up to the last minute. But for now I'll move to the coda and share my thoughts.

While the House process always leaves behind some frustrations and lingering questions, there was at least one common theme that I found encouraging... mostly. There were two groups seeking to "find their voice". One was the PTAs as they continue to push for greater voting rights within the States. And the second was New Professionals. To me, "voice" was the central theme of essentially every bylaw amendment before the House. While it was more explicit in the PTA initiative, the 'block' of bylaws addressing APTA executive leadership related, both directly and rhetorically, to New Professionals.

If you weren't there, I'll spare you a description of the 150+ possible combinations of new rules the APTA almost had. I say almost, because none of them went to a vote and thus, nothing changed. Three different states brought forth initiatives to facilitate more rapid turnover of APTA leadership. Again, I'm oversimplifying to spare you the minutiae. Discussion went on but the entire issue (transcripts attached) was punted to the Governance Review Task Force, a group which probably didn't expect to take center stage in House activities this year. Best of luck to them as they try not to step on any toes now...

Good things that came from this year's House: APTA will be guiding us to better address the obesity epidemic. (Even if it's peds alone, we have to start somewhere.) APTA is more explicitly saying that torture is bad. (Despite it being inherent in our Code of Ethics, if our governing body wants it spelled out, so be it.) Extender language was discretely withdrawn. (I applaud the Private Practice folks for rousing a little rabble in the process.) And my personal favorite, the APTA is going to try to do a bit more of the "League Building" which I'm such a big fan of with other primary care provider organizations. (And I would like to politely take a little credit for that "other" being in there.)

Cheers to all!

Ben


ps~ Wish me luck being a mentor tonight at the Student Assembly mixer! And please, please, PLEASE, share with me what you all want this blog to be about!!! Coming soon: Passing the OCS, prepping for the NCS, Why lobbying is more effective if you're under 30, and a New Professional asking why we aren't on the APTA board yet! New Energy, new authors, and your topics!! (if you just email me them)

House Update

For those that are Twitter savvy (though, I'm only pretending to be), I'll be giving updates with the hashtag #hod2010.

~ben

Thoughts from Day 2

My biggest take away from today is that this year's House Motions justify the governance review process. What I mean by that is that we need to change the way we do business because we're doing the wrong business. It's not necessarily that I disagree with our process. I just think the resource allocation (human capital and financial) could be better allocated. For instance, this year there are a number of bylaw amendments being proposed because "It's a bylaws year." when in fact bylaws can be, albeit more difficulty, heard in any year with the right amount of support and prior warning. That may be a bit jargony but the point is that we're running on tradition over reason. I hope this theme won't persist. Instead of waiting to see what an appointed group recommends changing, we are debating, at great length, what changes should be made...

In other news though, a good group of New Professionals and current student leaders socialized, mentored, and networked over several tall, tasty pints at Pour House. Wish you all could have been there! More to come tomorrow.

Cheers and Good night,
Ben

Early thoughts on this year's House

My biggest take away from today is that this year's House Motions justify the governance review process. What I mean by that is that we need to change the way we do business because we're doing the wrong business. It's not necessarily that I disagree with our process. I just think the resource allocation (human capital and financial) could be better allocated. For instance, this year there are a number of bylaw amendments being proposed because "It's a bylaws year." when in fact bylaws can be, albeit more difficulty, heard in any year with the right amount of support and prior warning. That may be a bit jargony but the point is that we're running on tradition over reason. I hope this theme won't persist. Instead.of waiting to see what an appointed group recommends changing, we are debating, at great length, what changes should be made...

In other news though, a good group of New Professionals and current student leaders socialized, mentored, and networked over several tall, tasty pints at Pour House. Wish you all could have been there! More to come tomorrow.

Cheers and Good night,
Ben

Boston, Boston

Well, I'm unemployed and on my way to Boston.  I suppose, actually, I have a job waiting for me next Monday, but it still feels like limbo. The blog has been down for I while, but I'm hoping for a nice little spike in activity for the House of Delegates(APTA's governing body). 

There are a couple nice things on tap for New Professionals at this year's House.  Among other things, Laura Doskocil and I are trying to pull together all of the NP delegates for a caucus.  In the past, and this isn't a criticism, new delegates were primarily exposed to members of their own delegation, those sitting nearby, and perhaps a regional caucus.  This will be the first time a group of us convenes based on the New Professional demographic.  I am very curious to see how the opinions of this small group defer from those of the group at large, or if they do for that matter. 

I am also going to try gprs tweetcast from the House.  I've never done that before, so we'll see how it goes.  The two big issues worth bringing up in advance are a) should PTAs have full voting rights in each state chapter? and b) how should APTA term limits change to improve participation in leadership?  I've been accused of over simplifying the issues.  But, sometimes I find that help in order to see how people develop support or opposition for the underlying concept.  That, or I just over simplify... 


    Cheers and more to come (hopefully note from my phone in the airport),  Ben

I have moved (well, at least vocally)

Considering the name and intent of this blog, I apologize for there not being much online action of late. I'm glad to have the readership and participation that we have and I'm always hoping to build on it. Surely you guys come back hoping for someone else's rants than my own!

Right, so, on that note, I have officially resigned for my first time ever. Hopefully this goes some distance in explaining the last month of downtime for the blog. Loan debt being what it is, I couldn't really risk being let go to far ahead of schedule. I listened to a lot of advice about what is too much or too little notice and opted for 5 weeks. I "tenured my resignation" on Monday, provided a formal letter on Tuesday, and started telling coworkers today. I have only 21 more work days with my first professional employer. The following week will see PT nerdiness and shenanigans in Boston and then it's on to Job #2. I will be the float PT (full time) between teams that specializes in Brain Injury (Stroke and Traumatic).

I am definitely excited about that but I'll save my best case scenarios for another blog. A few thoughts on resigning. One, everyone tells you something different about "appropriate notice". Two, even if you don't intend to turn in "the letter" on the day you give verbal notice, it helps to have it written. Three, your employer will ask where you are going. Four, they will not like your answer (but will tell you what they wish you were doing instead). Five, at least one coworker will always claim they 'saw it coming.' And six, you will end up feeling like you should have told more people at once to avoid repetition and gossip.

What have you all notice about resigning? How much notice did you give? Any horror stories?


yours,
Ben

Money vs. minutes, the trade off for NPs

What's more important: higher pay or reasonable hours?

Given that many of us have a crazy amount of loan debt, I'm curious where the scale tips. Certainly everyone is different, but what's the spread? I have a relatively low cost of living in Atlanta. I would be happy to work fewer hours for proportionally less money. But other people may be trying to eliminate their debt more quickly or may be placing a higher premium on having more time later in their careers. What's the ideal take home for an NP after paying bills and loans each month? 1k, 2k, 5k (in my dreams)... Okay, okay, too many questions. I would love to get some discussion going though!

Cheers, ben

Dealing with Different

Some times you get the best case scenario and some times you get reality. Right now I have reality. But for a brief moment things were looking well above my expectations.

Within the last week I was offered a job at a higher salary than I expected, with the expectation that I mentor new professionals, and with a choice of which team to be on. And, not incidentally, I thought I stood a real chance of being the next President of the Physical Therapy Association of Georgia (and therefore the youngest component president in APTA history). And then there was reality...

I won't say my opportunities have disappeared but the framing has changed...

My follow up questions to the job offer (sign on bonus for starting early, more time off for professional endeavors, rate of time off accrual, etc.) all came back with negative answers. Then I met with my mentor, the one that at CSM suggested enthusiastically that I run for president. He was less than enthusiastic. He was equivocal. And perhaps he was so for good reason, but, Dah!

My confidence in my ability to win the election has faltered. My desire to try anyway has not.

Life and my plans for the next few years seem less rosy. Admittedly, some of that is just the letting of wind out of my sails. This situation makes me wonder how close other NPs have come to making big career changing decisions and then either gone for it, consequences be damned, or backed off and acquiesced quietly.

I think it's time for a change and I'm not prone to run for challenges. It would just be nice to feel that a) a company is willing to bend rules to bring me on board, and b) that I had a strong advocate in my corner for running for a milestone position for an NP to achieve.

More on that come. And certainly, a blog on my nonexistent negotiation skills will follow.

Cheers,
Ben

How quickly things can change

Since returning from Belize, things have happened rapidly! To get to the crux of it, I have interviewed for a job and been offered a position. I am now having the "should I stay or should I go" theme play out with a very real set of consequences. I could leave my "comfy" 40 hour a week job which is... not 100% fulfilling. Or, I could take a salaried job that involves many more hours but also much more stimulation. (And they have better toys.) The initial offer was better than I expected salary-wise but there is little promise of adequate professional time for leadership activities outside of the facility... Salary is not my motivator. Time is.

So I asked a series of questions, and it's a good thing I did. Essentially every question I asked came back with a negative response. Literally, I had a written out best-case-scenario and not a single condition was met. That being said, the opportunity is so good that I'm not eager to jeopardize it with my shoddy negotiation skills. Although a blog on how not to negotiate could be highly entertaining, for everyone but me. ... ... nah, not worth it.

More to come on the negotiations and why I might need more professional time tomorrow night!

Cheers,

Ben

The cure for all New Professional ills... Belize

Hello all,

As the title would suggest, the blog has hit a lull because I have been taking some much needed R&R, three nights to be specific. It would have been longer, if only NPs accumulated PTO a little faster or did not have to use it quickly on things like conferences, job interviews, and hangovers...

Joking aside, I do not want to turn this into a travel blog. That is what my nonproductive blog is for. But I will say that meeting people with incredibly different lifestyles, cultures, and perspectives can do wonders for your resolve and productivity. It turns out to be a funny contrast between making me want to run from responsibility (most notably to tropical destinations) and reminding me how passionate I am about my reasons for putting my nose to the grindstone. I cannot say that the appeal of 6 months or a year of travel did not hit me hard, but I really do see the importance of working for change within our profession and culture more clearly.

So if you want to read some travel ramblings, read from the link above. And if you're waiting for the next NP blog, keep waiting. It should happen soon and be about a concept on the horizon within the House of Delegate to promote NP involvement in APTA leadership on a non-voting level... I hope enumerate the reasons I believe this to be a horrible idea.

Cheers, or perhaps Kampai, Ben

A challenging situation and a dangerous subject matter

I imagine some of the other NPs out there have more experience on this one than I do. I've been with the same employer for going on 4 years, ever since I graduated. So now I'm weighing my options and considering moving to a different company. How on earth do you discretely have conversations with your potential "next" employer when you're at work 8:30-5? I have a 30 minute lunch break, a student, and about zero privacy. Don't get me started on my utter lack of paid time off, in the event I actually make it to the interview stage. Does one call in sick? Schedule a day off without explanation? Lie? I have a knee-jerk, honesty response which could get me in trouble soon. Not to mention there are all sorts of inadvisable things about writing this type of blog in the first place.

I see the risks of putting this information out on the interwebs. I'm banking on the benefits outweighing those risks. But in fact, I'm happy to report it's getting a bit more treacherous! The Move It Blog is up to 75 visitors and counting. It's even getting some attention from APTA staff, and no, not just my ex-roommate ;o)

My philosophy is that we are in an age where there is no sense in not having a commonality of resources and shared experiences. I love being a PT, especially a neuro-PT! I take the opportunities before me for advancing my clinical expertise and trying to foster leadership cred, but that isn't always enough. As New Professionals, we have unique stressors. I would like to think that this blog will eventually give voice (and not just my own) to remedies for, or at least ways to handle, that kind of stress.

Something that would help me would be a periodically updated list of PT negotiation skills and advice for job hunting in a depressed economy. Any know any? ... Bueller?

Back to the resumé ~ ben

A Blog on Beginnings

So, I believe a simultaneous advantage and disadvantage of being an NP is the concept of a fresh start. Perhaps it's a byproduct of being a "not burnt out" PT. We are in a field with huge opportunities. The strength of our position is that each new thought, each emerging initiative is an invitation to recreate our careers. For me, PT nerd that I am, that's an exciting idea. I think I may be coming to the realization, though, that that ability to change paths might also be a contributor to physical therapy burn out.

We have these opportunities, we're exposed to these new ideas and we either incorporate some parts, ignore it all, or, potentially, change everything... So on some level, our choices become a) become insular, b) become flippant, or c) add something to an ever-shrinking plate. oy!~

So because this blog, admittedly, has become self-centered, what are my beginnings? What is out there to to be ignored, incorporated, or added? Clearly, the supervisor position I've talked about in the past is not working out. (Hurray! for a door closed :o) To begin or not begin: Last night I hosted/moderated a panel discussion on 'what's wrong with rehab..." The title was obviously a bit different but the objective was clear: Talk about the problems-> discuss what should be done. The panelists, all at once stimulating, challenging, and intimidating, spoke clearly on 3 themes:

Theme 1) The way we validate what we do, does not validate what we do.
Theme 2) The lack of validation, however unintentional, is jeopardizing everything we stand for, e.g. improvements in health, clinical consistency, and, well, beneficence (the idea we are good--in fact better--than substitutes).
Theme 3) Advocacy is our shot at redemption. And I chose the word redemption carefully. We went wrong. As a profession, yes, but within a flawed industry, emphatically yes, we went wrong. To not protest is to consent by acquiescence. The fight was never downhill, or really even level, but the longer the status quo holds, the steeper our path to correcting the wrongs.

The beginning I now face, once again, is the question of how to address a demonstrated need for change. I would like to build a resource center for patients and professionals who are not satisfied with the status quo. I want to empower people to identify the flaws, articulate the arguments, and champion the cause of process improvement in health care/rehabilitation. How do we tackle the huge problems as New Professionals? I know it's wrong to wait on others to take action! It's just so hard to take a breath and make the leap when we have soooooo many possible roads to travel.

I would like to end with a fantastic quote from Mark Twain that I worked into the panel: "All large political doctrines are rich in difficult problems -- problems that are quite above the average citizen's reach. And that is not strange, since they are also above the reach of the ablest minds in the country; after all the fuss and all the talk, not one of those doctrines has been conclusively proven to be the right one and the best."

word. Ben

Catching up on catching up

I would be remiss to let a full week go by after CSM without a follow up blog! The event itself was a whirlwind with lots of learning, networking, and a great deal of fun. True to NP form, we rush to prep for it, we cram in as much as humanly possible, and then we drag ourselves through the following week. Basically, in spite of that pesky fatigue business, it's as fast-paced, stimulating, and PT-geeky as a week can be. I had a blast. The following 5 work days, though, oye! Stress almost seems more intense until the next 'real' break. I needed to catch up on sleep and read a distracting book just to reset my brain. I'm afraid I don't have much else to contribute tonight. I am prepping for a panel discussion taking place on Wednesday. More on that after the event, "Is Our Dynamically Changing Health Care Environment Jeopardizing Successful Rehabilitation Outcomes?". Yours truly will be serving as moderator. Good times...

Cheers,
Ben

An expert profession versus a profession of experts

One of the themes from the NCS prep course was that expert clinicians run towards difficult patients not away. Embracing challenge was touted as a sign of excellence. Over the next few days that theme jumped out in a number of other talks. Interestingly, some of the parallels were not actually linked to clinical skills. Specifically, I attended Incubating Innovation which was about coming up with new ways of solving problems, thinking laterally, and overcoming barriers. The thought occurred to me that in some ways we are our own barrier. Specialization in physical therapy is coming and it’s a wonderful thing! But the challenge we face as a profession is to specialize ‘smarter’ than the MDs.

This means two things to me:
1) We should strive to address emergent, growing health issues by “cutting them off at the pass” (i.e. obesity, diabetes, sedentary lifestyle).
And 2) We should focus our expertise around symptom complexes and the skills necessary to address a given constellation of impairments (i.e. bariatrics, metabolic syndrome, community-centered, activity-based wellness).

Our current system, through the APTA/ABPTS, is superb at imparting knowledge but is far from svelte. Where is our Prevention specialty? How about Obesity? Metabolic syndrome? These demographics are where we, as a profession, should be running! PTs should own obesity. We should champion prevention!

Perhaps I’m naïve. Perhaps the profession would go bankrupt because no one is paying us to move in that direction yet. But I am willing to bet that our market share, public image, and evolving skill set would be larger, better, and more relevant if we take ourselves there, instead of being led.


We are the movement experts. We should tackle the hardest, most prevalent movement disorders within our scope of practice. Here’s the exciting thing, everyone moves. And movement, framed as exercise or not, changes gene expression and brain structure. We have the capacity help these people change who they are, mentally and physically, for the better, just by doing what we love to do. Our depth of knowledge puts us in a position to have a significantly impact societal needs, if we rise to proactively meet the challenge.

Welcome to Move It

Just wanted to thank everyone that has expressed interest in the blog here at CSM. I'm happy to have some more readers. And I am also looking forward to seeing how this initative evolves with more feedback and suggestions. While it has become an avenue for me to express personal ideas and stories, I really hope that this will be a step towards an established, collaborative community of New Professionals.

Cheers, Ben

ps~ Topics on the horizon include Technology and Vision 2020, Disrupting the Status Quo, what students should be learning from NPs, and what an NP organization would look like. Please add to the list or become a contributor to the blog yourself!

Intuition shmentuition

I must say that I thoroughly enjoyed my first ever pre-conference course! While it admittedly had a lull here and there, so does my attention span on warm sunny days. I will, briefly, take issue with one assertion from the course. A differentiation was made between "Intuitive" vs "Systematic" decision making. I just want to say that I do not believe in intuitive decisions. (Please argue with me if you disagree.) I believe that all decisions that we make are systematic. We may not have the words, or perhaps the evidence, to support that decision, but in the end, a decision, any decision, is a hypothesis. It is a guess based on something. A gut feeling (the intuitive's cliche) is more than nothing. Perhaps our language has not yet evolved to explain the decision making process, but somewhere, on some level, data is being analyzed and a hypothesis is being tested. Our goal as a profession, for the good of our clients, is to make these hypotheses progressively more standardized. That standardization was the strength of the NCS prep course and I think has important implications for all aspect of practice!

Well, for someone 3 hours 'ahead' of East Coast time, this is the best I can do for one night. I hope anyone coming across Move It for the first time after CSM will find something relevant to themselves. Please comment, contribute, or, by all means, heckle.

Cheers,
Ben

Mid-air musings

As I write this, I’m somewhere between here and there. On my way to San Diego and also trying to figuring out what it takes to be an expert clinician. The reason for my early departure from Atlanta is a preconference course, Neurologic Practice Essentials: Clinical Decision Making as a Foundation for Expert Practice. As a NP I've practiced in a Geriatric Hospital as an LTAC and outpatient PT and in an Acute Rehabilitation Hospital as a PT on the general rehab floor. The NCS seems like my best choice for advanced certification, should I go for it. It also, of course, matches my obsession with neuroplasticity (seriously, read that book).

So with the goal of adding 3 letters behind my name, and with a year and change left on the NP shot clock, I am rolling the dice on a career focus. While I’m a little behind some of my peers and while I won’t be able to sit for the exam until after I lose my New Professional status, it feels like the right move. The whole process seems like a huge undertaking both from a financial and from a time management standpoint. Nonetheless, getting certified seems like one of the best ways to maximize your clinical skills during the initial stages of our practice. I’m hoping to get a contributor or two to blog on their experience with the Board Certification process from an NP perspective in the near future (ahem, KATE).

I finished an article on the flight about characteristics of expert practice amongst role-model PTs. It makes me wonder what the parallels would be between those individuals and, for instance, NPs that pursue residencies and early (relatively speaking) board certification. Are we “future experts” with pre-existing, similar philosophies or does the philosophy develop concomitantly with the expertise? Maybe this course will let me know.

I’m curious what the makeup of the course will be. I hope to see some other NP faces in the crowd. This type of course really captures an aspect of the “Move It” mentality that I would like to develop within our cohort. One day I hope there will be a clear post-academic track for new professionals seeking involvement, opportunity, and excellence.

Cheers and much more to come as the week goes on!

Ben

CSM excitement and a nice idea from Bo

Hello all,

For a little while this morning I am blogging instead of packing. I have about 10 hours before my flight to San Diego, good times!!! I just wanted to share an idea and a website with all of you. Change.org which I just learned about from Bo's blog has a very interesting initiative going on. Anyone can submit an idea for positive change within our society. The top 10 most popular ideas will then be presented in Washington to members of the Obama administration. You can go and read my suggestion or vote for it over on the right. Feel free to let me know what you think. And definitely make your own suggestions! This is the kind of participatory governance that democracy is founded on! Finally our technology is catching up to the scale of our population.

Cheers and much more to come in the next few days~ Ben

Sweet, sweet (frustrating) simplicity

So, seemingly HR thought better of approving my qualifications. I received today what appeared to be the negative counterpart to their original communication. Rather than confirming that I met the minimum job requirements, this one disputed that prior assertion. No explanation, no personalization, just a recantation. Go figure. I will chalk it up to a second read through by a less open-minded reviewer. (That, or they are one of the dozen or so people to read my blog in the last few weeks.)

Well, It never hurts to take a long shot, well, maybe a little. :o) I'll be prepping for CSM in the next 7 days and hope to post some new hopes before my departure.

Cheers and let me know if anyone has had a similar experience!

Ben

The Waiting game and Valuating our time

A friend of mine recently found out a coworker's salary is nearly 100% more than their own. Should we feel worth 50% less? Do we contribute 50% less, bring in half as much business? How far does salary.com go when we are asking questions like these? We all feel we have special traits that make us particularly marketable. We think we know where we should fall within that bell curve. But how do we decide how much to ask for our time? I think this is a frequent question for New Professionals and it's certainly not an easy one. Nor can we be sure that we all gravitate to the appropriately deserved income. Some of us are just better at haggling, negotiating, and schmoozing than others.

Here's what I think. As new professionals we are inherently undervalued. But my reasons for thinking this are a little nontraditional. I don't think we're doing the right jobs. Generally an NP's talent in patient care is developing but we have other immediately helpful, untapped skills. We are coming through a period where critical analysis, studying, and technological resource savvy are paramount. I think that those skills could often be put to use early in employment in meaningful ways across a variety of practice settings. What if we respected those skills enough to allow NPs some time to collaborate on and potentially initiate programmatic change? New grads could be seen as consultants and fresh eyes. To me, that's powerful.

The situation reminds me of politics. The status quo is such that by the time an individual is in a position to enact change, they are so thoroughly vested in the traditional way of working that the risks are too great to rock the boat. Clayton Christensen has talked a lot about this phenomenon as it relates to business and later health care. When someone else is committed to cyclic, ongoing innovation, those less willing to be disrupted always lose in the end.

I would like to think NPs could and should be that injection of creative thinking and of unbiased appraisal without predilection. But perhaps this whole blog is all shallowly subconscious supposition about my worthiness for the Rehab Supervisor position. Regardless, I think valuation of our time and expertise should extend beyond current clinical contributions and incorporate the capacity we have for disruptive innovation. I would like to see what more NPs rocking boats would do to our health care climate, PT and non-PT alike.

To finish, I would like to share an anecdote, courtesy of my mother, about our demographic's potential contribution to society if we were valued a little more highly. During a discussion about stimulus packages a few months ago, my mother made the clearly brilliant suggestion that forgiving graduate student loan debt would be an exceedingly effective way of boosting the economy. This is why my mother might have made a better Senator than Social Worker. She observed that people in their late twenties are usually in the process of accumulating 'stuff' and are often constrained in their purchases by lingering loan debt. I couldn't agree with her more. I, for one, would take many more trips across the country and purchase more goods and services if I weren't climbing out of a giant pit of Emory loans. I'll keep you posted if she decides to come out of retirement and run for office.

Cheers,
ben

New Hotness and furthered possibilities

It has been a technophiliac week for this NP. I type this blog from my living room on a brand new Netbook I picked up today. I'm hoping that having something new, faster, and even more portable will increase the regularity of my blogs. That being said, it was not the only improvement, advancement, or discovery of the week.

I have added Google Analytics to my repertoire of things I possess pseudo-knowledge of. That's right. I now officially know the readership of this blog: approximately one viewer every 10 days.

I remain undeterred. If anything, at least I know now that it is highly unlikely any of my coworkers are reading. (The viewer was in Alaska... or crafty like a fox.)

On the subject of people around the office, and given the perceived unlikeliness of any cats escaping, I will happily announce that I have made it through the first phase of pursuing the level 4 position where I work. No, no, not the "Resume updating for the first time since my first job after grad school" phase (though that merits a blog in and of itself), nor the "Cover letter circulation amongst your brainiest friends" phase either, this was much bigger.

The job description indicated that a minimum of 5 years work experience with at least 2 in supervisory/management capacities were required. [Note: Depending on how you frame that, I could have neither.] Well, and here is a testament to what working with the Student Assembly will get you, I made it through! They stated in an email that I met the minimum requirements! At least now, if I do not get the position, it will be someone that has actually met me making the decision and not someone rejecting a paper likeness. I would not be applying for the position if I didn't think I could do the job. But, somehow the fear of rejection is worse for me when it is based exclusively on selectively documented qualification.

On some level I just feel awkward and uncomfortable putting achievements down on paper. Is anyone else in our group like that? And beyond being awkward, it is downright hard to decide: what goes where, what to keep in from college, what to leave out from social'ish endeavors, who's format to use, complete or incomplete sentences, punctuation, bullets, and on, and on, ad nauseum. I worried that my voice was not the one on the page by the time it was tweaked hither, tither, up, down, and sideways.

Well, I hope it was not not my voice that got me this far.

Cheers and wish me luck! I will try to flesh out a little more of my thought process on the decision to pursue the supervisor position over one of the other endeavors when I have a little more time. The tiny little keyboard is getting to me tonight ;o)

Ben

A Blog, a #2 pencil, and Musings from a barstool

Or, my options runneth over...

As if, at last blogging, my choice were not convoluted and difficult enough, the plot has thickened. My supervisor has resigned effective mid-February. This creates two additional potential options: 1) vault, inconceivably, from level 2 PT to level 4 inpatient PT manager, or, more realistically, advocate for one of the level 3 PTs to get the level 4 spot for semi-self-interested reasons. Both options keep me "in the system", which I am presently, enthusiastically opposed to. But arguably, I'd be insane not to pursue the 4 position. At 28, from an outsider's perspective, to not show the initiative in applying/interviewing would be a bigger hit to my "in system" career than flat out leaving for a better opportunity.

Speaking of which... there are more.

But first, in a world of real problems, in which global attention is rightly centered on the decimation in Haiti, this blog must read as the trifles of a spoiled brat. When forced to step back and contextualize my "difficulties", life is gloriously good, idyllic in fact. My pitfall, I suspect shared by others feeling the need to Move It, is micro-focal worries. One day I will learn to make decisions in the macro-mindset... maybe when I grow up, that is.

But yes, on to more. A peer suggested business opportunities on the horizon in a technology related PT field. "Dynamic" and "Innovative" were also thrown about just to press all of my nerdy, over exuberant buttons. Add to that a friend of a friend heading up some part of the Health initiative at Google and my imagination is a whirl.
So what does this all mean to my largely inchoate plan? No going down to 32 hours! That's probably not a move they would look for in an aspiring manger... or could it be a brilliant piece of strategy. Promote me or lose me.!?... In another system perhaps that would/could be understood by the powers that be. Here I fear it would be missed. Unsurprisingly, I'll leave the hours drop on the table, surely no one would expect me to narrow my options, right?
An aside, I discovered today that I made less money in '09 than in '08. 'Huh?', you say? 'Huh?', I echo. Within a small company, in a slow economy, that's plausible. "In system", I feel duped. To reiterate, spoiled brat = me.
So where, in all of this, does decision theory come about? How do you compare disparate options on an ordinal scale? Therein lies a problem. New Professionals don't compare options, we compare hypothetical, parallel futures. If that's not treacherous, I'm not sure what is. Why are we better at weaving baskets than divvying up eggs? (Weaving, which I am clearly better at than coming up with analogies.)


While that seems a reasonable stopping point for a blog, I'll attempt to implement the Hemingway'ian method of 'stop while you are writing'. That seems counterintuitive in the age of blogs. We stop at a sound bite; we stop with a theme. Reward, not provocation, is the endpoint. Is that an evolution of prose or a byproduct of our shrinking attention spans? If I answer that question, do I perpetuate the cycle? In all fairness, I should concede that, also Hemingway'esque, I couldn't stop quite yet because I was not finished with my drink and didn't want to leave my spot at the bar.

Cheers,
Ben