Physical Therapy Haven

As we say goodbye to 2014, we reflect on the changes and uncertainties that seem to have become the norm in medicine. 2014 marked the first year that we saw the full impact of the implementation of the Affordable Care Act. If initial indicators are a predictor of the direction we are heading, the outlook for providers in most settings appears to point towards increased patient loads, paperwork and objective data gathering to demonstrate necessity of service – all while reimbursements continue to decline.

Historically, our profession has been successful at riding the crests and lulls of health care waves, but this current tsunami is a phenomenon unlike anything we have experienced in modern medicine in the states and 2015 will be a pivotal year that defines PT’s role. The wave is on the horizon and the coming months present us with two options: put on our life preservers (hoping to survive) or we can grab our surf boards and lead others as we aggressively paddle head first to the crest!  It’s a chance to stand high on top and lead others through these uncharted waters while enjoying the thrill of the ride - not just surviving, but thriving!

Change begins with self-assessment and the humility to identify weakness. In preparation to write the book Built to Last, Jim Collins and Jerry I. Porras took eighteen exceptional, long-lasting companies, studying each in direct comparison to its top competitors. They examined the companies from their very beginnings to the present day -- as start-ups, as midsize companies, and as large corporations. Throughout the process the authors asked these simple questions, ones that we should use to facilitate our own change:

1. What makes the truly exceptional companies different from the comparison

companies?

2. What were the common practices these enduringly great companies followed

throughout their history?"

2. Innovate

“{Great companies} talk about strategy, performance, becoming the best and about winning. But they never talk in reactionary terms and never defined their strategies principally in response to what they were doing. They talked in terms of what they were trying to create and how they were trying to improve relative to an absolute standard of excellence. “We can be delighted, but never satisfied.” -Good to Great

We can no longer afford to sit idly by and wait for change to benefit us. We must begin to use the principles of supply and demand to reach our patients - innovative business and clinical models that put the patient and treatment quality first, but provide profit for the undervalued services we provide. The December/January issue of PT in Motion includes a detailed feature titled Pioneering PTs, spotlighting practitioners across the country that are embracing the entrepreneurial and creative spirit, while leading us through unchartered waters; “..these creative niches and focused care models are not just about competition. They often are about changing the rules of the game.”  The innovative, cost-saving, quality based models that are being developed in the private sector will naturally, over time, become utilized by other settings, reducing cost and improving outcomes. You see, it’s the challenges like the ones our health system is currently facing that create a market for innovation and healthy competition.  Physical Therapy is perfectly positioned to spearhead that campaign.  We just have to take calculated risks and be brave enough to dive into the water.  

3. Build to Last

As a profession, we know who we are and what we offer, but in order to progress we must begin to learn to sell our unique skills and awesome product (function) to the public and other professionals! (Click here for an excellent article recently written by Dr. Jessica B. Schwartz PT, DPT, CSCS detailing this paradigm shift). Jim Collins details the 4 pillars that the exceptional organizations demonstrate that allows them to be exceptionally long-lasting.

1. Clock building, Not time telling.

2. Understand the genius of AND. Figure how you can have Purpose AND Profit/Reimbursement - not A or B.

3. Core Ideology: Instill Core Values and fundamental values beyond money.

4. Preserve the Core & Stimulate Progress.

I would rank our professional model at 1½ out of 4 stars based on the four Built to Last pillars. Thanks to a well defined APTA Vision we are generally well versed and united in preserving our core ideology and purpose.  Innovative practice models must remain true to our Core, but do a better job of satisfying the other necessary traits of a sustainable, thriving service that Jim outlined through his research.

4. Supply and Demand

Dr. Ben Fung, PT, DPT recently wrote an excellent article highlighting our professions’ current business mindset. (I highly recommend reading this article as he details the source of our struggle and potentials for growth through innovation, professional representation and outreach from a business perspective).  In it he states that, “it is as if we have 2015 capabilities but are operating out of 1995 mentalities; we need to get beyond this barrier and into a place where we can utilize our skills to the max, bringing all the benefits we offer accessible to the public.” I agree that the most valuable role for PTs in the outpatient setting will be as primary care providers and managers for musculoskeletal (and neurological) conditions. We all have a good understanding of our skills as entry level and seasoned PTs and we know that the evidence supports our expertise with the musculoskeletal system, yet current DPT curriculum barely, if ever, touches on promoting the profession and selling our services to the public. I find this to be a huge disservice to our patients, community and other medical providers. Every time we fail to capitalize on (or create) an opportunity to promote ourselves by demonstrating our skills and expertise, we immediately lose an individual who would have directly or indirectly benefited from our services - who, in turn, would have recommended our product to friends and family. Our service is of excellent quality and our product literally transforms people’s lives - It’s time we let everyone know it!

5. Finance the Future

The framework of our professional identity is built in PT school since people generally stick to the principles and patterns that they were taught. As I mentioned, the weakest link in DPT education is the complete lack of any business education. Equipping students with business and financial skills would benefit our future directly for three compounding reasons. 1) Student loans make us feel a slave to debt and our job, often resulting in burnout early in the working world. 2) Business/finance knowledge will improve our leverage when dealing with the public, employees/employers, competitors, insurance companies and promote increased involvement in health policy. 3) Entrepreneurial PTs will be fueled and empowered to challenge the status quo fresh out of school. As someone who has had an itch for understanding and studying business and finances since graduating from PT school in 2011, I can attest to how time consuming it can be simply developing a basic understanding. Under the weight of student debt and an increasing workload it is easy to understand why many PTs never get involved in the APTA, promote the profession, or get involved in research. Quite frankly, it’s easy to see why professionals experience burnout. They never feel in control of their situation. We must lay the foundation for business and financial success in DPT school.  

6. Between Goals and Achievement...

On the patient care side of things in 2015 we will learn to grow individually and progress collectively. The principles of goal setting and plan of care discussions that we have with our patients can often be flipped and applied directly to us as the clinician.  If we are to progress from a reactive to a proactive profession and mature into a leader of healthcare innovation then we must be disciplined, self-directed students while consistently implementing the three pillars of evidence based practice. EBP is defined by Sackett as integrating individual clinical expertise with the best available external clinical evidence from systematic research. While evidence and research are necessary and important, they mean nothing without expert clinicians who understand how to seamlessly integrate the latest findings into clinical practice.  He goes on to state that “Without clinical expertise, practice risks becoming tyrannized by external evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient….”.  

In today’s climate it is necessary for new professionals find a trusted mentor (see my recent article on PT Residency) and engross themselves in full-time patient care/problem solving for no less than two years after graduation. The temptation of initially moving quickly up the management ranks is strong, especially given student loans and 6-8 years of having minimal income. But, a career is an investment toward your future - and your future is an investment towards our profession. The lessons learned early on will be the keystones that the rest of your career will be built upon. Take the difficult caseload and don’t be afraid to fail, push yourself and with the guidance of a mentor - grow! It’s very difficult to reform a foundation once practice patterns and habits are developed. 

Furthermore, the early clinical experiences will create a desire to know more and grow. Whether you enjoyed learning about and understanding research in the past (or didn’t), your patient interactions, successes and failures will lead you into the evidence. And if the evidence is lacking, you will want to fill the void by creating a case study, RCT, etc.  But without the initial clinical experience your career and our profession risks becoming stagnant.

#PThrive!

All of the themes for 2015 are centered on one thing - The Patient. The future of healthy patients, communities and a sustainable health care system are relying on physical therapy to drive innovation that works efficiently and effectively. All of these themes are focused on having the capacity and humility to self-assess and turn our weaknesses into strengths. The stronger we are as individual clinicians, the stronger we are as a profession. The stronger we are as a profession, the stronger our medical system is. The stronger our medical system is, the stronger our patients and communities are. In 2015, it’s time for PT to Thrive!