2018 Presidential Address
APTA President Sharon L. Dunn, PT, PhD, addressed the House of Delegates, June 25, 2018.
My fellow members of the American Physical Therapy Association, welcome to the 2018 House of Delegates, and thank you for this opportunity to address you tonight.
Three years ago, this body elected me APTA president—a tremendous honor that opened a door to an even greater privilege. I have always been proud to be a member of APTA, and I have always been fulfilled by opportunities to contribute to this association, but serving as APTA president has been enriching beyond measure.
Tonight we gather together three years removed from our centennial—a milestone that, like being elected president, is less a landing place than a launching pad. Our future awaits, and we have the opportunity, the honor, and the responsibility to shape it.
It's a journey we've already begun.
When our bicentennial arrives in 2121, astute historians will note that in 2013 the House of Delegates foreshadowed a fast-approaching new era for our profession—and hastened its arrival. Five years ago this body propelled us beyond our previously inward-facing Vision 2020 to today's outward-facing Vision Statement for the Physical Therapy Profession: Transforming society by optimizing movement to improve the human experience.
In that truly transformative moment, our profession and association were nudged out of our familial nest and made to spread our wings. And just as birds are meant to fly, as professionals dedicated to serving others, we were meant to look outward all along.
That is not to suggest that we were misguided in the decades spent fighting for our autonomy and ensuring our profession was well positioned to capitalize on hard-earned independence. Most of us in this room wear those battle scars—and quite proudly. But where our past was shaped with sharp elbows, our future must be shaped with open arms. Where our origins situated our profession in recovery and treatment of disorder, our future will be characterized by an increased role in sustaining health and proactively preventing disability and disease. And where previously we have demanded respect in part by staking out turf and occasionally pointing to the shortcomings of others, in our future we will demonstrate our value based on the irrefutable data of our own outcomes and in partnership with our colleagues across disciplines. The health care system and our patients will demand nothing less.
We will not arrive at our centennial fully formed or having conquered all challenges. Traditional payment models do not align with the present day cost of physical therapist education. The rich patient relationships that have been a hallmark of our profession are threatened by misaligned incentives and mounting administrative burdens. Outdated insurance plans and old-fashioned attitudes about the patient journey continue to create financial and behavioral barriers to our services. The fact is, at present, our societal impact is less than we desire, and too many physical therapists feel challenged to provide the kind of care that drew them to this profession in the first place.
For those reasons alone, we all should feel a sense of urgency. But we should approach our future with enthusiasm, not dread, because our profession has never been satisfied with our position within the status quo. Our existence has been one of almost constant self-challenging evolution. Our progress has never been inevitable; it has always been hard-earned. So if we truly desire to not only see society transformed but to shape that transformation, we must not only weather the storm of health care disruption. Instead, as Dr Alan Jette urged in his 2012 Mary McMillan Lecture, we must face into the storm and choose questing over resting.
But let's be clear: simply embracing change does not create change—and it doesn't make change easy.
A few months ago, I was on the phone with my nephew, who is a youth pastor in a large church in Central Texas.
You don't need me to tell you that right now our country at large is struggling for and struggling with change. That environment has created tension within my nephew's experience in ministry—and within my nephew himself. He described his current state as "waking up" to the many challenges of today. As we were talking he asked me, "Aunt Sharon, how can you be so nonjudgmental?"
I told him it's because I have been judged, and I know what that feels like.
Likewise, throughout our history, in ways large and small, our profession has been judged, and we know what that feels like. And we have participated in judgment as well.
Judgment is delivered with folded arms, not open arms. It thrives on bias and stereotypes. It fosters tribalism. It ends conversations rather than starting them. It frequently dismisses nuance and entices us to build narratives around intent and hidden motives that sometimes say more about the judge than those being judged. It shackles us to old attitudes and routines. Perhaps worst of all, it draws us to the margins of the issue rather than the center, making us critics instead of change agents, more interested in tearing-down than building-up.
We cannot transform society through judgment. Our vision charges us not to stand at a distance and point our fingers at our nation's ills but instead to accept a personal responsibility to try to make a difference.
In that conversation with my nephew, he encouraged me to read Dr Martin Luther King's "Letter from Birmingham Jail," written in 1963. Sitting in prison, having been arrested for parading without a permit, Dr King learned of an advertisement placed in the local paper by eight religious leaders he once considered his friends and colleagues in the ministry. The ad labeled him as an "outsider" who was trying to influence change in a place he supposedly didn't belong, and it condemned his nonviolent tactics for inciting hatred and violence.
In his response, Dr King was compelled to point out the idle indifference of his critics, writing: "I am in Birmingham because injustice is here. ... I am cognizant of the interrelatedness of all communities and states. I cannot sit idly by in Atlanta and not be concerned about what happens in Birmingham. Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. Never again can we afford to live with the narrow, provincial 'outside agitator' idea. Anyone who lives inside the United States can never be considered an outsider anywhere within its bounds."
As an association and profession, we must ensure that no one feels like an outsider anywhere within our bounds. This obligation is spelled out in our recently updated mission statement: Building a community that advances the profession of physical therapy to improve the health of society.
To fulfill our mission, our community must vastly improve our diversity by being intentional about inclusion. We must prioritize listening and learning. We must enable the next generation of physical therapists and physical therapist assistants to transform our association, just as our association must transform society. Most of all we must get involved—with open arms and open minds—not only as a community, but as individuals.
I understand that in today's turbulent climate the problems we face as a nation and profession can seem too complicated and volatile for any one person to make a difference. For our younger members, this might be the first time you have felt this way. But we have been here before.
Fifty years ago, almost to the day, APTA members gathered in Chicago for APTA's annual conference of 1968. Dr King had been assassinated not even three months earlier. Robert Kennedy had been assassinated just over three weeks earlier. And around those tragic deaths there were riots in Chicago, Washington, DC, Baltimore, and other places across the United States. The conference was unfolding in what APTA President Eugene Michels called "trying times."
In his annual member address, President Michels said, "Our journey, both in society and in the world of health care, is beset with difficulties—with wrangling, haranguing, and with conflict between forces. ... We are exposed daily to arguments and counterarguments over whether ours is a sick society or a violent culture."
Sadly, those words ring true today. And it's not the only place in which Michels' 1968 address resonates.
He articulated that "there are disturbances of some human functions which the skilled physical therapist can evaluate more competently than the physician." He noted that physical therapist "'treatments' rarely comprise the total physical therapy program of any one patient." And while advocating for the physical therapist's autonomy, he cautioned against clustering together in specially trained groups and erecting, in his words, "high, surrounding fences with warning signs that say, 'Special Functions-KEEP OUT.'"
Instead of isolation, Michels urged cooperation. That would mean, he said, "sitting down as adults for frank, well-informed, intelligent dialogue in which areas of agreement and disagreement can be mutually explored," and "doing this at all levels, ... for the practice of physical therapy is just as broad as what all of us do, and just as deep as what each of us does."
As Don Berwick, the former administrator of the Centers for Medicare and Medicaid Services, recently described in a keynote lecture, it is time we as health care providers snuggle for survival within a collaborative health delivery system, instead of struggling to survive in isolation.
These conversations are more urgent than ever, and thankfully our profession has never been better equipped to have them, and our association has never been better positioned to lead the way.
APTA is strong. Membership is larger than it's ever been and growing at a rate not seen since the early 1990s. We are months away from breaking ground on a new headquarters in Alexandria, Virginia, having already paid off the land we purchased just one year ago. Our association has benefitted from strong financial stewardship going back at least to the early 1980s when our current headquarters was purchased—an investment we have maximized. But the most valuable asset in our portfolio has always been the engaged member.
When we formally charge APTA to act, or simply daydream about "what APTA should do...," we sometimes behave as if we're writing a check for someone else to cash. But as an individual membership association, we are charging ourselves-we are writing our own to-do list. APTA is not a distant factory that churns out ready-to-order physical therapy progress on a conveyor belt. It's a community of physical therapists, physical therapist assistants, and students. It's our community. We are APTA, and APTA is us. Our association's growth, commitment, and determination cannot outpace our own personal development.
Make no mistake, the disrupted health delivery environment is an opportunity. It's a sign the system is malleable enough to be transformed. Since at least the turn of the century, the health care experience has been dominated by the quick fix and the passive patient experience. The result has been more opioids than are safe, more scans than are necessary, more surgeries than are helpful, and more people who are physically inactive than a healthy society should responsibly accept.
These aren't just trends. They are a genuine societal need that must be addressed. We not only have the ability to be agents of change, but as a health profession we have an obligation to do so. We won't solve these problems alone, but change must begin with individual action.
In the spirit of Dr King, we must follow our dreams with our own footsteps.
If, like I do, you anticipate a day when physical therapists, like dentists, are part of our society's regular health routines, don't just point the way—raise a hand and accept a portion of responsibility to take us there.
If, like I do, you believe that we gain strength not just with increased membership but with greater engagement, find a colleague who isn't as involved and demonstrate the spirit of inclusiveness our community requires.
If, like I do, you believe that the power of our profession is boundless, that it can optimize movement and health in every corner of the world, then dare to look beyond traditional delivery and payment models; our patients and clients are likely just as frustrated by the limitations of the status quo as we are, and they are eager for the precise and personalized service we can provide.
Above all else, if you believe, as I do, that our profession is more educated and skilled than ever before, that our potential is greater than it has ever been, then join me in demanding that we provide only the highest quality of care and that we are immediately accountable when the data suggest our patients and clients deserve something better.
As Eugene Michels said 50 years ago, "We must promise only what we can deliver and we must deliver what we promise. ... As a profession, we need to improve our posture and add one cubit to our stature by tending to some of our own deficiencies. ... As for the signs of professional maturity, these cannot be generated by a committee, legislated by our House of Delegates, or financed and carried out by some program. They are a matter for our collective and individual consciences."
A few months ago, I was reminded what it looks like to deliver on a promise when Lynda Woodruff, a notable member of our community, passed away at the age of 70.
Lynda was a physical therapist and an educator. But more than that she was a trailblazer. She was the first African American to join the faculty in the Division of Physical Therapy at the School of Medicine at the University of North Carolina. She was the founding director of the physical therapy department at North Georgia College. She began the transitional doctor of physical therapy program at Alabama State University. And she was instrumental in establishing APTA's original Advisory Council on Minority Affairs and the Office of Minority Affairs, as well as the Minority Scholarship Fund and the Minority Scholarship Award for Academic Excellence.
Lynda was a doer, never charging others with a task she wouldn't take on herself. She was a mentor, shaping and inspiring her beloved "Woody Babies." She was someone who found people on the outside and brought them into our community. Lynda was a leader in the purest sense of the word.
In 1962, Lynda and a young man named Owen Cardwell became the first black students to attend the all-white E.C. Glass High School in Lynchburg, Virginia. The landmark Brown v Board of Education decision had been established in 1954—but it was Lynda who delivered on what was promised.
What I didn't know until I attended a memorial service for Lynda was that sometime before her first day at E.C. Glass High School, that little 13-year-old girl sat in her living room with her family and talked to a 33-year-old African-American Baptist minister who counseled her about the strength and courage it would require to be a pioneer of integration.
That was roughly a year before he would write his "Letter from Birmingham Jail," but already Dr Martin Luther King realized that he could not sit idly by in Atlanta and not be concerned about what was happening in Lynchburg. He, too, delivered on a promise.
I knew Lynda in life, but hearing friends and family memorialize her showed me I didn't know her well enough. I regret that I never got to hear Lynda tell her whole story. I regret that I missed an opportunity to better understand her experience. But knowing what I know now about Lynda, everything about her makes sense. She was a strong woman and a powerful presence—one who deeply understood the redemptive power of love, and one who had the requisite tenacity to see dreams to fruition and to deliver on promises.
Thanks to trailblazers like Lynda Woodruff, we have unprecedented freedom to pursue a better tomorrow. But time is precious, and we cannot waste it.
When we enter our next century as an association, we must not close the book on our proud history, shaped by those who led by example. That would be both ungrateful and unwise.
Instead, we must strive to match their commitment for progress with our own, fully aware it will lead to a tomorrow much different than today, because the pursuit of anything less would be an injustice, both to those we hope to serve and to those coming behind us.
Our bright future is already shimmering on the horizon, and we don't need to wait until the sun rises on our centennial to begin to realize our potential or accept our responsibility.
At our core, we are healers, and as much as ever our country and our society need healing. It is not enough that we tweet about it in judgment. It is not enough that we adopt policies that articulate our principles. It is not enough that we sit idly by, in the comforts that were afforded by those who forged the path before us.
No, our history tells us that when we stand together and act, we are a force.
The members of the American Physical Therapy Association were bold enough to dream of transforming society. Now we must deliver on that promise by following the most universal piece of advice we provide to our patients and clients: we must move!
APTA President Sharon L. Dunn, PT, PhD, Board-Certified Orthopaedic Clinical Specialist, was reelected to a second 3-year term, June 25, 2018.
Yes, We Should: 5 Ways to Transform Your Mindset to Improve the Health of Society
By Todd E. Davenport, PT, DPT, MPH
Valerie Rucker, PT, DPT, is right: "Yes, we can" be leaders in improving the health of our communities. As she pointed out in her recent #PTTransforms blog post, our Millennial colleagues are our profession's future. But I don't think we should just leave it to a new generation of physical therapists to transform how we think about health and health care. This Gen X-er is here to tell you that all physical therapists and physical therapist assistants have an important role to play.
The United States is home to some of the most advanced and abundant medical care. Our medical technology, research and development, and per-capita number of specialist physicians are among the best in the world. We spend 17.2% of our gross domestic product on medical care, which is the highest in the world by almost 5%, and amounts to over $3 trillion per year.
If US medical care is so advanced and we spend so much money on it, then our health outcomes must be at or near the top in the world, right? Not necessarily. Just look at the stats related to medical process and outcomes. We have higher rates of overall mortality, premature death, and preventable deaths than comparable countries, on average.
It's now clear we have a health problem in the United States.
It's also now clear that health care and medical care aren't the same thing, and that we aren't going to treat our way out of poor health using our old ways of thinking and doing.
I believe these 2 ideas should inform how we operationalize our new American Physical Therapy Association mission statement: "Building a community that advances the profession of physical therapy to improve the health of society." In turn, our efforts at community building will propel us toward realizing our professional vision: "Transforming society by optimizing movement to improve the human experience."
So, how do we start thinking about society so we can transform it?
And how do we start talking about communities so we can build them?
The answers to these questions are simple, but they're not necessarily easy to do.
Our mission and vision statements invite a fundamental change in how we see ourselves as PTs and PTAs, from expert and caring practitioners who provide care within the confines of a clinic to population health change agents.
Does that sound like a lot? It is! And that's what makes the challenge interesting and exciting.
Here are 5 places to start:
Find your tribe. Find a group of people with whom to share, collaborate, learn, and act. There are PTs and PTAs who are actively involved in population health activities. Check out APTA's Council on Prevention, Health Promotion, and Wellness. The council already has assembled some great resources on the APTA (members-only) Hub, and they have organized some great conference programming to help you get started. Also, the Academy of Prevention and Health Promotion Therapies is an organization that cooperates with APTA and has some fantastic materials and collaborative tools to help clinicians of all backgrounds.
Get to know what your community needs. You might know the needs of your own patients very well. However, your caseload might not reflect the broader community and might be skewed by case mix, insurance, referral sources, and geography. A good place to find more information about your community's needs would be your state or local public health department or nonprofit hospital system. These organizations often produce community health needs assessments that can help you get to know your community in a new way. Public data also can help you understand your community's health needs.
Do a little asking around. Find agencies that align with critical community health needs, and ask how you can help. For example, local opioid safety coalitions have been organized in California to address the unique social, cultural, and political underpinnings of the opioid crisis. These organizations can coordinate with other stakeholders in providing services that can mitigate the incidence and prevalence of opioid use disorder in our communities, including addiction treatment programs, prescribers and pharmacists, school representatives, city and county officials, and public health officers. This model could be extended to other coalitions organized around active transportation, healthy aging in place, and other community health needs.
Find new income sources. Funding for population health initiatives will require us to "add by subtracting." That is to say, every dollar of savings on lost productivity and medical care that we provide to an organization can become our dollar of income. This way of thinking will require us to get outside our predominant habit of fee-for-service medical billing. Direct-to-employer contracts and community benefit funding are just a couple of examples of income sources to cover your costs while improving the health of your community.
Direct-to-consumer wellness arrangements also might be designed to address community health needs. Be aware that these types of cash-based services will be directed to people who can afford your services out of pocket, which might lead you to unintentionally widen existing wealth-based health disparities in your community.
Advocate for a healthier society.
Sixty percent of the variance in premature deaths is attributable to an individual's behaviors and social factors. Social and environmental contexts often influence whether an individual practices healthy behaviors. These social determinants of health are group characteristics that, in turn, predict an individual's health and access to health care. They include race, gender and sexual identity, occupation, education, wealth, built environment, and geography. In other words, your health depends in large part on who you are, where you live, what you do, and who you're attracted to and partner with.
Physical therapists and physical therapist assistants should be active in advocating for a society in which people can be healthy where they live, work, play, learn, and worship. Part of advocating for a healthier society will necessitate that our profession addresses health and health care inequities that exist based on our communities' relative social vulnerability.
So, I add a hearty "Yes, we should" to Valeria Rucker's "Yes, we can." By building healthier communities, we can ensure that the physical therapy profession remains vibrant, engaging, and dynamic in responding to our public's changing health needs now and in the future.
Todd E. Davenport is professor and director of the physical therapy program at University of the Pacific.