PTs Are 'Abilitation Specialists'
Estimated Reading Time: 2 minutes
It's time to consider striking the word "rehabilitation" from the lexicon used to describe the profession of physical therapy.
Long known as rehabilitation specialists, we are contributing to the public's belief that physical therapists (PTs) are health care providers who people seek out solely after illness or injury.
In fact, the extensive knowledge and skills that PTs possess translate easily to "abilitation" as well. Abilitation means to keep people healthy and active, with or without the presence of injury or disease.
For many years, PTs have asserted their role in health promotion, defined as "the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions."
The vast majority of PTs continue to practice at the individual level addressing existing impairments, which remains a vital component of our practice that should never be abandoned. Even in this setting, we can promote healthy behaviors, and beyond this, we also can be expert providers in the organizational and population health spaces as well.
The health behavior model that encompasses all of these domains is called the socio-ecological model (SEM). SEM underscores the importance of multiple levels of influence in a person's health behavior.
Even PTs who work with patients at the individual level must consider the impact of one's family, social circle, organizations they belong to and work with, and the policy environment that surrounds them. All of these domains may positively or negatively impact a person's health.
How do we do that? Start by talking to them about nutrition, smoking cessation, stress management, sleep hygiene, family and relationships, their career, their general environment, and, of course, physical activity, but only after you consider the whole SEM and what methods may be most successful in helping your patient or client overcome the health challenges they face.
Personal theories of health behavior shape one's choices, and simply providing patient education may not be enough.
Seek out information on how to assess and address health beliefs through standardized tools and behavioral interventions, such as motivational interviewing.
Providing health promotion services to your patients may not need extra time or resources, but it does require a further understanding of an individual's psychosocial belief system and how to guide them to change when they are ready. For assistance, APTA has a new Council on Prevention, Health Promotion, and Wellness that provides information about our profession's roles and responsibilities in promoting health and wellness.
Similar to physicians, dentists, and other health care providers who provide both preventative and tertiary care services, once we, as a profession, get the word out that PTs can prevent impairments and disabilities as well as rehabilitate them, our opportunities to impact and improve the health of our society will grow exponentially.
Jessica Maxwell, PT, DPT, PhD
The Broadway PT
Estimated Reading Time: 2 minutes
The backstage door is on West 41st street.
Press the doorbell and let the security guard know that you are the physical therapist (PT).
Walk up 1 flight of stairs and the call board will be on your left side.
Continue up to the third floor.
Walk down the hallway, past the makeup and hair rooms. The PT treatment room is on your left, next to the second track cast's wardrobe.
Those were my instructions for how to reach the treatment area of the new Broadway show I will work with every Monday and Wednesday, from 5:00 pm to 7:00 pm.
I get similar instructions from my manager every time a new show premieres.
These old theaters are magnificent. An ever-changing maze, and I'm not known for having the best spatial memory. I make it to my treatment room and set it up as needed, and I wait for today's performers to arrive.
When performers start to arrive, that's when the fun truly begins. As my mentor always said, "You never know what will come in through that door." She's right.
Sometimes, it's just a fun surprise in the form of a performer wearing the character's full makeup and hair ready for their physical therapy session.
Other times, the surprise comes from the clinical conundrum of yellow and red flags that you could face in any orthopedic-based setting.
During the 8 years that I have worked with Broadway performers as part of the production medical staff, we have helped identify multiple serious conditions like bone fractures, concussions, and deep vein thrombosis.
On those occasions, the show's physician was consulted for confirmation or rejection of the working hypothesis.
Most shows have an integrative team of health care professionals keeping the performers healthy and on-stage night after night.
With an average of 8 shows a week, you can imagine the toll it takes on the performers.
Broadway musicals typically involve singing, acting, and dancing. Have you ever treated a singer, a dancer, or an actor? They are the most resilient, passionate, and sensitive people I have ever met.
The athleticism of Broadway performers is complemented by an eternal search for beauty. It is the ultimate mind-body challenge for both the performers and the clinicians.
Psychologically informed practice is delivered together with skilled orthopedic manual therapy most days of the week, and while it's both exhausting and exhilarating, I would not change it for anything in the world.
Hector Lozada, PT, DPT, currently works as a clinical supervisor at the Hospital for Special Surgery and provides backstage physical therapy to performers of various Broadway musicals. He received a bachelor's degree from the University of Puerto Rico and a doctor of physical therapy degree from Boston University. Lozada is a certified manual physical therapist, and he completed an orthopedic residency program at the Hospital for Special Surgery in New York City. He is a board-certified clinical specialist in orthopaedic physical therapy. You can connect with him via email.
Unique Career Highlights: US Public Health Service
Estimated Reading Time: 5 minutes
Are you looking for more than just your average physical therapy career?
Are you passionate about public service?
Are you interested in a career with ample opportunities for advancement and diversification?
Working as a therapist in the US Public Health Service (USPHS) Commissioned Corps is a unique opportunity to grow in your career, while serving your country. Despite the lack of publicity, being an officer with the USPHS is an exceedingly rewarding career path on multiple levels.
According to its website: "The Commissioned Corps traces its beginnings back to the US Marine Hospital Service protecting against the spread of disease from sailors returning from foreign ports and maintaining the health of immigrants entering the country. Currently, Commissioned Corps officers are involved in health care delivery to underserved and vulnerable populations, disease control and prevention, biomedical research, food and drug regulation, mental health and drug abuse services, and response efforts for natural and man-made disasters as an essential component of the largest public health program in the world."
Lieutenant Commander (LCDR) Selena Bobula, PT, DPT, is a graduate of the University of Wisconsin and has been practicing for 8 years. Her first encounter with physical therapy was in high school after tearing her ACL, and this experience led to her future career.
Now, as a commissioned officer in USPHS Bobula works at Fort Carson, Colorado, in the Warrior Recovery Center/Evan Army Community Hospital.
Bobula first heard about USPHS while on a traumatic brain injury rotation at Fort Bragg, North Carolina. She thought it seemed like a great opportunity to try a variety of jobs in physical therapy, to travel, have upward mobility, and to serve as a federal employee with all of the perks that it entails.
Below is an interview with Bobula who shares her USPHS experiences and her professional development journey.
What is a physical therapist's (PT's) role within the Commissioned Corps?
A PT in USPHS can work for a number of agencies, although most clinical PTs work with the Indian Health Service (IHS) or Bureau of Prisons (BOP). Depending on the clinical site, you may work purely in outpatient, inpatient, or a combination of both. Most sites have an orthopedic need, although in my experience working in IHS the needs are so great for all types of PTs that you can be a neurology, geriatric, pediatrics, wound, EMG, women's health, cardiopulmonary, or any type of specialist. Meanwhile, on a deployment team PTs can function in administrative/leadership roles, such as the logistics or operations chief, or PTs can be clinical and assist with ADLs, and sometimes wound care.
What, if anything, makes working for USPHS different than working for a private practice or hospital system?
I have always worked in some sort of federal hospital system and I like having a variety of specialists available for consultation, as I prefer a team approach versus silo approach to optimal patient care. I really like being a commissioned officer because of the wide variety of opportunities available (eg, working for the FDA, headquarters, USDA, DOD, IHS, BOP, CDC) as well as the really nice benefits (ie, free health care for me and my family, 30-days of leave per year, federal holidays, a pension retirement with 20 years of service, and upward mobility that otherwise is not really available in other health care systems). Lastly, the great freedom of being a federal PT is really nice, allowing us to order imaging, be a valued member of the health care team, and not worry about insurance limitations (unless ordering equipment). We can see someone as much or little as deemed appropriate without letters of justification, and can practice to the limits of our scope of practice.
What are the top 3 reasons you would recommend a career with USPHS to a new grad?
First, benefits: retirement with a pension, free health care for you and your family, 30+ days of leave per year, 12 weeks of maternity leave, unlimited sick leave, and more. The sooner that you get in the sooner that you can retire—and you've got to work somewhere. Why not serve your country and be well reimbursed for it? The income is significantly higher than average PT incomes once you make O-4, for which you are probably eligible in 3-4 years.
Second, the wide scope of practice and interesting opportunities: Keep up your generalist skills that you learned as a new graduate and decide the type of physical therapist specialty you want to practice. This is especially true with IHS. I got to run a wheelchair clinic, start a falls clinic, start vestibular rehab services, start concussion services, lead an area-wide neurology special interest group, and earn my board-certified clinical specialist in neurologic physical therapy by filling a gap in patient care that I was interested in. As for other interesting opportunities with USPHS, I have participated in providing free health care to a rural population in Tennessee, and responded to Hurricane Florence providing medical care to evacuees.
And third, loan repayment: If you work with IHS, loan repayment is an option as a civilian. Plus, students who are in the BOP Commissioned Officer Student Training and Extern Program receive a stipend while in school, and those years also count toward your retirement. The IHS Loan Repayment program was instrumental for me in paying off more than $90k in less than 5 years, while working in a very friendly environment and a BEAUTIFUL area of the country I had never visited.
Do USPHS officers get deployed in a similar way as the military?
Not quite. We respond to public health emergencies and typically only deploy for a few weeks at a time. Some recent examples include setting up and running a medical shelter to support evacuees from a hurricane or flooding, providing health care services to unaccompanied children crossing the border, mental health teams responding to school shootings, and responding to the Ebola outbreak in Liberia, aiding in controlling the epidemic and running a strict medical facility to ensure non–cross-contamination. I was fortunate enough to finally deploy for 2 weeks to assist in a medical shelter for evacuees from Hurricane Florence and really loved the experience.
If a student wants to complete a clinical rotation with USPHS, what should they do?
Contact me at Selena.email@example.com and I will help find contacts for the clinical experience where you may be interested in doing a rotation.
Bobula loves her job and in the near future sees herself as chief of a small clinic, hopefully closer to the midwest. Being a USPHS commissioned officer is a unique and diverse career opportunity where you will promote, protect, and advance the health and safety of our nation. You can find more information about jobs and applications on the website, but first she recommends paying attention in class, especially neuroanatomy, and know that "it depends" is really the answer.
Grace Couture, SPT, and LCDR Selena Bobula, PT, DPT, Board-Certified Clinical Specialist in Neurologic and Orthopaedic Physical Therapy
One out of Sixty-Four
Estimated Reading Time: 3 minutes
I always knew that I wanted to work in oncology physical therapy.
Out of my 64 classmates, I was the only one.
Most of them wanted orthopedics, with a few who had an interest in acute care or pediatrics. But oncology? No way!
"Why would you want to do that?" they asked me. I asked them the same question. "Why do you want ortho?" The same went for our spinal cord injury unit, which I hated. "Why don't you like it, Laura? Don't you think it's cool?" Sure, cool enough for someone else to do it.
I value my orthopedic and neurology skills, but practicing in outpatient orthopedics or at Craig Hospital in Denver? No thank you.
I was a "B" student in physical therapy school and I slogged my way through some of those courses. My true love was always oncology.
So when our cardiopulmonary tract rolled around, I got into it. My cardiopulmonary instructor used to say he probably still says it, actually"I've never treated a patient without a heart." The point being, even though most of my class stressed about orthopedics, every patient is going to have a heart and lungs to consider, so don't devalue what you learn through other coursework. I have carried that with me every day since he said it.
Physical therapy school, by design, prepares students for generalist practice. The task of specializing takes place after graduation with continuing education, mentorship, or residency. Oncology is no exception.
I landed at a clinic where the owner teaches her own certification course and provided mentorship for me when I started.
Much of specialization in oncology focuses on lymphedema. Sure, one can be a certified lymphedema therapist, but what about all those patients with cancer who don't have lymphedema? There are a lot of them out there.
That's where oncology rehab comes in; the clinic that has shaped (and continues to shape) my career.
Working in oncology allows you to work daily with those primary domains you learn in school: musculoskeletal, neuromuscular, and cardiopulmonary. Every patient who walks in the door has compromise to each of those systems.
The challenge of the job is prioritizing the one to address, which one your patient is struggling with, and where you can make the biggest difference. We learn about systems review in school; oncology is a setting where you must review all of them. Oncology is a specialty, but in a way, it's also the definition of generalist practice.
As much as I didn't love orthopedics, I stay sharp on those skills because my patients experience shoulder pain, neck pain, low back pain, hip pain, knee pain; the same as any other population.
A typical patient diagnosed with breast cancer may undergo surgery, chemotherapy, and radiation (or some combination thereof), depending on the stage and grade of cancer. An initial evaluation includes taking vitals, finding out if the chemotherapy the patient received, or will receive, has cardiotoxicity or neurotoxicity, learning if the patient has risk of developing lymphedema, determining if their shoulder pain is orthopedic or oncologic.
The same goes for peripheral neuropathyis it chemotherapy or was the hand tingling and numbness there before treatment? Maybe it's cervical radiculopathy instead. In one visit, you must use skills learned in orthopedics, neurology, and cardiopulmonary tracts.
That's not to say you should be intimidated by the field of oncology.
Yes, my patients have cancer, and yes, they are always medically complex. But what patient isn't complex to some extent?
Our job as physical therapists is to help our patients with their function and quality of life. Oncology is no different; you simply have a different set of circumstances to navigate.
I often get asked whether there are more contraindications to therapy in oncology, and I think this question comes from a place of fear. A patient with cancer is not a delicate flower to dance around. They are people, like you and me. Depending on their circumstances, there may be precautions, but not any more than you would see in a hospital, a skilled nursing facility, or outpatient orthopedics with a postoperative total knee replacement.
Oncology is challenging, but don't let that deter you if it piques your interest. It is a growing specialty, and there is a lot of work to be done. So why not join me?
Laura Vroman, PT, DPT
Rethinking Possibilities When It Comes to Research
Estimated Reading Time: 2 minutes
When most of us think about research, we think of randomized control trials, prominent authors, grants, institutional review boards (IRBs), and dreaded statistics. Daunting, right?
Not only that, but a common misconception is that if you are outside the university setting, you are unable to contribute to research for our profession.
I'm here to assure you that there are plenty of opportunities for those in private practice.
Improving internal clinical quality
While publishing a case series was my first official research contribution, it was clinical quality and analyzing internal results that started my research journey.
Our practice used FOTO to assess patient outcomes and satisfaction, but measures, such as cancellation rate and visits per episode of care, can provide insight into the clinical quality of a practice.
In addition, we can assess other variables and their impact on our quality numbers (eg, comorbidities, patient age, diagnosis codes, chronicity).
This internal research can provide valuable insights for your peers to drive improvements in clinical quality.
It is important to note that if you wish to publish observational data externally, you will need an IRB. This is where collaborations with universities can be beneficial, which I will cover later.
Case studies/series: poster presentations and manuscripts
As I previously mentioned, my first publication was a case series for the Journal of Othopaedic & Sports Physical Therapy.
Reporting on a case is a great opportunity to showcase either a unique patient type or a treatment approach that your peers would find interesting and beneficial.
While you cannot determine effectiveness or cause without a control and large sample size, you can provide a framework for future studies and plant the seed for additional questions.
It is also a great way to enter the field of research without an abundance of resources (eg, grants, research team, equipment).
Which leads me to my final point.
At the end of the day, research is about progressing our profession. Physical therapy is an outstanding profession, and we have a tremendous opportunity to help patients every day.
To provide the best care and to ensure adequate access (ie, direct access), we need to show our value in the literature.
Universities have the technical expertise and many needed resources (eg, IRBs, PhDs experienced in research design), while practices have large amounts of patient data in addition to clinical experts.
Together, we can drive the profession forward and advocate for the many benefits of physical therapy far greater than we can apart.
If you are interested in getting involved in research, I highly encourage you to seek a mentor, identify needs, and build relationships in all areas of the profession.
When researching an area that you are interested in and with a design to stimulate you, it turns out to be more enjoyable than you might suspect.
Zach Walston, PT, DPT, is currently the National Director of Quality and Research at PT Solutions Physical Therapy. Zach also serves as the assistant program director of the PT Solutions Orthopedic Residency Program and the director of the PT Solutions Mentorship Program. You can connect with Zach via email at firstname.lastname@example.org.
The 5 Ws and an H on Residencies
Estimated Reading Time: 4 minutes
When discussing residencies, the most common comment I hear from physical therapy students is: "I don't even know where to begin." That's where I come in!
My name is Brooke, I'm a #FreshPT, and orthopaedic physical therapy residency program codirector at Evidence in Motion, and I'm here to help!
So here we go, this is the first of a series posts all about residencies. Let's start with the 5Ws and 1 H.
What is a residency?
Residency is a postprofessional program designed to enhance the knowledge and skills in a certain practice area.
Through ongoing mentorship and clinical and didactic learning, the goals are not only to pass the American Board of Physical Therapist Specialties examination, but to improve your clinical practice and decision-making skills.
The American Board of Physical Therapy Residency and Fellowship Education accredits residency programs in acute care, cardiovascular & pulmonary, clinical electrophysiology, geriatrics, neurology, oncology, orthopaedics, pediatrics, sports, women's health, and wound management.
Why should one pursue a residency?
Residency is a direct route to refining your hands-on skills, growing and maintaining a strong knowledge base in evidence-based practice, building your clinical decision making and reasoning, and advancing your career.
In speaking with many residency graduates, the main reason most of them pursued residency was for the mentorship in their specialty.
Mentorship is important for many reasons, but I feel the main reason is building confidence because this is what most new therapists feel they are lacking within the first few years of their career.
Many employers promise mentorship to new graduates, but in many cases it is very limited or completely forgotten once the therapist appears to be ready to carry a full caseload. While in residency, you have to complete a minimum of 150 one-to-one mentoring hours with an experienced mentor.
Who should pursue a residency?
The answer at first glance can seem simple, anyone.
Anyone who is ready and willing to learn, better themselves, and be put on the fast-track to sit for and pass the specialist certification examination in their area of study.
However, one thing that must be considered is your financial situation. Every situation is different, but you should consider your current debts, ability to potentially take a reduced salary while in residency, and ability to pay for residency yourself while still living comfortably.
This is something that many people battle with when deciding to pursue a traditional residency or looking at residencies that offer flexible or extended options, such as completing in 18+ months instead of the traditional 12 months.
When should I start a residency?
Most residents begin within 3 years of graduation.
Some physical therapists leave school knowing exactly what they want to specialize in, but some like to take a few years to try working in a few different settings before deciding.
However, some clinicians pursue residency after being in practice for 10+ years.
There is no right or wrong answer here.
Where are residencies located?
This is where it gets fun!
There are brick and mortar residencies in many different states all over the country, but most of these do require that you move to wherever they are located, which can be difficult due to the cost for those who have families.
There are many programs that are now offering hybrid and distance residencies where you can work and have a mentor in a location of your choosing, while completing your coursework online and attending hands-on labs throughout your residency.
When thinking of where and when it comes to residency, therapists should think of their learning styles and need for flexibility.
How do you start a residency?
This is different for each person and program.
First, you need to do your research and find a program that best fits your needs.
Do you want to teach during your residency? Do you want to conduct research? Do you want a program that focuses on manual skills?
You need to assess your goals for residency and then find the program that matches.
When you start to narrow down your search you might want to think about a couple of other things. Are you willing to relocate? Are you familiar or comfortable with the teaching style of the program—online versus live classroom?
Once you have answered these questions, then you need to look at the application process and time line. Again, this will be different for every program because some have strict once-a-year application cycles while others are on rolling admissions.
Tweet me @brookejanicky and let me know what questions you want answered in our next post!
Brooke Janicky, PT, DPT, is a physical therapist and board-certified clinical specialist in orthopaedic physical therapy in Baltimore, Maryland, and orthopaedic physical therapy residency program codirector at Evidence in Motion. She can be reached at email@example.com or @brookejanicky on Twitter.
Fundraising in the Fall
Need inspiration for your next Pitt-Marquette Challenge fundraiser? Check out the winner of the "Most Creative Fundraiser" for the 2017-2018 Challenge! Saint Louis University held a "PT Spirit Week Fundraiser" where they had a friendly competition between their classes and faculty with activities like penny wars and a kickball tournament.
The possibilities are endless especially with the holiday season approaching. Have an Ugly Sweater Sale where students can put holiday decorations on second-hand sweaters and sell them to faculty and friends. Or simply host a holiday cookie bake sale! For more ideas, check out our toolkit here.