• Feature

    Facing True North from the Louisiana South

    New APTA President Sharon Dunn, PT, PhD, OCS, talks about movement, the APTA vision, payment reform, listening, smartphones, lessons from her mom, shoe polish, and alligators.

    In this interview with PT in Motion, new APTA President Sharon Dunn, PT, PhD, OCS, talks about movement, the APTA vision, payment reform, listening, "True North," Find a PT, lessons from her mom, shoe polish, and alligators.

    You have an accomplished career, to say the least. What's been your proudest professional moment?

    My proudest professional moments have been when I get to contribute to the success of others. I can't choose only one, but here are some examples.

    When our DPT graduates move on to their professional and personal lives, and they achieve their individual successes, I'm proud to know I had some small part in that. One of our grads is president of the Louisiana Physical Therapy Association, and the immediate past president also was one of our graduates. Knowing I contributed to their passion for the profession and leadership is awesome.

    I'm proud of working with groups at APTA toward a successful outcome. My first big experience with that was when the House of Delegates passed the new Code of Ethics for the Physical Therapist in 2009. Babette Sanders had been liaison to the Ethics and Judicial Committee, but as secretary of the House she wasn't permitted to carry the process through to the deliberations of the House. I was identified as the point person to manage the conversation on the House floor. I relied on the wisdom of the House officers, content experts, and delegates, and when they successfully got through deliberations, it was fun to see them excited about what they'd done.

    Students, faculty, the Public Policy and Advocacy Committee, the Board of Directors movement system work group, and more—I can give many examples of working in a group toward an outcome. When the group members are proud of their participation and success, it makes me very happy.

    You've just been elected APTA president! What are you going to do next?

    Communication, partnerships, and our value proposition are key initiatives. I am listening to stakeholder groups, and our board is committed to fostering alignment toward the association's vision. A high priority will be placed on partnerships to achieve efficiencies and reduce redundancies in our combined work; together we will be best positioned to reach our potential. Key projects toward our value proposition beyond communication include payment reform and the physical therapy outcomes registry.

    By the end of your term, how do you want to be remembered?

    There are so many key projects in play right now. I don't think any of them will or should be attributed to any one person. What I would like to see is that by end of my term we've aligned our talents and resources toward our new bold vision that the value story of physical therapy is evident, and we're telling it effectively.

    Speaking of aligning with the vision—"Transforming society by optimizing movement to improve the human experience"—what's the most important thing an APTA member can do to help achieve it?

    I love the vision because it's beyond just us and more toward society's need for us. One of the best things we can do as individuals is bring our absolute best to each patient encounter every day. With pressures for productivity and volume, added to challenges such as busy schedules and documentation, it's harder to do. But it's worth it for the public to understand who we are as a profession. If a patient gets only half our effort, then that will be his or her impression of our profession, and it will influence that individual's perception of whether or not the services were successful.

    What's the key to improving member engagement within APTA?

    This is something near and dear to me, because as I see members become engaged in a project or initiative, I see the hook being set for their desire to continue to make a difference. To improve engagement we must provide opportunities for members to use their talents to further projects and initiatives toward outcomes that affect the profession. APTA is not a top-down organization; it's an exchange and collaborative effort. I like to think of it as a hub-and-spokes model, where members on the front lines of practice, education, and research are as influential in pushing us forward as the leaders at the hub.

    What can our frontline members do?

    They can share their positive experiences and invite others to come along, both physically and intellectually. Gathering feedback from others is so helpful to our work.

    What will you emphasize in enhancing member engagement?

    Gathering feedback from others is tremendously helpful to our work, and I think we need to become a better listening organization. I would like to emphasize listening and collaboration as a huge part of our communication effort. Part of any disconnect with members is that we shout at them, but we don't give them avenues to talk or even shout back. We think, for example, when we send a member survey that anyone who wants to give us feedback will do so, but time constraints—or a feeling that their response won't matter—keep people from responding, and so we don't hear everything we should.

    How will APTA's proposal for payment reform benefit patients and clients, the profession, and the health care system?

    The incentives fostered by the current fee-for-services volume-based system aren't patient-centered; they're provider-centered. Under the current system, the more you do, the more you're paid, whether the patient needs it or not. As a result, volume-based incentives drive up health care costs without showing any improvements in patient outcomes. Health care spending as a percentage of gross domestic product in the United States is well above the world average, yet our outcomes are worse than most. This spending growth is unsustainable, and continuing along that path will break our economy without any significant change in the health of society.

    The purpose of the value-based approach being ushered in by health care reform is to flip the incentive to benefit the patient. Under value-based purchasing, outcomes-based incentives drive practitioners to provide what the patient needs, when they need it—no more and no less.

    Using that approach, APTA's coding proposal moves us away from the time-based and procedure-based codes and toward a value-based system. The proposal in play right now has the PT identify the patient's presentation and determine the intensity of service using a per-visit code rather than multiple time-based or procedure-based codes per visit.

    These codes have the potential to move us away from a technical "trade-like" service industry based solely on what we do with our hands (for which others use the same codes and thus profess they are qualified to provide physical therapy) and toward what is happening between our ears: our analytical and critical thinking to determine what the patient needs and how best to meet those needs.

    One of the elements of the vision, "Identity," speaks of defining and promoting the movement system as our foundation, and we have adopted a definition. How can recognition of the human movement system enhance physical therapist practice?

    Recognizing the human movement system restores and renews our professional identification with human movement. Some would say we're already identified that way; others would argue we drifted away from our core principles and need to come back to what we're most skilled at. Where is our unique body of knowledge, our distinct contribution to health? It's in movement analysis—understanding its efficiencies and enhancing its performance.

    If we return to this concept, we have the potential to reduce variation in practice, which is an important objective toward demonstrating the value of our services. But we also can use the concept of the human movement system to gain public appreciation for what we know, over and beyond what we do.

    When a consumer recognizes pain as a toothache, she goes to the dentist. If she's having a movement impairment or pain, we want her to think, "I should see my physical therapist."

    One challenge is that movement is visual and dynamic—pictures and video are worth more than a thousand words—and we need to add the nomenclature of the movement system, including relevant diagnostic labels, to direct our practice and interventions.

    You've spoken about the importance of professional collaboration. How can APTA facilitate it?

    I love that APTA is a federated organization—a national organization with our chapters and our special interest sections. The beauty of it is that we have a single vision with overlapping objectives and the opportunity for alignment. APTA can partner with these internal groups to maximize efficiencies of scale and reduce duplication of efforts to pursue our shared goals. These internal partnerships are vital and, on one hand, require a lot of communication and cooperation.

    On the other hand, external collaborations can't wait in the wings—particularly in this health care environment, in which accountable care organizations and patient-centered medical homes are a reality. In rural communities, for example, practitioners may need our participation but lack awareness of or access to PTs who can help them. We need to partner with these providers and the organizations that represent them. What if, say, other providers use Find a PT on the APTA website to connect with local PTs to give their communities better access to physical therapy? Conversely, there are times we're working with patients' movement conditions, and their complex medical needs are beyond what we can manage for them. We need to be part of a team to ensure the patients get the right services for their condition.

    There's been discussion about the model used to educate physical therapist students. Do you think the current process is satisfactory, or would you make changes?

    The last 2 Mary McMillan lecturers inspired me to look at physical therapist education on a broad scale. I'm not convinced we have a huge problem, but we have had growth in academic programs, and the quality and curricula are all over the map. CAPTE [Commission on Accreditation in Physical Therapy Education] has done a tremendous job setting standards and applying them to this phenomenal growth, but we haven't stepped back to see what the effect of growth ultimately has on the profession. Are our resources—financial, intellectual, capacity, faculty, research, scholarship opportunities—being so diluted across many programs that they have a negative impact?

    Turning to clinical education, I think it is a regional issue that depends on the density of academic programs in different regions of the country. In some regions, academic coordinators of clinical education have no problem finding clinical sites for their students. In other regions, they're having to change their curriculum so they can place students in a limited number of positions.

    Ultimately, we need some level of standardization for entry-level education, whether it's related to outcome expectations or curricular expectations. The American Council of Academic Physical Therapy (ACAPT) and the Education Section are already grappling with these questions. What curricular models will best produce the kind of clinicians who will meet society's needs? I don't have all the answers, but the need for collaborative effort among ACAPT, the Education Section, CAPTE, and APTA is going to be critical.

    In your candidate materials you described physical therapy's "True North." How do you define that, and how does it relate to the vision?

    Our True North, and it's true about everyone who chooses to be a PT or PTA, is our fascination with the human body and how it works, combined with the strong desire to help people. I think this is our calling and what we went to school for. When we conduct interviews for students entering programs, they tell us they came to this profession because they want to help people. Their fascination is with their relationships with patients. They do it for those moments when the patient is finally able to achieve a physical goal or an emotional goal, when they can help patients restore whatever brings them not just movement but dignity, joy, and quality of life. Being present for those moments is our True North.

    Your students clearly are a priority for you. What do you like best about teaching, and particularly at LSU?

    I love our student body. We're a state-funded institution, so we largely draw hometown, family-oriented kids from all over the state. My students keep me real, they keep me honest and human, and they support me in what I'm doing at APTA. Those 36 sets of eyeballs looking at me every day, with their desire for the profession, is inspiring. They work hard, and they play harder—and I get to work hard and occasionally play hard with them.

    Has "playing hard" ever meant playing pranks on you?

    At one of our annual "hello, good-bye" parties on July 1, where we send off graduating students and welcome the new class, they shoe-polished my car with some interesting comments.

    What words do your students use to describe you? Do you agree?

    Passionate. Tough but fair. "She has high expectations, but we know she loves us."

    A student told me once to "quit looking at me; I feel like you're looking into my soul." Making eye contact with people came from my father, who used to say "Look at me when I talk to you!" He thought eye contact was important. I guess my gaze is scary to students sometimes, like I'm reading their mail. I'm glad they think I can read them that well!

    I can't argue with what they'd say, and I'm pleased that's what they think of me.

    Was there a moment or particular catalyst that led you to become a PT?

    When I was an undergrad, I didn't even know physical therapy was a career. At first I was in secondary education to be a math teacher, but after I substitute taught in middle school the first time, I immediately changed to pre-health profession. [Laughs.] Problem was, I didn't want to do medicine, and even though there was a great pharmacy program, I was less intrigued with it because there's not much engagement with the patient; it's more an across-the-counter approach.

    The moment came when I went to a football game and met Myra Buller [PT, now in Baton Rouge], from a small Cajun community, who was in a PT program. She was watching video of a tennis serve for homework, seeing how the muscles produced movement. I knew then I'd finally found the match for who I was. I found our True North—the insatiable curiosity about the human body, how it moves, what makes it work, and how we can channel it into the 1-on-1 personal interactions we have with our patients.

    Tell us about your family and interests outside of physical therapy and teaching.

    I am a product of education—my mom, dad, brother, grandparents, and great aunt all are or were educators. My brother and I grew up in an environment in which we were allowed to make mistakes, be responsible for our mistakes, and grow from them. My parents never said "you can't do" this or that; they inspired me to do what I love and love what I do—"Do whatever blows your dress up," as Mom would say. Dad, who has a PhD in education, is a retired school principal and immediate past president of the Louisiana Retired Teachers Association. He's a perpetual advocate for his profession and set the bar for me to be the same for mine.

    Mom, after being divorced more than 20 years, was remarried 2 years ago to her grade school love, and she moved with him to Phoenix. She has taught me lessons in vulnerability that I never knew existed—being open to love and life like there's no tomorrow.

    My brother, who's 3 years older than me, has 4 kids who are now giving him grandbabies. I get to be the cool aunt in their lives. He texted me over and over after the House of Delegates because he was so anxious to hear about the outcome of the election. Becoming quite frustrated with his little sister's inaccessibility, his texts heightened in tone and language, like only a big brother can do.

    It's likely your family won't have the same access to you they used to while you're APTA's president. What's your strategy to stay in touch?

    Just do better at it. It's so important to stay connected with people who ground you. My brother and his kids, and my parents, certainly do keep me grounded. They have already made it clear that there is no presidential stroke in the family dynamic and structure.

    What's the funniest ICD-10 code you've seen?

    I looked through the codes and found "Struck by pig, subsequent encounter" (W55.42XD) under W55, "Contact with pig." I figured that's an occupational hazard for farmers and somewhat regionally biased toward the Midwest, where farming is huge. So I wanted to see if there were codes more biased toward my area of the country and looked up alligators and crocodiles. Yes! I found 35 codes related to them under W58. With separate codes for "bitten," "struck," or "crushed," and for initial and subsequent encounters.

    Foodwise, Cajun or Creole?

    Both! The difference is in how they're seasoned. Creole is slower cooked, more subtle with the seasoning. Cajun is hot and spicy. To be honest, I'm from north Louisiana, so food-wise I might as well be from Texas or Arkansas. My college suitemate was from southern Louisiana, and I went to visit her and experienced authentic Cajun cooking. It was all so good because of the seasonings.

    What else do you want your members and the PT profession to know about you?

    Please don't dare me to do anything. I'm always obligated to take a dare. I'm all-in in this role, and I think people who know me understand that. I absolutely love our profession, and I have expectations that we will reach our full potential.

    Sharon Dunn: Profile

    TITLES: President, American Physical Therapy Association

    Associate Professor and Chair, Department of Rehabilitation Sciences for Louisiana State University Health Sciences Center (LSUHSC)

    "Cool Aunt"

    EDUCATION: BS in physical therapy, MS in health science, and PhD in cellular biology and anatomy from LSUHSC

    CERTIFICATION: Certified by American Board of Physical Therapy Specialists in Orthopaedic Physical Therapy

    MEMBERSHIPS: American Physical Therapy Association Board of Directors, president, past vice president, and director

    Louisiana Physical Therapy Association Board of Directors, past president and past vice president

    Orthopaedic Section, Education Section, Section on Research, Private Practice Section

    Louisiana Sports Medicine Society, International Society for Hyaluronan Science

    RECOGNITIONS: David Warner Distinguished Service Award, Louisiana Physical Therapy Association, 1999

    Allen A. Copping Award for Excellence in Teaching, LSUHSC, 1998

    OTHER ACTIVITIES AND INTERESTS: Family, fitness, Winners Circle Youth Camp (past counselor), USA Triathlon


    Yes! One of the happiest accomplishments in my life: convincing Sharon Dunn to change her major in college to Physical Therapy! I told her she would never be bored. So far, so good, I think!
    Posted by Myra Buller,PT on 9/30/2015 1:04:36 AM
    You are an inspiration to more than your students Sharon, you are an inspiration to us all! So proud to have you leading our profession! :)
    Posted by Jennifer Turner on 9/30/2015 4:43:57 PM
    I am very proud to have been a part of your progression through the ranks of the APTA. You will be a fearless president who will keep us focused on the real reason we all entered the profession: To help our patients be all that they can be.
    Posted by Gail Pearce on 9/30/2015 7:57:51 PM
    Hi Sharon. Congratulations on becoming president of the APTA. I dare you to get us reasonable reimbursement rather than us being nickeled and dimed (or rather, dollared) to death year after year so that, even in nominal dollar terms (to say nothing of real dollar, inflated adjusted terms), I'm making less per patient than I did 23 years ago. And I'm having to jump through a hell of a lot more hoops that are getting higher, smaller, and now surrounded by fire to get that reimbursement. In fact, I double dare ya!
    Posted by Brian Miller on 9/30/2015 9:11:09 PM

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