ADVANCE Perspective: Physical Therapy : Workplace Issues

Deciding Where to Live and Work

Lisa Lombardo — Mon, 12 Oct 2009 13:37:00 GMT

How much does the outlook on physical therapy jobs affect where you live and work? This month, AfterCollege.com researched the top metro areas across the country to for people looking for jobs in physical therapy. ( See the full story here .) They looked...(read more)

New Medical Staff Might Be Bad For Your Health

Elizabeth Puliti — Mon, 28 Sep 2009 13:04:00 GMT

Starting a new job in emergency medicine? You may want to be extra careful on your first day. Research from Imperial College London states that the death rate is higher among patients admitted to English hospitals on the first Wednesday in August--the...(read more)

Now for Something Completely Different

Lisa Lombardo — Mon, 24 Aug 2009 17:30:00 GMT

ADVANCE is already receiving some nice feedback about our Aug. 10, 2009, cover story on therapists who entered the profession later in life, many after following established careers in other fields for years. The story, "Late Bloomers," tracked several...(read more)

CT Nursing Home Lawsuits Involve Lack of PT

Lauren Fritsky — Mon, 15 Jun 2009 15:31:00 GMT

There's an interesting story out of Connecticut from this weekend. It involves a nursing home facing lawsuits for neglecting two patients, both of whom died. In the first, part of the argument is that the client did not receive "medically necessary physical...(read more)

Are You Prepared for Swine Flu?

Elizabeth Puliti — Mon, 27 Apr 2009 17:39:00 GMT

The Department of Health and Human Services declared Swine flu a "public health emergency" in the United States, sparking fear and confusion in many Americans. The World Health Organization confirmed 73 cases of swine flu worldwide and 40 cases of the...(read more)

PTAs Weigh In!

Lisa Lombardo — Mon, 30 Mar 2009 14:06:00 GMT

I was happy to see my editorial from March 23 print issue (Up Front, page 3) received so much response. The editorial read in part: "How has the changing profession of physical therapy impacted PT assistants? Changes to Medicare, third-party payer rules,...(read more)

What Do You Resolve to do in 2009?

Elizabeth Puliti — Tue, 06 Jan 2009 18:13:00 GMT

ADVANCE wishes you a happy new year! Several editors and bloggers here have resolved to change for the better in 2009. Her are our resolutions for the new year:

Jason Marketti, PTA:

1. Spend more quality time talking to my children and holding hands with my wife.
2. Stay in contact with friends.
3. Be more flexible with people's faults because I have a ton of my own.

Veronica Haywood, SPT, ATS:

1. Lose 15 pounds.

Lisa Catenacci, SPT:

1. Get to know myself better.
2. Figure out what it means to have a peaceful heart.
3. Gain closure from all of 2008.
4. Stop feeling the need to defend myself, my beliefs, and my actions. I am who I am.
5. Take a vacation. From everything.
6. Enjoy the transition from student to practitioner.
7. Make evidence-based practice a habit.
8. Form good relationships with my co-workers.
9. Start the journey of paying off student loans.
10. Be thankful every day.

Toni Patt, PT:

My goals are to work hard at school and find more time for myself.

Lisa Lombardo, editor:

1. Save more money.
2. Make some home improvements. This might not fit with resolution 1, but I'll work on a budget.
3. Get back on Weight Watchers; it worked last year.
4. Be more outgoing!
5. Try something I never did before.

Beth Puliti, senior associate editor:

1. Take better care of my body by starting a regular exercise routine and eating fresh, natural foods.
2. Stop judging people based on my first impression of them.
3. Figure out what truly matters in life and work to achieve happiness.

Lauren Fritsky, associate editor:

1. To travel more.
2. To work on my writing.
3. To do more things outside my comfort zone.
4. To make more quality time for family and friends.

Did you make a New Year's resolution? If so, tell us!

Are Changes Coming?

Lisa Lombardo — Thu, 06 Nov 2008 19:51:00 GMT

America has elected a new president--an historic event that even other nations are taking notice of. Sen. Barack Obama's election as the first African-American president will rightly be remembered as a turning point in U.S. politics. But without too much prognostication, how will his election affect changes to health care policies? And specifically to issues affecting the physical therapy profession?

As we reported in our Sept. 22 issue previewing the election, the largest component of President-elect Obama's health care plan is his commitment to making affordable health care coverage available to all Americans. This includes 46 million--at least 8 million of whom are children. According to his campaign statements, under Sen. Obama's plan all Americans will be afforded the opportunity to buy a plan--at affordable rates--that mirrors the Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. No American will be turned away from Sen. Obama's plan due to pre-existing diseases or conditions. The plan will cover all essential medical services, even such instances as maternity and mental health.

Aside from major health insurance changes, will the Democrat-majority Congress now decide to make changes to the top issues affecting PT: getting rid of the caps on outpatient therapy under Medicare, pursing a plan for direct access to PT under Medicare or holding the physician fee schedule at its current rate?

What do you think? Will Democrat-managed decisions on Medicare make a difference in the next four years?

Don't Miss It!

Elizabeth Puliti — Wed, 05 Nov 2008 15:33:00 GMT

From November 5 - 8, Orlando, FL, will host APTA's 2008 Private Practice Section Conference. This year's theme is "Capturing the Magic of Business Success."

According to James E. Glinn, Sr., PT, owner and founder of FutureRehab, LLC in Bakersfield, CA, this year's not-to-be-missed events include:

Early pre-conference workshops, including legal issues and how to implement employer-paid industrial services;
Educational sessions each day, running the gamut from reimbursement/retention of professional staff to the latest on information technology systems implementation;
In-depth educational sessions focusing on such subjects as "Building Bone Health into Your Practice" as well as methods on increasing "Business Profitability and Autonomy";
Intensive educational sessions including 3-hour presentations on "A Twelve Month Plan to Managing Your Practice," "Boosting Direct Access Through Wellness and Non Physician Referrals, Direct Marketing and Brand Identity" and "Succession Planning Foster Practice Success: Your Five Year Plan."

The conference is sure to profit physical therapists, business managers, marketing personnel and other healthcare professionals.

For more information on how to get the most from the conference, click here.

For the 2008 PPS conference schedule-at-a-glance, click here.

Caring, Cooperation Ease Flood Effects

Lauren Fritsky — Thu, 10 Jul 2008 19:04:00 GMT

Officials this week have released the financial toll of the floods that ravaged Iowa a month ago.

The University of Iowa in Iowa City incurred more than $230 million in damages. In Cedar Rapids, the price tag is likely to exceed $1 billion.

Despite the destruction, the residents of the state continue to band together in their recovery. Health care workers are pitching in as well.

University of Iowa Hospital was not forced to evacuate, but did struggle with getting staff to the facility amidst road closures on June 12 and 13. But people from varying departments worked as a team to make sure the patients were cared for.

"A lot of our outpatient staff, because there weren't any clinics and all of our appointments were canceled, were able to do inpatient care, and we were able to meet the needs of the patients for those two days," said Ken Leo, PT, director of rehab therapies at University of Iowa Hospitals and Clinics. "But we had to be kind of creative in how we did that."

Before flood waters forced Mercy Medical Center in Cedar Rapids to evacuate, staff members stood side by side sandbagging to keep them out. When the natural disaster left only a single awkward entrance available, workers cooperated with ambulance drivers to usher out patients. And when staff members themselves lost their homes, coworkers ventured out to help demolish the structures, pump out water and pull off dry wall.

"It was kind of a bonding experience," said Lou Ann Weber, OTR-L, director of inpatient rehab at Mercy. "I met people. I was in the water helping sandbag next to physicians and housekeepers and there was lots of camaraderie to save our hospital."

Anyone who is interested in donating to the affected communities and individuals should visit SaveIowa.org

Physical Agents: In or Out?

Lisa Lombardo — Wed, 25 Jun 2008 19:29:00 GMT

Since becoming the editor of ADVANCE in 2000, the thought has often occurred to me that PTs and PTAs are a surprisingly well-informed and opinionated bunch.

But they are also a lot of fun as well.

This was proved to me on June 13 at the annual APTA conference in San Antonio, as APTA premiered its first Oxford Debate. PT experts on both sides considered whether physical modalities that might not be based on evidence should be used and billed by PTs. Despite the seriousness of the topic, the therapists on hand made being confined to a conference room on a gorgeous sunny day in Texas more entertaining than can be expected!

The debate addressed the question: Should physical therapists remove the use and billing of selected (infrared, laser, diathermy, thermal agents) physical agents from their practice?

The idea behind the debate was to question the appropriateness of the removal or maintenance of use of these interventions, the impact of them on current practice, and how removal of them would affect PT's image and independence as a professional body.

An Oxford debate is similar to British Parliamentary debate, pitting two teams of three making the arguments both for and against the question. Each team selects an opening speaker, a second "rebuttal" speaker and a third "summator" speaker for their respective arguments, and the audience comprises the "floor," allowed to ask questions of each panel before the summator speakers wrap up. Competitors are encouraged to maintain civility but also to debate with "animation, passion and creativity," according to traditional Oxford rules. And the PT panelists certainly rose to the challenge.

The debate was lively, fun and inciteful (thanks to the participants!). In a unique twist, whenever one side gave an argument, the audience could move from one side of the room to the other to show their support for the stated argument. There was a lot of up and down as many therapists switched sides.

This struck me as particularly interesting, because it showed how complex the issue really was. More than one debate attendee mentioned that professional credibility for PT could be at stake if PTs turn too often to unproven agents for treatment.

Should PTs use modalities in the clinic-and bill for them-when patients can find hot packs and other agents in drug stores and use them at home? How much should therapists rely on physical agents when there is little to no solid evidence that they work in the long-term? Are therapists just billing, in effect, for placebos? Or are therapists wrong to reject agents that might work well for their patients' rehab?

What do you think about using physical agents? Do you use them, and how? Do you feel other therapists might rely on them too often?

The 2008 Rothstein Debate

Lisa Lombardo — Mon, 16 Jun 2008 16:07:00 GMT

SAN ANTONIO—Preparing Students For Clinical Practice: Does the Current CI Model Work?

Clinical education for physical therapy is getting much scrutiny recently from both educators and the employers who hire newly minted graduates following their clinical instruction (CI).

In the opinion of those in the practice community, these new grads do not have the required skills to serve full caseloads in the clinical environment. The opinion of some others is that what students are learning, and how they are learning, in their clinical affiliations doesn't adequately mirror what they will encounter in the clinic setting.

Many PT educators and CA providers do agree that change is needed, and quickly, but can the current model of clinical education be changed for the better, or is an entirely new model needed in order to prepare students for practice under the goals of Vision 2020?

The 2008 Rothstein Debate asked those questions and more, as Larry N. Benz, DPT, MBA, ECS, OCS, with the Kentucky Orthopedic Rehab Team in Louisville, and Michael J. Emery, EdD, PT, FAPTA, of Sacred Heart University in Fairfield, CT (pictured below).

Dr. Emery held the supporting position of the main debate question: Does the Current Model of Clinical Education Really Prepare Students for Practice? "It's hard to just argue for the status quo when we really do need changes," he admitted. "We don't have a model of differing lengths of instruction, for one. There are really three defining characteristics of our current model: 1) a divided locus of control; 2) simulations of practice, ideally to introduce students to a higher level of practice while they are not practicing, and 3) a student apprenticeship that both allows variability but also is fixed."

Dr. Benz said he wished that he could say that the clinical model now practiced "fits perfectly. But I have to say it is completely broken."

Dr. Emery argued that the outcomes support keeping the clinical education model-but that addressing its execution is needed. "The first-time pass rates on exams are going up despite these clinical problems, and 99.6 percent of new graduates still report getting a job within a month of graduating," he said. "The CI system has absorbed the enormous capacity of graduates to fill all the needed positions. So is the execution of the program done properly, or is the model broken entirely? Do we really need an entire replacement strategy?" Dr. Emery advocated reviewing the preparedness of CI instructors and how well CI programs fill their CI instructor slots. "Before we throw it out entirely we need to compare this model to any other new ideas," he said.

But Dr. Benz said pass rates don't necessarily reflect preparedness on the part of students following their CI. "Employers still report a disconnect between what [students learn] in CI than what they see from them working in a clinic. The model turns CI students around in a very short amount of time. Often, clinics facing staff shortages and declining reimbursement take these students on for CI merely to pump their own recruitment."

Both panelists agreed that what drives any model of clinical instruction planning should not be how clinics are reimbursed for students' work in the clinic.

Bridging the Gap

Elizabeth Puliti — Fri, 13 Jun 2008 16:44:00 GMT

SAN ANTONIO—This morning's session "Generational Ethics: Bridging the Gap From Traditionalists to Millennials" was one of the most interesting lectures I've attended at an APTA conference. Maybe it was because it wasn't really a lecture. PTs were encouraged to sit at round tables in the room and discuss issues among themselves. Maybe it was because this is such a hot topic in any work environment now. I see numerous examples of generational differences even within my publishing company. Or maybe it was because the audience consisted of PTs spanning all generations. This made for interesting case study solutions!

Whatever the reason, I learned a great deal about the four or five generations (Generation Y is split between Generation X and the Millenials) that currently work together and how they/we think.

Traditionalists (born roughly between 1900 and 1942), also known as "the greatest generation," overcame the economic depression, are very civic-minded and masterfully raised the next generation, which turned out to be the largest. Baby boomers (born from 1946 to 1964) were encouraged to dream big, and were born during the largest economic growth period. Generation Xers (born between 1965 to 1982) grew up living in the shadow of the boomers. They have what speaker Jon T. Nordrum, PT, DPT, DScPT, GCS, from the Mayo Clinic called, "the middle-child syndrome."

"This generation gave us the term latch-key kids because it was the first time in history that elementary-aged children were coming home to empty houses," he said. Because of that--as well as seeing military failure (we lost a war), political failure (a president was impeached) and economic failure--this generation became survivor-based.

Millenials (born approximately from 1982 to 1997) are nurtured, have parents who are strong advocates for them and have instant access to information because of the Internet.

Dr. Nordrum made it a point to tell the audience of PTs "it is more about how the generation thinks, feels and acts together and less about the date."

Because each generation has different values, conflicts ultimately arise in the work environment. In order to find balance in the workplace and provide optimal care for patients, change must occur, Dr. Nordrum advised. He and other PTs recommended the following:

Be sure to have an open-door policy where everyone is welcome to discuss their thoughts;
Establish mentoring relationships;
Evolve with technology;
Play to the strengths of all generations.

However, some generations, such as boomers, are embracing new values, an audience member pointed out. Dr. Nordrum agreed. "Boomers may be jealous of Xers work-life balance. They were smart enough to ask for it up front, and it's taken us all these years," he mused.

No matter their value differences--and they are just differences ("they're not better, not worse, just different from one another," Dr. Nordrum said)--it is obvious the collaboration of all generations is what creates the best possible team. This was particularly apparent at the end of the first hour when Dr. Nordrum put out a call to any Generation Xers or Millenials in the audience who could help him stop a message from popping up every few minutes during the power point presentation.

Enraged Actor Sheds Light on Medical Errors

Elizabeth Puliti — Tue, 15 Jan 2008 17:00:00 GMT

Just last week actor Dennis Quaid and his wife, Kimberly, found out exactly what happened to their twin babies mere days after they were born. They have recently made headlines because they are infuriated to learn of the details surrounding the medical error months after the initial incident.

A preliminary report detailed that the Quaid's newborns were given doses of heparin (a high-risk blood thinner) 1,000 times stronger than what was prescribed. However, last Wednesday a second report showed that the children were actually given two vials containing 10,000 units per milliliter of heparin--or 2,000 times stronger than what was prescribed.

How the hospital tackled the issue of medical errors was regrettably left off the front page--and that's something that shouldn't be ignored. In this case, the hospital took steps to review all policies and procedures involving high-risk medication and provided more training to its staff.

Unfortunately medical errors happen too often. So, to help health care providers reduce mistakes, the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) designed 17 free, publicly available toolkits that can be adapted to most health care settings.

Released in December, the toolkits focus on an array of issues, including identifying high-risk practices and reducing medication errors or other patient harms. The following are examples of different toolkits:

The Re-Engineered Hospital Discharge "Project RED" toolkit.
The Medications at Transitions and Clinical Handoffs "MATCH" toolkit.
The Preventing Venous Thromboembolisms in the Hospital and the Interactive Venous Thromboembolism Safety Toolkit for Providers and Patients toolkits.
The ED Pharmacist as a Safety Measure in Emergency Medicine toolkit.

For more information and a complete listing of the 17 toolkits, visit http://www.ahrq.gov/qual/pips.

Breaking Down Barriers

Rob Senior — Thu, 01 Nov 2007 15:03:00 GMT

Last week, the Los Angeles Dodgers made news by hiring Sue Falsone, MS, PT, ATC, CSCS, as the first female physical therapist in Major League Baseball. The hire highlighted the increasing trend of professional sports teams bringing in their own physical therapists.

In the past, injured athletes would be sent to independent physical therapy practices for rehabilitation. Teams would have unwritten agreements with certain providers to send players exclusively to that particularly facility for rehab, so some may see hiring a team PT as simply the next logical step.

From a professional standpoint, this can only be seen as a positive. Each sector of society that accepts and embraces physical therapy as an essential part of its organization is another important step towards professional autonomy. The fact that athletes comprise such a large portion of rehab patients makes this particular victory all the more vital, while the hiring of a female therapist emphasizes the importance of equality in the workplace and the availability of these jobs to all rehab professionals, regardless of gender.

What are some other areas of society that could benefit from the inclusion of physical therapy?