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Transition to Rehab Management

Looking Ahead
by Karen Schiff
The "Big Day" is arriving. Not a moment too soon. As my daughters and I pack our bags to take our family trip and attend my graduation, we reminisce about our last vacations together, and quickly agree that this will be the best vacation we have ever had!

I have taught my daughters to be independent warriors for the past few years, to stand apart from all the rest and do the right thing even if it meant getting in trouble for it. This parallels what I have been doing for the past two years as I transitioned from my bachelor of physical therapy to my doctorate of physical therapy. I have, at times, felt as though I stood alone yet I held my ground that obtaining my DPT was one of my most important decisions. Others have questioned the necessity of such a move, but instead of "going with the flow" and being grandfathered in, I chose to be a leader and coach others to do the same.

As the three of us prepare to go on our expedition of Washington, D.C., and Winchester, Va., we are happy to be together, experiencing such a wonderful occasion and celebrating our little family together, more than we ever have before! Just as I'm as proud of their choices and decisions, I can see their pride in me, and the strength I have found to pursue my higher education. Thankfully, I can share my success with them.

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Case Report Accepted
by Karen Schiff
The day has finally arrived. The conclusion of the DPT program came just a few days ago, when I received the "green light" from my mentor. After two years of preparation, the day has come where I can close my laptop on my distance-based, transitional DPT preparation. Now the fun begins as my daughters and I plan our vacation around graduation.

To encourage others to return to school to earn a DPT and not just be "grandfathered in" has always been important to me, and on almost a weekly basis I discuss the necessity of the same with peers. A question that has been posed to me time and time again is, "Will it really make a difference in how you practice?" I quickly respond with my answer, "Yes!" Not only will it make a difference in how I practice, but how I approach other healthcare professionals and make decisions about the most appropriate treatment for my patients.

What keeps many physical therapists away from returning for their DPT may be exactly what kept me away for a few years; raising two daughters alone, fostering and adopting homeless pets, working 40-plus hours a week, playing tennis frequently, volunteering as a Guardian Ad Litem, and having quite an active social life. Self-discipline, love, patience and my faith navigated me through this journey, and certainly did not interfere with my ability to complete this career goal.

As I've said before, I'll say it again: If I can do it, anyone can. In less than two weeks, I will accept this honor and continue to support those around me to do the same. For now, it's time to plan some much-needed family vacation time!

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PT School: Two Weeks Left
by Karen Schiff

With just two weeks left of school, and fresh from hitting the "send" button for my third submission, I'm feeling a little pressure coming off my shoulders. While taking a break from rewriting my introduction and discussion (again, yes, again), I've decided that there's a good chance I may actually graduate on August 16 with my DPT. To celebrate this thought, I have booked our family vacation to Washington, D.C. and then on to Winchester, Va., for this most memorable moment. All of this activity has been prompted by an amazing weekend with my peers at Shenandoah University to complete our thought-provoking final course, "The Doctoring Profession."

Early on in the curriculum of the DPT, I worried that I wouldn't know what to do once I obtained my degree. I was, and still am, considering my PhD, but with the expert knowledge of our speaker, I've come to realize that specialist certification may be necessary at this point. Most visits to physicians are for musculoskeletal issues, so it makes sense to become the primary caregiver for orthopedics, now that we're able to differentially diagnose within the scope of physical therapy, and continue to medically screen our patients (as we always have) for other referral. However, the role of doctor of physical therapy is settling in, and has been for the past two years, when discussions arise with other healthcare professionals.

After all the blood, sweat and tears, I've chosen not to be "grandfathered" into the role of DPT, but rather take an active effort to learn, share and add to our current body of knowledge. This is what I've learned about myself over the past weekend. Knowledge is not something that can always be done independently. There's just too much information out there, with more being added every day. Synthesizing every bit of information, incorporating it into practice, and verifying that what is being done has been shown to be effective is just impossible without pursuing the assistance of others.

I'm refreshed and extremely honored to say that I've experienced the greatest knowledge I can achieve up until today. Tomorrow will be something new, and I'm dedicated to providing the best to our patients by sharing what I know and what I suspect. I encourage everyone to do the same, at whatever level you are comfortable with. You won't be disappointed.

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A Sense of Accomplishment
by Karen Schiff
Taking a day off work before I leave for Shenandoah University to attend the final onsite class for my DPT was more than just necessary. The last two weeks have been challenging, to say the least. Thank goodness my director suggested I take a day off to arrange my house for a weekend with no parental guidance, prepared for the worst yet hoping for the best. Two teenage girls will be monitored by neighbors, my sister, and a boyfriend. The time available today to pack for a weekend with my peers is being utilized to sit down with my daughters and share time to discuss the plan. We're celebrating my birthday with lunch before I leave, as this birthday weekend will be spent with some of the most amazing women I've met in my professional career.

The five of us will travel on Friday to Virginia to complete our onsite class. As I reminisce about two years ago, when we traveled there to begin the quest for our DPTs, I'm overwhelmed by the sense of accomplishment we're experiencing at this moment. Five years ago, I enrolled in the program to obtain my DPT. But I decided to put the plan on hold because of an impending divorce and the family upheaval surrounding it. Not only did we survive a traumatic event, but my daughters and I also set goals and boundaries for our future.

Today at lunch, my girls and I reminisce about those times, and appreciate how the negative allows us to grow and succeed at whatever we wish for in our future. This is my accomplishment, to complete my DPT with my girls by my side and amazing coworkers around me to share our knowledge and appreciation for what we've learned. With graduation around the corner on August 16, there's still much to look forward to. Second submission is in the hands of my mentor, and travel reservations are in place to receive the honor of my DPT.

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Time is Running Out
by Karen Schiff

Just when I thought I had it all figured out, my entire background and discussion need to be re-written. Don't get me wrong: I realize that my mentor's comments are entirely true and acceptable. Thankfully, he offers suggestions to assist me with the daunting task of rebuilding my case report. In the beginning, I was given a shell to fill with background information gathered to support my case, my patient case itself, and a specific outline to follow.

Everything was filled with enough detail to replicate my intervention for a patient with a complicated acetabular fracture with associated femoral and obturator nerve. However, building a background and presenting a specific aquatic therapy protocol continues to be a struggle. Right now, my biggest challenge is completing a discussion that has to be completely re-written as a result of making no sense whatsoever, especially after reading my mentor's comments.

These days have gotten quite long: making sure G-codes are being entered for Medicare patients, writing and presenting performance appraisals, trying to do home visits on the two kids who I'm a guardian for (and missing court hearings due to meetings at work), keeping track of teenage daughters over the summer, and every so often sitting in front of the laptop to finish this case report. When I realize that I'm too tired to do that, I lay in bed with my iPad and my Writing Case Reports book. This doesn't last long.

Looking forward to the weekend to sleep in, finish this thing, and go out for some much-needed dancing with my significant other. I must remember, though, that time is running out. I'm less than one page away from completing my second submission. Next weekend is something to enjoy: weekend class at Shenandoah University over my birthday weekend with four very good friends and fellow DPT candidates. Give me strength, give me insight. Mostly, give me a passing grade!

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Preparing for Second Submission
by Karen Schiff

The first draft of my case report literally created sweat, tears, and probably a little hypertension. Having turned it in and not hearing a response was a relief, yet worrisome in that I wanted to make sure my mentor actually received the document. After missing sleep wondering if his email was working, I had no choice but to email my mentor to ask if it was received.

Ask, and you shall receive. Not only did he receive it, but he went through it with a fine-toothed comb. As I reviewed the track changes with a heavy heart, I couldn't have agreed more with each and every comment left for me to reconsider. My initial thoughts before reading the response were: Take a deep breath, there is an answer, I've made it this far and I'm not going to freak out that I might have to re-write my entire report. Those are still my thoughts, and I've been contemplating for a week what I'm going to do to respond to his suggestions and finish the final project for my DPT.

This summer is laden with goals. This four-day holiday weekend has given me the chance to get together with peers from my previous position in the healthcare system. Attending a BBQ last night and commiserating with another DPT candidate regarding our plans to sit at our laptops over the weekend was quite relaxing. As we shared our thoughts on what our plans are, we have similar goals: to dedicate this weekend to our professional and personal fulfillment. There's nothing more consoling than the realization that I'm not in this alone, that the occasional panic I feel is shared by others.

As we prepare for the second submission of our case reports, quickly we realize that our final weekend course at Shenandoah University is approaching on July 19. What better way to celebrate the proximity of our DPT than by spending a weekend with our fellow candidates and friends, in a three-day dedication to the doctoring profession. Besides, my four classmates and I will spend some quality time together, enjoying each other's company away from our busy lifestyles in South Florida. What's not to look forward to? Preparation of second submission is underway!

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Relief In Sight
by Karen Schiff

A weight has been lifted from my shoulders. The first submission has been emailed to my mentor. Now is the time to take a deep breath and pray for a clean return of my case report. After months of sweat, sleepless nights, and emotional ups and downs, I can now settle into my position as an effective manager and make sure that all G-codes have been entered at work, my home gets cleaned and the laundry gets done. Scheduled court hearings for the kids I am a Guardian for are in place before my visit to Shenandoah University for my final weekend class over my birthday weekend. The light is definitely at the end of this tunnel.

It's amazing the relief I've experienced since the first submission. I've learned so much about the APA style of writing and the content of a case report that's fit for publishing. Although I know my case report will need more than just a little bit of revision, I consider myself closer to finished than I was two months ago. With just a few days since the email was sent to my mentor, I've come to appreciate my family and work even more than I feel I ever have. The support I've received from everyone around me, the patience of my employees and peers, the love and space provided by my family (due to my emotional instability right before submitting) has been appreciated more than I can put into words.

With more relief in sight, and graduation around the corner, I'm now comfortable with purchasing airline tickets for my daughters and I to travel to my school for my graduation ceremony. This has been my goal from the very beginning -- to show two great daughters of a single mom that anything can be accomplished, and we will celebrate with a great family vacation.

I await the response of my mentor. This is the time for great reflection and sharing with my peers the necessity of continuing our education. Thankfully I have enough on my plate to keep me busy until I receive that response from my mentor, and complete one of my career goals, my DPT.

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Making Changes
by Karen Schiff

Preparing a case report for initial submission isn't as simple as I thought it would be. Having followed the guidelines set forth by the APTA website for the content necessary in a case report, I failed to achieve a very important part: limited word count. A word count of 3,500 doesn't sound like a lot, and trust me, it isn't. Now that the paper is completed to somewhat of my liking, I have to cut it down by more than 1,000 words. Not an easy thing to do for someone who enjoys writing, especially when related to my profession.

I consider myself to be a week overdue for my first submission, which doesn't make me happy. Tonight will be the night I take my work to the cutting board, slicing away what may not make it to the final product. This is the most difficult time for me to focus, as I know I must make arrangements for my daughters and I to fly up to Virginia in August for graduation. Perfect time for a family trip, to explore Washington, D.C. and the countryside of Virginia, not to mention the experience of having my girls see me receive my DPT.

It was in the beginning, and remains at the end, the most amazing experience of my educational career. Perhaps I'm just too excited by the thought of finishing, or maybe it's the thought of my mom and dad's pride as they watch from above. What matters most is the impression I've left on my girls, as well as the amount of knowledge I gained and put to work, and have been putting to work on a daily basis. Whatever it is, I know that the next few days will be most stressful until I hit the "send" button on my school email account.

To put the icing on the cake, G-codes are just around the corner. More changes on the way with the documentation we provide in patient charts, as well as what we attach to the bill. Just when I thought my stress level was a bit high, I feel for my team of therapists. Confusion, concerns and worries regarding what is required as of July 1 are what consume them. However, they know that whatever we change now will likely change again in the near future, so all the fuss of making changes is literally just a dynamic process. Such is healthcare and moving forward into the future!

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Investing in Our Future
by Karen Schiff

Along with all the chaos that accompanies a capstone project, additional pressing issues come to the front lines. Within the past few months, the subject of G-Codes has taken up a majority of time in regard to educating ourselves, clinical and ancillary staff, as well as a busy IT department. In preparation for a mandatory July 1 compliance date, many hours have been spent trying to configure an operating system that complies with all the necessary information in treating and billing our Medicare patients. Now that the deadline is just around the corner, it's time to test what has been set up to comply with the rules.

A new language was introduced to rehabilitation staff this past week, and although confidence in attempting to explain what needs to be done after July 1 was in the message being delivered, a hint of heightened insecurity was detected by all. As in most situations where major change is about to occur, questions arise about how the implementation will take place, rather than what the final product will look like. This is a time of great change, again, and as the saying goes, "what doesn't kill us will make us stronger." Soon, this too will be behind us, and the next major change is no doubt lurking on the sidelines.

As another weekend approaches, and a plan to complete the first rough draft of my capstone is at the front of my mind, I'm quickly reminded why we need to educate, document and research the reasons we do what we do. In times where reimbursement is becoming more complicated, we must become more savvy in the way we approach payers, by demonstrating a need for our skills and what we can contribute in the care of their clients. By doing so, we're investing in our future, as well as the future of our patients and new professionals in the field.

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Consumed by a Case Report
by Karen Schiff

When it rains, it pours. That's the only thing I can think of as I write endlessly into the night about pelvic fractures, aquatic therapy, and my case report. Sentences are not scarce, and the time to condense the content of this paper is coming this weekend. Limited sleep and awakening to ideas in the middle of the night that I can include in this paper to finish my doctorate is what life is comprised of these days. At least that's all I thought I'd have to deal with in these final weeks.

As I sit at my desk at work, I frequently think of content to include in my report. Yes, I'm consumed at all times with this final project. However, today an event jolted me to the point where I had to step away and call it a day. Tangled in the manuscript in my head, I was startled by a staff member who asked to speak to me behind closed doors. What happened next was quite an alarming admission that her paycheck wasn't what she expected it to be, and that once she paid for part of her rent, she wouldn't have enough money for food for the next two weeks.

Dealing with patient care issues on a daily basis has been quite challenging over the past four months, including difficult patients, parents, and insurance issues. However, I never imagined that my own staff would have to deal with issues like this. Not knowing what to say or even suggest, all I could do was listen and support the employee's concerns. Surprisingly enough, I was able to come up with an idea that may help her situation, but not within the next couple of weeks. Now that I've had time to absorb the conversation, I've come up with other ideas as well.

Another mission is on my plate, to help those around me that need more than I. Rather than losing sleep for the next week, I'll exhaust my energy on others that need help, and continue the chaos of paper-writing during my waking hours. Changing the strategy may be what I need in order to finish the final project for my DPT.

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Taking a Look Back for Rejuvenation
by Karen Schiff

Organizing a case report is proving to be more challenging than ever. Although my patient case is, in my estimation, a complicated issue, I thought for sure that I'd have more than enough to research and background information to present than I'd know what to do with. Interestingly enough, during the exhaustive literature search from last semester, I found minimal information in regard to acetabular and pelvic fractures that I could use to support the need for this case report.

However, as I sit down to begin the background information, I try again to find articles that may have been published on the subject. Instantly, there are four journal articles published in the past month on just the subject I was looking for! As I feverishly read the articles, I realize that this is just the starting position I need to be in.

Starting broadly on the different aspects of my patient case and then paring down to the specifics, I need to tie my patient's comorbidities together. The issues present in this case made the decision to place the patient in an aquatic environment almost a last-ditch effort to hasten her recovery with as little trauma as possible to her already traumatized, post-surgical pelvis.

Thankfully, this motivated and mentally prepared patient was the strongest person I've ever met in my practice to this day, and because of this, she was chosen to be the one I'd describe as my most successful case. As I admitted to her in the middle of her care, I wasn't sure how far she'd progress, but thankfully she took this admission as a challenge to prove my doubts wrong. To this day, she continues to amaze me with her energy, activity and social life (and this is years later).

This is what keeps me reading article after article, in an effort to support the need for this case report. The complexity of the situation, combined with the tremendous outcome due to the patient's personal strength and theoretical basis for the treatment chosen for this case, all play a major part in the development of this report. Now it's time to get back to writing, reading, reviewing and completion of this project.

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Let the Fun Begin!
by Karen Schiff
The dining room table no longer is clear. It's covered with journal articles, the Guide to PT Practice, and numerous notes from all of the classes I've completed so far. With the final two classes upon me, I'm feeling quite a bit overwhelmed and I'm not sure why. Previous classes have been quite challenging, and now that I have to incorporate all that I've learned with what I know, and apply it to my patient case report, I'm not sure how to put it all together in one document. Thankfully, I'll have more than one chance to present this case report.

What has helped me most with this task so far has been reading other case reports. I've learned writing styles vary greatly and each case report is significantly different from the rest. This is what makes even an "average" patient case more interesting and adds to our current body of knowledge. Trying different techniques on similar types of patients, applying techniques that may not be familiar to us, and describing patient case management are three areas I'm considering focusing on with my particular case. However, I believe I have to incorporate all these areas to complete a professional, publishable document for publication.

In an attempt to stay positive and relatively stress-free for the next couple of months, I arrange a busy lifestyle to keep my mind and body healthy. With hard work and determination, I'll end up with my goal being met, and come out with the reward: my DPT!

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Burning the Candle at Both Ends
by Karen Schiff

As the dust begins to settle from separating one department into two, this extended break from school allows me to get a grasp on what being a manager really entails in an outpatient rehabilitation facility. From balancing payroll to juggling hours in three disciplines to staying productive, to completing performance appraisals and performing chart reviews, I quickly realize why I absorb only five hours of sleep each night.

Just like other leaders around me, I thrive on being able to mentor, support and at times counsel staff in a positive light to promote a better system of healthcare. This has been a challenge as more duties are put on my plate. Perhaps five hours of sleep is all that's necessary, except for the fact that I can sleep like a bear on Saturday and Sunday mornings -- which, as a matter of fact, is the time I'll need come this weekend to write the final paper for my DPT.

Some of my most productive "thinking" for this final assignment occurs during the most unexpected times of the day. I find humor in the moments that I come across these productive thoughts, and wonder if I'm the only one who experiences random bursts of mental energy for what I'm about to initiate in this final quest. For example, I've been blessed with a new friend who meets me for coffee before work every morning. As a Native American, he provides such insight into how the universe is connected to us mentally and physically, along with sharing life experiences and influences.

In the midst of such a deep conversation, a flash of a table in a particular case report I read the previous night comes across my mind. Trying to take mental notes of thoughts for this project has proven to be less than successful, so I rely on modern-day technology to save these thoughts for my weekend project. Perhaps it's just the coffee stimulating these thoughts, or perhaps this friend has stirred something in my mind to produce little tidbits that will hopefully assist in building this case report. Whatever the reason, I find myself making an apology for pulling out my phone to keep track of what I may need to complete my project.

Another thought is that I may be burning the candle at both ends, where I keep myself so busy that I only have moments during each day of the week to review in my mind the subject at hand. But even if this is true, I'm determined to produce the end result gracefully. Once this is completed, I'll sleep endlessly, and undoubtedly be able to provide more to my family, friends, dreams and career. Time will tell, my friend explains to me, as the spirits and the universe work together to unfold what is yet to come. I don't know what this means, but I surely embrace positive energy to keep me on track for this journey.

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In Preparation for the DPT
by Karen Schiff

Amazing what can happen in one week. In a major healthcare system of a large metropolitan area surrounded by water, we've successfully accomplished separating pediatric from adult rehabilitation in preparation for our growth as the Rehabilitation Institute of South Florida. Every day of this mission has started at 5 a.m. with communication with one of my best friends, the leader of this department (in addition to being the leader of several other departments). When I look back to the time we met more than 20 years ago, I remember thinking that this person would be someone I'd follow someday. Here I am, years later, reporting to her on a daily basis.

As I struggle with keeping our department productive and mentoring staff including physical, speech and occupational therapists, I'm comforted by the words of many friends that we're becoming a vision for the future of rehabilitative medicine. Not only does a comprehensive rehabilitative system provide every facet of care needed by the community, but also offers a link to other services not regularly affiliated with us (i.e. outreach programs).

Thankfully I'm able to support therapists' ideas to expand our care into the community, as well as continue my support on an individual basis with the Guardian Ad Litem program. Every day is an adventure at this point, between work and a fulfilling personal life with the Guardian program. Time will pass quickly during this transition, as my new semester starts this month.

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Good Timing
by Karen Schiff

A short break between semesters has proven to come at the best time for me. Today brings with it a major change in my facility, where one department is becoming two. Employees have been preparing for months for this change, with hopes that everything goes smoothly. In a large department where things don't always go smoothly on a regular day, we have great expectations that the preparation will pay off and a smooth transition will occur.

Starting today (and hopefully for only the next week), we'll be re-registering every patient who comes through our front door. Our first line of defense, the front desk, will be inundated with the process of obtaining signatures for financial and medical consents. We've already begun the process of changing patient accounts to be reassigned to either the adult or the children's hospital, whereas before today the patient's account was registered to only the adult hospital. In preparation for this day, we've assisted our front lines to make the transition as smooth as possible and reduce the chaos that's looming in the next couple of hours.

As I tossed and turned throughout last night about the impending change, I realized that the faith I have in our registration team is what would give me one more hour of sleep before the alarm clock went off. Thankfully, all of this change couldn't have come at a better time. It amazes me that these 11- to 12-hour days at work are only possible because I have two more weeks of break between semesters. However, I continue to gather information for my final paper, which I work on only during the weekend now. School has become my break from a busy work schedule. I welcome the thought of finishing my DPT and wonder what the future holds when I complete my goal.

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