APTA Michigan Lines is a blog to promote collaboration between professionals and students of the physical therapy profession in Michigan.

The goal is to create a space where individuals from many backgrounds can share knowledge and experiences with each other and the community.

We would love to hear from you about a topic you are passionate about. Posts are submitted by individuals and reviewed for posting. You can submit yours by emailing new blog items to contact@aptami.org


 

Change is inevitable. Everything must change. Change is the only constant. These commonly used expressions hold some truth, and in considering our profession’s evolution as we celebrate the Centennial, they have got me thinking about our collective future. What will physical therapy look like? What should it look like? What must it look like? There are three potentially very different answers to these questions. We only win if the answer to all three is the same. We only win when we do it together, as a unified association.

We have some existential threats that will shape who and what we become, and we must deal with those threats successfully if we are to thrive. The ones I want to focus on here are value-based payment and diagnosis. I believe these two issues to be key drivers of many other related issues including the worsening student debt-to-income ratio, our lack of workforce diversity, our professional identity, and physical therapists being the providers of choice.

Regarding value-based payment1, we are clearly not thriving on procedure-based, fee-for-service payment models. Payers are not offering substantial increases in payment, even if we demand it.  Gone are the days that we will be paid for the volume of service provided, especially when it is not linked to outcomes. I believe that the only way we will be able to see increases in payment is by clearly measuring and demonstrating our value. This requires systematic measurement (and reporting) of outcomes…patient satisfaction, patient-reported outcomes, objectively measured functional performance outcomes, and down-stream cost savings with regard to reduced imaging, surgery, opioid use, emergency department visits, hospitalizations, and specialist consultations. When we demonstrate our value, we have the best chance at increasing payment for our services. Salaries can increase. Student debt-to-income ratios improve. PT school will be more affordable and a more attractive career option to a greater diversity of people. The diversity of our workforce can start to reflect the diversity of the communities we serve.

Regarding diagnosis2,3, I have been following with great interest the ongoing discussion about diagnostic labels and their relevance to not only our professional identity, but also to research and payment policy. There are no easy answers here, and as Dr. Deusinger puts it, this is a “wicked problem.”3 But we must confront it. What makes me cringe is the high probability that a single patient could see 5 PTs and come away with 5 different diagnoses. This is true of all PT clinical settings and specialty areas, but is especially true in the outpatient orthopedic world. Without having a single, unified, data-driven diagnostic classification system that is universally taught in entry-level professional education, we rely upon a continuing education industry to sell competing approaches and certifications to licensed clinicians for how to diagnose and treat patients. Not surprisingly, we can have 5 or more different diagnoses for the same problem in a single patient depending on what treatment approach the clinician “follows” and “believes in.” The path forward is indeed “wicked”, but if we do not develop even some semblance of a research-supported universal classification system, how can we assure payers, policy-makers, and patients that we can consistently and predictably deliver on our brand promise and be the provider of choice?

 

Predicting the future is difficult. Ignoring history is condemnation. Since 1921 our profession has faced many existential threats and wicked problems. As we reflect on the past 100 years, let’s remember the single constant: It is only as a group of professionals unified by OUR professional association that we have succeeded. The next 100 years will be no different. Here’s to the start of our second centennial!

 

1 Dianne V. Jewell, Justin D. Moore, Marc S. Goldstein, Delivering the Physical Therapy Value Proposition: A Call to Action, Physical Therapy, Volume 93, Issue 1, 1 January 2013, Pages 104–114, https://doi.org/10.2522/ptj.20120175

2 Shirley Sahrmann, Defining Our Diagnostic Labels Will Help Define Our Movement Expertise and Guide Our Next 100 Years, Physical Therapy, , pzaa196, https://doi.org/10.1093/ptj/pzaa196

 

3 Susan S Deusinger, PT, PhD, FAPTA, Robert H Deusinger, PT, PhD, Achieving Diagnosis-Based Practice: A Wicked Problem in Physical Therapy. On “Defining Our Diagnostic Labels Will Help Define Our Movement Expertise and Guide Our Next 100 Years” Sahrmann, S. Phys Ther. 2020 https://doi.org/10.1093/ptj/pzaa196, Physical Therapy, , pzab005, https://doi.org/10.1093/ptj/pzab005

 

 


The Underrated Benefits of APTA Michigan Membership

I’d like to preface this article by saying that there is no single best reason for maintaining a professional membership in ATPA Michigan (APTA MI). Membership provides a list of benefits that is long and varies from person to person—and that’s okay! Today, however, I’d like to take a little time to recognize the membership benefits that I consider to be unsung heroes. The benefits, in my humble opinion, often go uncelebrated. The benefits that are typically overshadowed by some of the other, more tangible benefits our professional association provides.

If there is one thing that I have learned in the past three years by volunteering for APTA Michigan’s Membership Committee, it is that each person measures the value of our professional association differently, and one person’s reason to be an APTA MI member may be completely different than another’s. In full disclosure, my data on this subject is purely anecdotal; however, often times when I ask individuals to discuss the aspects of their APTA MI Membership they find most valuable, the most common responses I hear are things like:

1. Access to content and resources.

3. APTA MI conferences and events.

4. Networking opportunities with other professionals.

Don't get me wrong, I love and appreciate these benefits too! I’ve utilized my unlimited access to content and resources, like PTNow, Rehab Reference Center, and APTA Article Search on countless occasions. I enjoy member discounted rates for registration at conferences and continuing education courses. More than once I have used the network of professional relationships that I’ve built through this association to my advantage. Moreover, the place I’ve found within the APTA MI has helped me to feel like I’m engaged in my profession and a part of something larger than myself.  I am grateful for these aspects of my membership and I understand why other members enjoy these benefits too.

Membership benefits like access to resources, attendance at conferences and networking opportunities are the aspects of APTA MI membership that we are most readily able to see, experience and utilize for ourselves. Today, however, I want to recognize three benefits that sometimes seem to go on behind the scene. These benefits may be less visible and less palpable to us than other benefits, but they are in no way less important:

  1. Payment
    1. While you are enjoying the access to resources, conference, and networking opportunities, your membership dues are working to advocate for our profession’s best interests by allowing APTA MI to sit at the table with third party payers such as BCBSM and CMS to ensure that their policies are consistent with the current professional standards of practice and Michigan state law.
  1. Legislative Advocacy
    1. Additionally, your membership dues are working to give our profession a unified voice, by allowing APTA MI the ability to analyze legislation to ensure it reflects our current scope and standards of practice on both a state and national level.
  1. Physical Therapy Identity
    1. Finally, your membership dues are working to develop our profession’s identity, by allowing the ATPA MI to promote recognition of the breadth and depth of physical therapy services to the public, our consumers and other healthcare professionals. 

I know these benefits may not always be something that members are able to directly see or experience as they materialize. Oftentimes, the individuals who make these benefits possible are silently at work while we are busy tending to our daily lives and focusing on our own practice. However, it is still important to acknowledge that these aspects of our membership do in fact have a direct impact on our professional practice. As a profession, we all benefit as a result of the continual efforts of our professional association to represent our best interests. Together our membership in ATPA MI creates a unified front when it comes to issues related to legislation, payment and our professional identity, which is something that as individuals we could never hope to accomplish. Once more, establishing a unified profession is one benefit that I think we can all agree is truly priceless.

So, before I leave you today, I hope you take a moment to reflect on and maybe even reconsider the value you see in your APTA MI membership. While I know that as members, we will continue to enjoy the conferences, the resources and the networking, I hope that we can also give some of the other ATPA MI member benefits the recognition that they truly deserve.

 

 


When the world took a turn with Covid-19, we were ready to think on our feet and adapt to our conditions in order to be successful. In PT programs across the nation, we saw adaptations such as reduced class size, hybrid learning, reduced lab hours, full PPE in labs, and limited lab partners in PT classes. Not only did we make rapid accommodations, we did so in a way where we remained confident that students were clinic ready. This resilience in the face of adversity is a testament to what we are capable of as a profession.

Covid-19 is not the first situation in which this resilience has been warranted; however, it is perhaps the first situation where it was necessary. For various religious or cultural reasons, people have requested accommodations. Sadly, many have been treated as though their accommodations were impractical or a hindrance to learning. Today we might see those barriers as largely self-imposed. As an observant Muslim woman, I have firsthand experience with this. I requested religious accommodations in PT school, which included having a privacy screen and not having the men in my class work on me during lab. I made sure to be clear about these accommodations from the first day of class. I have never been hesitant to speak up, and I have advocated for the accommodation of Muslim students at the state and national levels. Despite going in with a message of clarity regarding my religious accommodations, I realized quickly that I could not lose vigilance in the advocacy for my rights. To me, my situation was simple. To others, it was a hassle that was at most tolerated. One memorable event occurred in class, when I realized I was mistakenly paired with a male partner. I switched partners with the person next to me and proceeded with my learning.  An instructor noticed and called me out after class. I was told that I was unprofessional in my conduct and that my behavior was burdensome to the class. The instructor’s words weighed on me. I felt tolerated, not embraced or appreciated for my differences. Reengaging with learning is always difficult after such situations, and this was just one of many I have faced in school and in clinics. Asking for help becomes harder and finding the motivation to continue facing the same situation each day feels impossible. Covid-19 is a testament to how much we are capable of and how much better we can do. How many students were in situations like my own? How many did we inadvertently deter from becoming PTs due to the perception that we were not eager to accommodate them? How many hesitated to speak up about cultural, religious, or other accommodations because it did not seem the profession valued them enough? I am not speaking in hypotheticals. I was that student, and I have met these students. Most recently, I was asked by a new student if requesting an accommodation would “rock the boat” too much and impact her professional career.

Let us not underestimate ourselves in the future. While we hope Covid-19 ends sooner rather than later, this newly discovered creative ability should be something that is continued long after this virus is gone. It should continue as an essential element of our profession and should be applied to better treat, accommodate, and foster the success of minority students. It is a strength we should embrace today and in the future.

 


In the world of an acute care therapist working in a large metropolitan hospital, we live day to day knowing that we will not be able to provide treatment to the number of patients who need our services because of high patient volumes.  We spend most of our time trying to figure out some sort of priority list that tells us which patients are going to make the cut for treatment.  New evaluations, patients returning home, patients who need rehab placement.  Who needs us the most?  It’s the question that physical therapists in acute care struggle with every day.  Did we help the right patient at the right time and were we the right provider? 

Helping people to understand the role of the acute care therapist can also be a daunting task.  No, we aren’t just here to provide a discharge recommendation.  We aren’t just the resident lift team for the hospital either.  We are skilled professionals, experts in mobility and regaining function in the presence of disease, musculoskeletal impairments and critical illness.  We are here to help a patient regain their independence.  We are here to listen to what their goals and needs are so we can help them achieve those things.  Both of these issues are on the forefront in the life of acute care therapy on a regular basis, but then came Covid-19…

In the midst of the chaos trying to accommodate the significant number of patients with Covid-19 in a hospital right in the epicenter of Michigan’s coronavirus outbreak, we began to see our volumes for therapy decline.  Decline is probably an understated way of describing it.  It was more of a drastic, mind blowing decrease in the number of patients on our schedules.  Our ICU’s, where we have a robust early rehab program were filled with patients so sick, the only goal was survival.  Therapy wasn’t even a thought in those initial phases.  General practice units were being turned in to ICU’s to accommodate the volume of critically ill patients we were admitting.  For the first time in an extremely long time, we were needing to completely restructure our department to be able to utilize our staff.  We deployed some of our staff to a prone team for Covid-19 patients. Others became “screeners” and worked on identifying patients that would benefit from therapy services so discussions could be had with physicians to place orders for a therapy consult.  It was a whole new world for us, however it led us to the path that we had always wanted to be on. 

With this new world came a new sense of empowerment for therapists. Having the ability to see the patients who truly needed skilled therapy services daily.  After all, this was potentially the only therapy they were going to receive related to their hospitalization.  There were so few rehab facilities accepting patients, especially patients with Covid-19 after hospital discharge.  Physical therapists getting the chance to do what they do best- help a person reach their full potential for functional independence and return home.  The outpouring of appreciation from patients so energized to receive therapy in the hospital so frequently was invigorating during a period of crisis that felt like it could swallow us whole.  These patients were isolated. There were no visitors, minimal contact with hospital staff to prevent over exposure, and no going to the hallway.  They were isolated to 4 walls with the door closed.  The therapy sessions were a bright spot for these patients.  They were eager to work.  They were eager to get better and stronger.  They were eager to return home.  For once we didn’t have to justify why we couldn’t see a patient daily because our time needed to be divided by an enormous number of patients.  We had the ability to do it and it felt right.  It was the right thing to do - for the right patients. And we were the right providers.

What’s more is that the absence of therapy for our severely critically ill ICU patients, made other healthcare providers realize just how important physical therapists were to a patient’s recovery.  Upon our return to the ICU’s, we were greeted with “we missed you,” or “I’m so glad you are back working with these patients.”  We weren’t just there for a discharge recommendation or to lift someone who couldn’t be moved by the nursing staff.  They wanted us there for our ability to get patients stronger and assist in their overall healing process.  Our impact in those ICU’s was brought to light by Covid-19.

While Covid-19 will leave a long-lasting impact on us all, if we had to find a silver lining in the trauma and sadness, this would be one of those things.  When you hear about your co-workers contracting Covid-19, being put on a ventilator or worse, the look of gratitude on a patients face is just the thing you need to keep you going when you feel like you can’t take another step.

 

 


Into the Unknown

If you started belting “Into the Unknown” like you are Idina Menzel (Elsa from Frozen) after reading the title, don’t worry you aren’t alone. While for Elsa, the song was in response to a mysterious voice beckoning her into the unknown, perhaps the events of 2020 are calling us and our profession to a similar journey of self-awareness and discovery.

Has anyone ever asked you ‘where do you see yourself in 5 years?’ I think I am pretty safe to say that we have all been asked this question at least once, and that most of us NEVER envisioned 2020 going the way that it has. That being said, as I reflect upon the impact the COVID-19 pandemic and the Black Lives Matter movement had on this year’s APTA House of Delegates (HOD) meeting, I am reminded that we are a profession that has evolved and thrived on forging into the unknown. We address the necessities of our society by building upon our knowledge and skills, utilizing new technologies, pushing for educational advancement and by traversing into new clinical environments and specializations. Consider how far we have come over the past almost century. We have evolved from being an exclusively female profession of rehabilitation aids helping war veterans and polio patients to now diversifying our membership, expanding our presence in a multitude of practice specializations, achieving doctorate educations, and taking on more practice autonomy, to highlight a few. While we should both celebrate and be humbled by our achievements, let’s not stop here. If we were to ask ourselves ‘where do we see our profession in 10, 50 or even 100 years?’, what do we envision for ourselves? Where do we go from here? 

What does it really mean to be a physical therapist or physical therapist assistant? What makes us stand apart as a profession? Why do we invest so much of our time and energy on researching, advocating and providing the best care for each patient? What issues would we unite around and fight for?

Take a moment- I am sure you have come up with at least one fundamental issue that you would want to have changed or improved upon. Maybe it’s the education cost to reimbursement ratio, maybe it’s the burnout from lofty productivity goals and endless documentation, maybe it’s the wish to be an “essential” healthcare worker; whatever “it” is, I challenge all of us to step out from behind our documentation, differing environments and social media feeds to actively question the status quo and start a collective roundtable dialogue, invite all members of our profession to participate. The steps forward for our profession start now. Let’s not just #choosept, but let’s #prioritizept. Let’s start the new century as a unified front with a collective vision as we enter into the unknown. 

 


Note:  APTA Michigan supports all candidates, regardless of political party affiliation, who are supportive of issues important to our profession and patients we serve.

Many of you have heard me talk about the importance of civic engagement. I am currently running for State Representative in Michigan’s 60th House District and am in a competitive primary which takes place on August 4. While I highly encourage physical therapists and physical therapist assistants to consider running for office (we need more of us making decisions at all levels of government!), I wanted to discuss a few political options that can make a difference for our profession.

First, NOW is the time to consider volunteering, donating, and helping with a campaign and candidate you believe in. Trust me, candidates will REMEMBER those volunteers who spent time making calls, texting, lit dropping, putting up yard signs and giving of their time to help the campaign. Of course, monetary donations are also needed, but there is nothing like volunteering to make an impression with a candidate and future lawmaker.

Second, consider applying to serve on a city, county, or state advisory board. There are many – some to consider include Public Health boards, environmental boards, school boards, and planning commissions.

Third, use your social media platforms to help encourage people to vote for candidates you think are physical therapy friendly and will help promote our issues.

Last but not least, vote, AND take someone with you to the polls or encourage your friends, family, and neighbors to vote. And if you have students in your workplace, encourage them to get registered and vote.

Also, please consider thanking a candidate for running. Whether they win or lose, being in the public eye is a difficult endeavor. Few reach out and say thanks. Again, you will make a difference and stand out by sending a note of appreciation to your favored candidate after the election.  Include your business card and offer to be of assistance with any health-related legislation or issues that may arise.

Julie M. Rogers, PT

Candidate for State Representative, 60th House District

julie@juliemrogers.com

 


The Golden Retriever

                A long time ago in some undergraduate psychology class I vaguely remember taking a personality survey designed to best match an animal to your personality characteristics. One look at the title above and you can guess what mine was. My qualities of dedication, focus, playfulness, and loyalty forever cemented my place as…well a dog apparently. In all seriousness though I should have realized these qualities for what they were at that time, a prediction of my future role as a clinician and a leader.

                There is a reason golden retrievers are one of the preferred breeds as leader dogs for those with vision impairments or disabilities. This breed is caring when needed, but also committed and focused to accomplish a particular task and ensure safety. Golden retrievers are loyal beyond all else and exhibit a playful yet modest demeanor that cements them as a quiet leader. I possessed these similar qualities years ago and somehow have refined them over the years to carry over into my personal clinical and leadership style. How do you refine qualities similar to a leader dog and employ them in the world of physical therapy you ask? Well, let me try to explain.

Before I delve into this rabbit hole let me first say that this leadership style is by no means the best and is certainly not for everyone or every setting. This also is not intended to be a self-help guide; this is merely how I have evolved to think about leading over the last several years. One of the main reasons golden retrievers make good leader dogs is they listen. They patiently wait for a signal, noise, or action from their master to then quietly initiate a response. A quiet leader is quiet because they listen first. Listening to the verbal and non-verbal signals presented by others will enable you to understand their emotions, motivations, and fears. When people know they are being heard it helps diminish their stress reaction and introduce real communication.

Second, quiet leaders just like golden retrievers are genuine. A quiet leader believes in who they are and what they do. Confidence is equally important whether leading a person with a visual impairment across a busy street, or leading a department during a global pandemic. Any amount of hesitancy certainly will result in disaster, so the quiet leader calmly picks up the leash and their head and marches out. This does not mean you are always headed the right direction (even dogs get this wrong), but it means the people behind you will follow even if they are not sure because they trust you. This trust is not built solely on experience or skill, but on loyalty, focus, and dedication.  I have spent a lot of time over the past few years NOT reading leadership books. Instead, I read books on vulnerability, late bloomers, and the power of introverts.  These topics help me understand myself better as well as understand how to think the best of the patients and staff I work with. Knowing people and being intuitive help me motivate my patients and those I work with to get the best results.

Lastly, a quiet leader much like the golden retriever does not necessarily have to be quiet or silent.  The quiet is not a reflection on sound but more so calm, simple, and restrained. When danger lies ahead, the golden retriever might let out a short but emphatic bark to warn of an incoming threat. When necessary, even a quiet leader will give succinct direction, or speak forcefully to best advocate for their cause.  This action is only used though when imminent risk is present and immediate direction is needed. The rarity of utilizing your words in this way lends weight to them. When I bark, people generally listen because they know it must be important.

Well there you have it, my life as a leader dog. Ironic as it may seem, I really feel this is the best way to describe the style of quiet leadership. Even if you’re not officially in a leadership position, I can guarantee you that everyone is a leader to their patients. You are guiding them away from pain, towards recovery, strength, and independence. There are a lot of books on leadership, and I really could tell you I have not read that many of them. What I can ask you though is to think of people who you admire and follow, how do they inspire you? Now think of that golden retriever, who listens, is confident, calm, direct, and patient. I would follow that leader into a busy street, or a new project, or a global pandemic. Be the quiet leader that sets an even tone every day. Be a leader that listens first and waits patiently for a sign to act. Be the leader that is genuine and confident enough to be calm amidst chaos. Be the leader that is the role model for the ideal member of the group. Why not be a golden retriever?

               

 


Riding the Pine

Not familiar with the phrase? It is an expression in sports that refers to being on the bench…being on the sidelines and not having the chance to get in the game and contribute to the team’s effort.

I have found myself thinking a lot lately about my days playing basketball in high school. Those who know me may be shocked to know that yes, indeed, I played varsity basketball in high school. At 5’8 ¾” first thing in the morning when my intervertebral discs have been hydrating all night, “basketball player” is not the first thing that comes to mind when you think of me. And by “play basketball”, I really mean lots of playing in practice. And even when I got to play during the last few minutes of those games when we were crushing the opposing team, I missed a lot of shots and had several turnovers. There was a reason I was a pine rider.

So I got good at helping my teammates in practice to prepare for games and cheered them on, especially when the game was close or when we were losing. “Let’s go Blue!”  But I spent a lot of time riding the pine and enduring the frustration and disappointment that goes with it. I thought those days were long behind me.

Then came COVID-19.

My full-time employment is as an Associate Professor in a DPT program, and I try to squeeze in as many clinical hours as I can in my favorite practice setting: cardiothoracic critical care. I am blessed to have my academic office across the street from a large academic quaternary care cardiovascular hospital that offers the full complement of heart/lung transplant, mechanical circulatory support, and other services.

For those who know how little cardiopulmonary content I got in PT school and the dumb cardiopulmonary mistakes I made early in my practice, you would be surprised to learn that I now consider myself a “critical care PT”. And now, just as in high school, during the big COVID-19 “game”, I am riding the pine.

But here is where the COVID-19 pandemic and high school basketball are different. COVID-19 is not a game. It is life and death, and is leaving a wake of destruction in patients’ lives and the lives of health professionals. I am not in the game not because of lack of skill (or height), but because the pandemic has decimated employment opportunities for health care providers. Redeployment of full-time clinical staff means the part-timers like me aren’t (yet) needed.

So I sit on the sidelines and ride the pine. I am cheering for my friends and colleagues on the front lines, and am supporting them where I can. But I feel left behind. Powerless to make an impact on my community and help patients in need. Worried about the health and safety of my comrades in the game. But this is not a game- it is war.

I signed up on the State of Michigan volunteer provider portal. I signed up as a respiratory therapist as PTs weren’t yet listed. I volunteered to take advantage of Executive Order 30 allowing PTs to serve as respiratory therapist extenders. Over three weeks later I finally got the call to go to the East side of the state to help. I started the on-boarding process. I jumped off the bench, tore off my warm-ups, and ran to the timer’s table and took a knee waiting for the next stop in play.  Excited, nervous, but ready.

Then I got called off. Their needs changed. Back to the bench. Disappointed. Frustrated.

But here’s the thing that makes it all OK: My impact was made years ago. So many of my former students and who are now my dearest colleagues have stepped up and are leading. They are warriors.  They are fighting. They are making the difference. “Let’s go PT!”

The next group of first year DPT students are taking my cardiopulmonary course this summer. It is another opportunity to further develop our profession’s capacity to manage patients with complex cardiovascular and pulmonary conditions across the continuum of care. I hope they realize just how seriously they must take this course. It is life and death. These are skills they need. That our country needs. COVID-19 may be over by the time they are licensed, but they need to be ready for the next pandemic.

I have concluded that I am not riding the bench at all. No, I am fighting the good fight and am a critical part of the war effort. It is Rosy the Riveter kind of stuff, doing my part on the Homefront during a world war to prepare those on the front lines.

My clinical time will come. OUR time will come. For all of us not working clinically right now, health care WILL rebound.  Our country’s health care needs have not gone away. They have gotten worse. We will ALL be needed. Riding the pine sucks. But this game won’t be won until we are all off the bench and playing. This is a game we can’t lose, won’t lose, and we will all play our part. Get ready to tear off those warm-ups…

 


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