The following is an excerpt from a speech given by Jason Richardson at the Graham Session in Salt Lake City, Utah, in January 2014.
There is a historical story worth sharing to put its powerful perspective directly into our field of physical therapy today. In a letter to President Andrew Jackson, Martin Van Buren supposedly begged President Jackson to protect the canal industry from the new railroad system for three reasons:
- If canal boats were supplanted by “railroads,” serious unemployment would result. Captains, cooks, drivers, repairmen, and lock tenders would be left without means of livelihood.
- Boat builders would suffer and be left destitute.
- Canal boats were essential to the defense of the U.S.
While I am not sure the letter is authentic, it describes a reality we often see in business and politics, where favors are asked for and granted to benefit small numbers rather than having their sufficient value to the public fuel the political and regulatory progress. There are parallels to this story of protectionism within the medical industry today that have consequences for our professional evolution. Fortunately, physical therapists have two inherent aces that will allow our field to grow and flourish on our own merits. The first ace is the manual physical therapy examination, and the second ace is our ability to leverage public demand for our expertise.
We are surrounded by substantial reform in health care, which is driven by intent to improve overall value to consumers. As experienced physical therapists (PTs), we know that PTs are grossly underutilized in managing musculoskeletal (MSK) patients. Physical therapy is typically introduced late in an episode after more than four physicians are involved in the management of the patient. Yet, clinical and health policy research shows a “physical therapy first” approach is most efficient and cost effective. This primary care role must be obtained so we can better influence value in a changing health care environment, which is searching for alternatives to pharma and surgery. Achieving primary care status for managing MSK patients will drive higher demand for our services and this demand is the key to leverage payment commensurate with our skill set and expertise.
As a profession, we must promote our industry. Physical therapy is not in the position of the canal boat industry described in the Van Buren letter. We are not promoting ourselves for the good of a dying industry, but as a real and needed solution in health delivery. We need to leverage our two professional aces.
Our first ace is our most unique skill set, the physical therapy clinical exam. A powerful statement is made when the therapist exudes confidence during the initial patient encounter. A subsequent appropriate treatment choice leads to rapid proof of success. This results in people having experiences that exceed expectations which in turn yield loyalty and referral of friends and family.
That is our second ace: earning public demand for our services. But there is just one problem. This second ace, public demand, requires that we are successful with our first ace—the physical exam. Too many PTs fail at our number one asset, the clinical exam. This leaves us with a challenge within our industry. We need to be assured that new physical therapists are effectively trained resulting in reduced practice variation. This is the only way we will reach our rightful place in health care delivery. Beyond this, we must move past our “ancillary” history and transcend to being a collaborative primary care provider who manages and triages patients with neuromuscular dysfunction!
We live in a country that is thirsting for what we do. Pain complaints are the leading reason for a physician consult. The traditional medical model poorly addresses these patients with costly diagnostic tests and over treatment from pharmacology, injections, and surgeries. Despite what many chronic pain management groups tout, you can’t fix a mechanical problem with a chemical solution. We have a moral obligation to impart our knowledge and skill set to help these patients. Physical therapists are the best-suited providers to help patients in pain, but too often we do not initiate our treatment until the problem has become chronic and more complex. By then there are multiple co morbidities present and multiple specialists, each concerned with siloed issues.
In addition to mastering the physical exam and reducing practice variation, we must embrace direct access at all costs. Our true value comes when we see these patients upstream. We must play a primary care role in health care delivery.
By definition, a helping profession has a contract with society. When that profession demonstrates consistent value to society, the population will demand access to those services. Public demand is the key to impacting policy, legislative change, and reasonable payment. Perfecting the physical examination, reducing practice variation, and embracing our role in primary care will assure our value in society and ultimately amplify our voice with payers, legislators, and regulators.
C. Jason Richardson, PT, DPT, OCS, COMT, is a PPS member and the vice president of clinical operations for Results Physiotherapy in Franklin, Tennessee. He can be reached at firstname.lastname@example.org.
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