QUITTER

QUITTER
“A recent survey revealed that 84% of employees plan to look for a new job this year ”
I actually think that this number may be higher in the physical therapy field. There are many people dissatisfied with the corporate structure of physical therapy, and I am among that group. I think that every year since 2010 I have reassessed my job outlook and searched for other opportunities.
“a US department of labor study revealed that the median tenure for the 55 to 64-year-old category is 10 years. For the 25 to 34-year-old category, the average tenure is only 3.1 years. ”
This one is interesting. There are multiple classmates of mine that worked 3 to 5 jobs within their first 3 to 5 years in the physical therapy profession. I have been out of school for about 10 years now and I I am on my second job. I have had multiple side hustles along the way, but I am still on my second primary job.
“The golden watch has become the other end of the golden handcuffs. ”
I recently received the silver watch. I’ve been at the hospital that I work for for five years and after five years one receives a Watch. I don’t consider the watch a handcuff, but it is a life ring from my perspective. There are many people that have been at this hospital for well over 20 years. Many people realize the problems within the institution, but few people want to change the institution. As much as I’ve tried to change the institution, I realize my power only go so far and that I will need to leave in order to create that change.
“There is a wiser way to get to your dream job, and it begins by keeping your day job. ”
In PT, I have a dream. Not that major dream from Dr. Martin Luther King, but a dream nonetheless. My dream is to see all patients receive quality care. There are many corporations that provide crap care to patients. I hear it from the patients every day. I recently had a patient who underwent 53 visits of physical therapy for her back pain. After two visits his pain was completely abolished and he rated himself as 100% functional. On the one he read it himself as 60% functional. This is a problem. Corporations should not be allowed to milk the patients. The reason why this continues to happen is because patients are under educated with regards to health care in the business of healthcare. If they knew that we get paid based off of how long they kept us they would start seeing themselves more as a $. Healthcare is a unique business because the patients place their trust in us to be altruistic. Unfortunately, the almighty dollar sign can override altruistic tendencies. 
“When you keep your day job, all opportunities become surplus propositions rather than deficit remedies. You only have to take the ones that suit your dream best. ”
I value educating people. I spend much time reading outside of work and I want to share that knowledge. If I would’ve quit my job in order to go teach at a university or community college, I would actually take a pay cut from what I’m doing today. This is why I do so much on the side so that way I don’t risk losing the pay that I currently have. If I want to quit my day job at the hospital, I would be very stressed for money and would have to take every opportunity that came my way. There are some things in the physical therapy field that I realize I don’t really enjoy doing. I love teaching students that are passionate, but I hate teaching students that are just there to check off a box, which is one of the reasons why I don’t see myself going into education long-term. I struggle to work with students who don’t share the same passion that I have for the profession. Students are spending 90,000 upwards to $200,000 in order to enter this profession, and it kills me to think that there are some students that are just checking off boxes and going with the flow. This is why I am very picky as to which schools I take students from. Some schools have better reputations than others for the quality of students that come out of the school.
“Dreams tend to challenge the status quo… At the heart of a dream is change”
Because my goal is to ensure that the most amount of people receive quality care, I realize that I have to leave the job that I’m at. I’ve been working on my side hustle now for years. This started with educating myself to become a better clinician. I finally feel confident enough in my clinical abilities and my leadership abilities to be able to step away from my job in order to create my dream.
“I’ve met hundreds of people who tell me they’ve never written their books because they are too busy. ”
Count how many times you hear ‘busy’ as the response when asking someone how things are going? How many of us would say ‘productive’? Is life truly busy or unorganized to an extent that it feels ‘busy’ and rushed? I stopped saying busy. I take at least 45 minutes to watch tv with my family per day. This is usually “Curious George”, but still unproductive time. I recently went to EntreLeadership 1 Day and the talk by Christy Wright was AWESOME. It had to do with prioritizing your top 5 priorities. I no longer feel that George is wasted time because it meets a priority of spending time with the family. I have more time now that I have prioritized my days. 
“You don’t ask the bottom less, ‘what do I want to do with my life?’ but instead, “what have I done in my life that I loved doing? ”
I have always been against bullying. I have always been the helper. I didn’t realize it at the age of 5, but that’s my earliest memory. There was a group of bullies that pushed a girl. I went berserk. Think of the movie A Christmas Story. It was kind of like that. They got me back later, but it was all three of them together to get me back. My point is that I stick up for people that are being bullied. The problem is that some people are naive or ignorant and don’t realize that they are being bullied. When I say “ignorant”, I literally mean that they don’t have the knowledge to know that they are being bullied. There are very few reasons that I can think to keep a patient in the clinic for over an hour and fewer still to keep them for more than 6-12 visits. Obviously there are some patients that will need more, but in an orthopedic setting we don’t tend to see that.
“A hinge moment occurs when you are planning to do something standard and normal, something you’ve done many times before… And then seemingly out of nowhere, something, a small detail usually, hinges you in a different direction.”

Way back 2009, I was offered a job by Mickey Shah. I turned it down. That was my hinge moment. I knew that if I had taken that job that I would be riding on the tail of Mickey my entire career. I wasn’t ready for that. I needed to take charge of my own education. I need to create my own presence. I need to create my own brand. And I have spent the last 7 to 8 years doing just that. 
“The things that you create and share will always outperform the things that stay stuck in your head or your desk or your laptop. ”
Last year was my step out into the public via a blog. I had 5,000+ views last year and already increased that by over 50% for the year, this year. Had I not done anything, the ideas would’ve taken me no where. I’ve met and conversed with many people this year and I believe it’s because of the writings. 
“You have the perfect amount of time each day for the things that matter most. The key is spending time on those things.”
Improving my role as husband and father

Improving my skills as a PT

Improving my teaching of PT to students and other professionals

Exercise

These are my priorities. The order changes as the seasons change. Some times I may have to devote more energy to teaching compared to learning. Some times I need to exercise because the other aspects have become too overwhelming. The average American watches 4.3 hours of tv per day. I may watch one hour of either news or a show my wife wants to watch. I find that in order to accomplish my 4 priorities, that there just is t enough time to know who married who or who got voted off the (insert modern reality tv show). 
“When enough people ask when you’re quitting, you start to feel dumb for staying. ”
This has started happening to me in the last year. I keep hearing “you don’t belong here…you think differently…you’re work ethic is different from everyone else”. Why have I stayed? The incentive to leave wasn’t greater than the safety of staying. The incentive just grew by leaps and bounds. My wife and I have a daughter with special needs. I don’t know what her future holds, but I have a responsibility to give her every opportunity to succeed. People say that money is t everything, but few people can prosper on social insecurity alone. Since her birth, I have driven the pedal down and pushed forward and harder than I have ever done in the past. My family is my inspiration to work harder now. I’ve always taken pride in being good at my job, but now I want the prestige and rewards that come with hustle and work. I’ve been grossly underpaid and have settled because of job safety for a long time, but that is rapidly ending. It’s time to leave the cave, kill something and drag it home, as Dave Ramsey would say. 
“Bad employees make horrible dreamers. You can’t loaf on your day job all week and then expect to magically throw the switch on the weekend and hustle on your dream. ”
I’ve always lived by a phrase “all hustle, no talent”. Obviously, I overstate the talent part, but I want to be known for work ethic. It’s one of the few things that I can control. In 2003 I was voted as employee of the year at Sam’s club and quit soon thereafter. The worst thing that can happen for me is to have no where to move up towards. I need a goal and an ability to continue to rise. I have no where left to transition to st my current place of employment and my boss is aware that I am leaving. I need to do bigger things next year than I did this year. I can say without a doubt that this has held true year to year. 
“The first thing you need is a passion. Like Malcolm Gladwell’s unquenchable curiosity to explore the unexpected relationships between things, you need a passion that will drive you forward.”
I’ve thought a lot about this through self reflection. What drives a person? Anger is a strong force and has driven me for a long time and continues to drive me. There was an interview with Lewis Howes (from The School of Greatness Podcast) on The Art of Manliness Podcast and he discusses how he was driven by anger for a long time. The problem with being driven by anger is that one is never fully satisfied because there is never enough positive to drown out the negative. I continue to be driven more by anger than by happiness. I see an injustice and I want to work to fix it. I see people being taken for a ride and I want to stop it. In PT, I see patients getting garbage care (if I could even honor it by calling it care) and I want to stop it. For every patient that receives garbage care (this means that the therapist is not providing treatment, but instead delegating treatment to someone unqualified, this means that the therapist is doing more harm with their words than good with their interventions, this means that a therapist is not empowering the patient to take charge of their health, this means a lot of things), I want to stop it because it gives my profession, and therefore me a negative reputation. 
“It’s not that difficult to be trans parent to a group of 10 readers. You realize that if you say something they don’t like and they all stop supporting your dream, you can always start over.”
This is something that I have struggled with over the last year. The movementthinker blog is finally starting to get readers, and the last thing that I wanted to do was to alienate any of the readers. Now, I don’t care as much about alienating readers as much as I care about me being me. If I lose readers, so be it. This is not meant to make me any money, but instead is an avenue to allow me to vent my thoughts. 
“It ultimately worked because I hustled… To push harder than the other person. To dream further. To work longer and faster… I don’t think any of the information in this book works without applying hustle to it. That’s the key. ”
This is the mantra to success. Some people are born into wealth and success. With that said, they have the blueprint from their fathers and forefathers for success. They have the shortcuts branded into them so that they don’t have to go through the heartaches of life. For instance, I started my career already 100K behind. I had to take jobs that paid the bills because I had a lot of bills to pay. My child won’t have to work for money the same way that I did, but they will have the privilege of learning from my mistakes and obtaining advices learned the hard way. I want my children to work and be successful, but I want them to be able to keep the money they earn instead of giving it away to lenders or poor investments. 
This is why I hustle. 
“Hustle is not hard.”
“Take it easy” is a phrase that gets said instead of goodbye. It kills me! I don’t want to take it easy. It took a lot of work to get to where I’m at in life, but that is the work that in used to doing on a daily basis. For me to take it easy is stressful. I have trouble not accounting for my time. I hear from colleagues that they wish that they could read as much as I do or invest as much time into the profession as I do, and I think BullShit! Everything we do is a choice. Hopefully, we have a list of priorities and are scheduling our day in order to maximize these priorities and minimize distractions. I’m okay if some therapists don’t prioritize their career or profession over other priorities such as family or religion, but to state that they wish there was more time is a fallacy. We all work with the same 24, but may work the hours differently. 
“I want the peace in knowing that it wasn’t for lack of hustle that I missed a target for my dream.”
When I was competing in powerlifting, I lived by the phrase ‘No regrets!’ I walked out of the gym on a daily basis knowing that I did my programming as best as possible to compete and place in the top 3. I’ve never been the strongest or the best at any one lift, but I worked my tail off. That work ethic carries over to everything that I do. If I were a street sweeper, which I’ve been, then I work hard to make sure I am among the best sweepers. That hustle comes from somewhere, but I don’t know where that hustle originated. 

“Hustle fills you up. Burn out empties you. Hustle renews your energy. Burn out drains it. Hustle impacts every other aspect of your life in a positive way as you learn to prioritize the things that matter. Burn out impacts every other aspect of your life in a negative way and your dream becomes the only thing that matters.”
Acuff J. Quitter: CLOSING THE GAP BETWEEN YOUR DAY JOB & YOUR DREAM JOB. Brentwood, TN: Lampo Licensing,LLC. 2011.

Get PT 2nd

“out of 137 patients, 100 had been recommended for spinal fusion. After evaluation, the group advised 58 of those patients to pursue a non operative plan of care”
There’s a slogan going around social media saying “GETPT1ST” I don’t know if I completely agree with the saying, but I can’t disagree with that either. The saying could just as well be get PT second. At some point a second opinion has to come in to play for a patient’s dysfunctions or pain. That second opinion, in my belief, has to come from someone without a financial stake in the surgery. This could be a physiatrist, PT, or a separate surgeon, which was done in the study cited. 
The take home point is that 58% of those recommended for spinal fusion were recommended to seek a separate form of care, thus advised to avoid the surgery initially. What this means for the patients is that a second opinion should always be sought out, because the person advising a plan of care is advising it from their perspective. I’d love to say that everyone has the patient’s best interest in mind, but I can’t. In that case, the patient must become more educated and advocate for him/herself. For instance, a surgeon does surgery, a physical therapist does physical therapy and a physiatrist does physiatry. We see problems from different lenses and therefore will advise different plans of care for varying presentations. Some patients need surgery and some don’t. Some patients need physical therapy and some don’t. We can’t say PT first because PT is not magic and can’t fix everyone’s issues. 
“As clinicians, we bring our own biases into the treatment plan for patients”
Want to decrease unnecessary surgeries? Have a multidisciplinary team do evaluations, researchers say. PT in Motion. April 2017:46. 

Revision ACL surgery

“anterior cruciate ligament… Sixth most common procedure performed by orthopedist, with more than 100,000 ACL reconstruction’s being performed annually in the United States”
In comparison to other types of surgeries, this is not a large prevalence. Anytime there is a surgery though, that injury is important to that one patient. This article cut my attention because of the author Dr. Bach. He practices fairly close to my region and I’ve seen previous patients from him. It’s always helpful to learn about the procedures that physicians perform in your area so that way you can be better prepared to treat the patients that these physicians operate on.
” The definition of ACL failure in simple terms includes symptomatic instability, pain, extensor dysfunction, and arthrofibrosis.”
  This essentially means that if there are continued symptoms after the surgery, that the surgery was a failure. I treated one patient previously, not from this doctor, in which the screw from the initial ACL reconstruction was never moved. The patient continues to have pain immediately upon starting therapy and I was beating my head against the wall trying to figure out why the patient continued to have pain. As a physical therapist we hate seeing patients experience symptoms that we can’t control. After sending the patient back to the doctor, it was found that the previous screw was in the joint space and causing the patient’s symptoms.
“Failures that occur within six months of reconstruction can be due to surgical technique, incomplete graft incorporation, and excessive rehabilitation or premature for trying to athletic competition.” 
The case described above, is an example of an error with surgical technique. I have also seen cases in which the patient was progressed through rehab to aggressively and the patient continued to worsen over the course of time. We have to honor the patient’s pain response when giving exercises and trying to make progressions.
“Revision ACL reconstruction’s are a “salvage” procedure to allow the patient to perform activities of daily living… Only 54% returned to their pre-injury level of activity”
To freeze this bluntly, let’s get it right the first time. As a physical therapist I will take part of the blame because sometimes our profession may progress patient a little to rapidly. We have to honor the patient’s pain and movement response.
There are a few parts of this article that I found very interesting. The doctors described patient positioning on the table and we are making conscious effort’s in order to reduce lumbar extension for prolonged periods of time in order to reduce strain on the lumbar spine. They went into great detail to describe how they remove the screw or insert the screw deeper from the initial ACL reconstruction surgery. I didn’t know that they could insert the screw deeper instead of just remove the screw all together.
“with the help of a physical therapist, and emphasis is placed on achieving full extension and equaling the opposite knee. Full flexion is usually achieved by 6 to 10 weeks.”
I fully appreciate the special mention a physical therapist in this article. The physicians did not have to describe this portion at the end of the article. PT’s are part of the medical team. If you or anyone you know is recovering from an ACL reconstruction, please seek out a physical therapist by word-of-mouth or through recommendations from friends and family. One could also look online to investigate the therapist that is treating you or your family member. The therapist that you were seeing should be educating you or your family member at each session and explaining the rationale behind each exercise, movement or hands on technique.
Excerpts taken from:
Creighton RA, Bach BR. Revision anterior cruciate ligament reconstruction with patellar tendon allograft: surgical technique. Sports med are thre revision anterior cruciate ligament reconstruction with patellar tendon allograft: surgical technique. Sports med arthrosc review. 2005;13(1):38-45.

Do your neighbors know what you do?

Do your neighbors know what you do?

 

“Many of our potential customers can’t tell the difference in therapists from one clinic to another”. This is an age old argument. Pepsi or Coke? Both colas and both had a strong following in the previous decades. I’d like to believe that the brands are losing strength in the days of paleo, crossfit and the resurgence of health and fitness. Not as much as I’d like to see, but it’s a start.

 

Let’s touch on this for a second. Why would Joe Shmoe believe that one therapist is any better than another? To start the argument, the APTA has stated that it would prefer that all PT’s place their licensed initials after the therapists name and then place all of the other qualifications after this. This means that my name is Vincent Gutierrez, PT, DPT, cert MDT, CFT. We get accused of alphabet soup, meaning that we have way too many letters after our names. We could easily cut that down by having the therapists establish themselves based on credentials and not on simply passing the licensure exam. For instance, if I wrote Vincent Gutierrez, DPT this would enable our customers to see that there must be a difference between BSPT, MPT and DPT. I’m not going into the turf war of whether or not one is better than the other, but we could allow clinicians to educate patients on why or why not the clinician chose to pursue one degree over the other. The public has a right to know what we do and how we are educated. This is a start. We make the assumption that a medical doctor went through 4 years of undergraduate schooling, 4 years of medical school and a few years to specialize prior to us going to the medical doctor. Us placing our initials after our names is the starting point to differentiation.

 

Past credentials, another way for Mr. Shmoe to understand the difference between therapists or companies is to soft market ourselves. When I say this, I don’t mean go for the sell, but instead educate the person in front of us while they are there so that the person that is in front of us can make a better choice of which provider to see for their problem when said problem arises. Otherwise, Dr. Superstar is no better than Dr. Squirrely in their eyes.   Every person that we encounter is a potential patient either for me or for one of my colleagues. I at least want to make sure that the potential patient has the information to arm themselves with confidence in making that decision.

 

Your “brand” is how people think of you or your company when the company’s name is mentioned.

 

Coke = Polar bears

Apple = easy enough for a toddler to use

Honda = 200K miles

Marianos = high end grocery shopping

TJ Max = bargain shopping

 

What words do you think of when I say your company’s name?

 

You can see that there are only two companies that my first though was positive for me. I want to exceed expectations for my patients so that when they think of my name they think of excellence and exceeding expectations.

 

Testimonials were previously against the law in our state. This changed recently and I recently learned of this. Testimonials seem to be the most powerful use of marketing for a service based profession. We are behind the times in healthcare. Let’s look at one brand and how testimonials are used. Crossfit has made significant gains in terms of business growth. How’d they do this? A simple Google search for “Crossfit testimonials” has yielded over 28,000 hits. This is how you brand a business. The same type of search for “physical therapy testimonials” yields about 4X that amount. Wow! That’s a lot of testimonials. What’s the problem with these numbers? PT has been around for almost 100 years and crossfit has been around for about 10. There are over 200,000 PT’s and only about 7,000 crossfit gyms. We need to do a better job of educating the public about the importance of PT using real people. Those that have experienced the joy of becoming pain-free, living life with improved function or simply receiving a consultation that assisted in a life-saving diagnosis. This is what we do! We need to make sure that our neighbors and their neighbors understand our value.

 

Theme from:

Barron B. Is Your Brand an Experience? The Importance of the “HOW” in branding for physical therapy private practice. IMPACT. January 2017:56-70.

Results based care

Results based care

 

I’m going to get away from typing out all of the quotes, which is what I have been doing for the previous year, for the sake of time. I have opinions that can be expressed without the need for the direct quotes. I’ll still link to the article so one can go back to read it if interested.

 

Health care is changing. We are moving from a fee-for-service type of setting to pay-for-performance setting. Some of us are thinking “about damn time!”

 

Fee for service indicates that a person gets paid for doing things to do. For instance, if I keep you for 90 minutes and do a bunch of stuff with you, then I would get paid much more than if I only spent 45 minutes with you. Now, if I see you for 90 minutes and see you 3 times per week for 4 weeks, then I would make a lot more money from the patient than if I saw for 45 minutes 1-2x per week. There is absolutely no incentive to get a patient better quickly. Do the patient’s realize this? I hope that this article goes viral so that the patient’s have a better opportunity to read this information. Some health care providers would hate for this to happen and other are thinking “HELL YEAH!”

 

Pay for performance: Some of the ways that this is being done is that a certain dollar amount is allocated for a specific diagnosis and this amount is paid regardless of how often or how many times I see the patient. I now have a huge incentive to get you better fast and to make you as independent as possible so that you no longer need to seek treatment for the same issue. If the patient can get better faster, then there is more money to be made in healthcare because we are not treating out of fear, but instead out of ambition. Some companies are afraid to discharge a patient because there may not be another patient taking that spot anytime soon. I’ve worked in these situations multiple times before, so I am not talking out of my A$$. Treating out of ambition allows the therapist to apply the evidence as best fits for the patient in front of us in order to get that patient better faster. No offense, but I want my patients to get better and leave. Hopefully, to never come back for the same thing again. I was listening to an episode of Mechanical Care Forum in which the therapist (Mark Miller) was describing an embarrassing moment in which Mark had a patient returning to therapy for the same complaint that the patient was there previously. He was proud because he thought the patient was coming back because he did such a good job the first time and the patient was satisfied with the treatment, but Robin Mckenzie, one of the most influential PT’s of the last century, noted that if the patient was actually better and if Mark did his job then the patient would know how to address the situation without seeking help again. I want to treat with the hope that the patient will only come back because they have a separate issue that needs a consultation for treatment. This is the ambition that I am talking about.

 

The article speaks of staying up to date on the literature, regularly attending continuing education classes, learning new approaches, tracking outcomes and adjusting treatment according to the patient. I would love to say that 100% of PT’s are performing all of the above in the list, but I can’t. There are countless articles speaking to the reasons that PT’s give for not staying up to date with the research, which indicates that there are some aren’t doing their professional or social duty. I take this stuff seriously. It’s Easter and I am typing about the stuff I just read. It sucks to take time away from work in order to find the articles, read them and then try to put the information out on the World Wide Web for patients and other therapists to read and criticize. I’d love to relax with my beverage of choice and just not think about it, but my patients and society, as a whole deserves better from my profession and me.

 

Anyway, Medicare is moving more towards a pay for performance method of healthcare and their goals are pretty aggressive. Medicare will have up to 50% of patients on this type of fee schedule by 2018 and for those that are still fee-for service, medicate will tie the payment to outcome measures in 90% of the cases by 2018.

 

I’m doing my part to educate, educate and overeducate the patient in order to get the patient on board with treatment. If I can get the patient to play an active role in the treatment, then I know that I have a better chance of getting that patient better.

Themes taken from:

Jannenga H. Tracking for success: Why outcome measures are essential to your practice. IMPACT. Jan 2017:53.

Build you and your brand

Build you and your brand.

 

“…your brand not only communicates who you are and what you value, but also elicits a response from those you are trying to reach.”

 

How many brands can we think of off the top of our head. I think Coke and think of polar bears and Christmas. I think Apple and think of technology so easy a 3 year old can use it, which lessens my fear of breaking it. I think Google and think the greatest search engine in the world. Our lives are surrounded by brands. Some we notice, but the great ones are just a part of our day.

 

“…branding process is about painting a positive picture that will stir an emotional response from your target market.”

 

I don’t know if I necessarily agree with this. Some brands are based on loyalty to the initial need that they made easier. For instance, I didn’t really use the internet before the age of 20, but now closer to 40 I am on it frequently because it is so portable and convenient thanks to the Iphone. Thanks to Amazon, I don’t have to drive to the baby store at night in order to purchase more bottles. Thanks to Facebook, I now have thousands of friends that I never have to see. I don’t know if the brand has to elicit an emotion as much as it has to fill a need.

 

“…a brand is a promise that is conveyed through a ‘combination of logo, words, type font, design, colors, personality, price, service, etc’”.

 

I am looking at the top 500 brands across the world and looking at the logos. There is a consistent pattern that I see with red, yellow and blue. I don’t think of colors when I think of logos, but obviously those much smarter at marketing have figured out that these colors give a response. After seeing this pattern, I decided to look up color schemes for logos and this cool infographic was the first link. I hadn’t thought this much about color, mostly because my wife says that I live in a black and whit world. Oh well.

 

“As a way to broaden your perspective, take a moment to objectively evaluate the other physical therapy clinics in your area and see if you can identify what they are promising”

 

Your brand gives the patient promise. Some clinics have the name of the owner on the front. This tells me that I am guaranteed to see the owner when I come in, but if I don’t see the owner I may not be as satisfied with my experience. Others name themselves after the feelings that they are trying to convey to the patients. The name carries weight when seen from an outside perspective.

 

“Once you are clear about your practice values and what you are offering your community, you can start to develop the visual look and feel of your brand…logo should be unique but also relevant…convey both who you are and what you have to offer.”

 

After reading this article, I scrolled through about 500 logos on Google images (again the only search engine that I use) and this logo was the best that I saw. It clearly states what the company does. It takes a person from a continuum of care from a non-walker to a runner.

 

“As you begin to express your brand, I can’t stress enough the importance of being invested in your community.”

 

This one is the most important for me. I believe that if I get in front of enough people that I will be able to sell my services. This goes back to some of the views from the Gary Vee show. He notes that giving away services can come across as a hack move, but it still gets people to buy. I can remember working for Sam’s club and on the wall would be a huge cardboard check of all of the money that the store has donated to the local charities. It makes the employees proud to know that they had a hand in providing support to the local charities. I am not sure if anyone ever shopped at the store because of it, but it made me feel good that I was able to give to those causes. I’ve volunteered at local races, though I haven’t gotten a single patient from those races. I rarely volunteer at those races anymore. I spend most of my time in the community doing patient education regarding back pain, blood pressure checks and the importance of staying active. These lectures bring in patients. This is how I stay invested in my community nowadays.

 

 

 

EXCERPTS FROM:

Stamp K. Painting a Positive Picture: How to craft an effective brand for your private practice. IMPACT. January 2017: 37-38.

Cover your ears

Cover your ears

 

“Scurlock-Evans et al reference studies indicating that while 69% of physical therapists (PTs) claim to read relevant research only 26% critically appraise it.”

 

This is disheartening. Tradition trumps evidence in certain cases and without actually reading and attempting to understand the evidence, we will continue to treat using a little bit of evidence and a whole lot of tradition. We are a doctoring profession. I went back to school to get this piece of paper that says doctor. I am also clinical faculty at GSU and have worked as a clinical instructor in both private and non-for-profit practices. I have seen first-hand that some (more than 90%) of students don’t have the passion, will, time, or knowledge to actually read anything more than is handed to them in PowerPoint. I have actually had students get upset when I give them reading assignments to do. Once students graduates, they enter the real world of the profession. If you didn’t have the time to read and take your studying seriously when all you had to worry about was the 40 hours of school, how is the switch going to flip and all of a sudden one will begin studying when leisure time is taken up by other priorities? We have to represent our profession…if for nothing else than for our patients and personal pride. Our profession is supposed to live by these core values, but unfortunately those that display all of them are highlighted instead of the norm. One person that is highlighted, for good reason is the founder of PT Haven. I had the pleasure of meeting Efosa before he graduated and he had his priorities in order then and has lived up to the standards that he set for himself during our conversation. This is but one of many PT’s that practice all aspects of the core values of our profession. I say many, but know that I can’t say all.

 

Back to the point, if we aren’t able to critically read the research, then we can’t confidently apply the research. So much for EBP or “evidence informed practice”.

 

“It has been estimated to take an average of 17 years for research evidence to fully integrate into clinical practice”

 

Are you F’N kidding me?! I know this to be true. I wish I had a thousand dollars every time that I heard a student say that they were told that the information learned was taught because it would be on the boards! I’d be retired by now. There is so much information that is outdated, but students continue to learn it because they will be tested on it. At this point, I can’t state that schools are attempting to produce clinicians, but instead are producing students that can pass a test. We are a doctoring profession. The damn well better be able to pass a test or they shouldn’t be treating patients!!! With that said, it is the school’s responsibility to ensure that not only can the student pass a test, but also be able to treat a patient with confidence and critical thought. This is where I believe that the school’s are failing the students. Should the student end up in a clinical rotation that doesn’t practice the core values of the profession, then the student will learn in a “trial by fire” by being thrown into treating patients although they are fully unaware of the mistakes that they may be making in the process. They aren’t prepared for this type of training. I have taken students for about 10 years and in 10 years I have had 2 students that I could say that I had nothing left to teach by the end of the clinical. I felt like Mr. Miyagi watching the crane kick by the final weeks. As you can see though, this isn’t the norm. Part of this is that school’s haven’t fully integrated the evidence to teach the students. I get it. I hear it from professors… “there is only so much time during the day”. I don’t know where the blame for a lack of preparedness comes into play. It could be the governing body of PT programs for not changing the required learning prior to taking the PT boards, it could be the universities for not embracing clinical practice but instead teaching from books that are at least 5 years outdated (don’t get me wrong, the students need to know the basics from the books, but this is the students responsibility due to the lack of time), it could be the lack of quality clinical rotation sites from which to learn from those therapists that not only practice using best/current evidence but also utilize the core values on a daily basis and finally it is the students fault for not taking more ownership over his/her education. There is a lot of blame to go around, but in the end it is the patient that suffers from this cycle of inefficiencies surrounding learning.

 

Schuppe V. Viewpoints: Exploring the knowledge-to-practice gap. PT in Motion. March 2017:6.