Big Picture
Transforming society on a global scale
By Ann Wendel, PT, ATC, CMTPT
In 2013 when the American Physical Therapy Association House of Delegates (APTA HOD) adopted the new vision statement for the physical therapy profession, many people criticized the lofty, somewhat nebulous goal of Transforming society by optimizing movement to improve the human experience.
I have to admit that at the time I was not so sure what that actually meant, or how we could begin to work toward that goal. Over the past two years of contemplating the magnitude of the vision, I have sought out examples of therapists being part of the solution to improve life for all members of society.
When asked to write an article on integrating treatment of underserved populations into today’s successful private practice, I realized how little I knew about this topic. So, I did what I always do when I need to learn more: I put out an SOS on Twitter. I was fortunate enough to have three different therapists reply with information on how they provide services for folks who might otherwise never have access to a physical therapist. All three work with this population in very different ways, and I was truly inspired by their stories. Their successes show that private practice physical therapists can improve the human experience in a global sense to transform society. Therapists working with underserved populations assist folks in returning to work to provide for their families. These therapists are part of a team that educates and empowers people to care for themselves and to, in turn, give back to the community that has given to them.
One way to work with underserved populations is right in your own community. Private Practice Section (PPS) member Michael Reilly, PT, DPT does this in Centreville, Illinois. Mike is the director of rehabilitation for Professional Therapy Services (PTS). His company contracts rehabilitation services to Touchette Regional Hospital, which opened in 1957 as a township hospital to provide care for low-income, underserved persons and others who were not welcomed in surrounding hospitals. PTS provides all manner of rehabilitation services including inpatient care and outpatient physical, occupational, and speech therapies as needed. Approximately 70 percent of the patients are Medicaid eligible.
Mike shared that initially some members of his organization were skeptical regarding providing services in such an impoverished area, but he states that the key ingredient for success was bringing in staff with an open mind and excellent emotional intelligence. Through this, they were able to create a culture of trust, which is an important factor in working with this population. Mike explains that, “Trust is an important factor in treating this population. They want to know that you care before they care what you know. It is all about relationships, but more so with this group because of possible racial and socioeconomic differences that may exist.”
One of the barriers to providing care to this community is transportation. Mike explains that because of the poverty and hazards in the community, Touchette provides free transportation services to and from the hospital and community health center offices within the primary service area. He has found that even with this service, the cancellation and no-show rate is still very high compared to other populations. He states, “Our job is to present value every day in the hopes that patients will complete the recommended course of care.”
Mike shares that the most rewarding part of this program is that this population benefits greatly from physical therapy services once they trust that you have their best interests in mind. He states that this population challenges you to work at the highest level of your license, since many patients have not seen a primary care provider (PCP) for years. The flip side is that improvements in health and function can happen rapidly because folks have often reached such a low level of function due to poor health. His best advice in starting a similar program is to be ready for both the comedy and the tragedy of serving this population every day, and to develop a mindset of service. Becoming a good listener helps you transform lives one at a time.
Another way to care for underserved populations is to travel to areas of the world that have little or no access to medical care. David Grigsby, PT, MPT, Cert. MDT and Jason Ward, PT, MPT, Cert. MDT, co-owners of Midsouth Orthopaedic Rehabilitation in Cordova, Tennessee, travel to Peru and Guatemala serving on multidisciplinary teams. David and Jason provide physical therapy assessments and treatments including bracing, general nutrition and hydration advice, and medical care. Care is provided on a pro bono basis. David says that he got started by working with a missionary in Guatemala who recognized a significant need for care for the physical limitations and pain of the local people, brought on by hard manual labor and farming. These folks work through pain, physical limitations, and sickness on a daily basis to provide for their families.
David shares that the greatest limitation he has experienced is that he and Jason cannot travel to these areas more often, due to work, patient care, and family constraints. Because they co-own the clinic and are the only physical therapists providing care, they cannot both leave the clinic at the same time for these trips. Additionally, going to different cultures brings its own challenges such as language barriers, potential for sickness, limitations in follow-up with patients there, and the inability to care for everyone in one trip. They have overcome these barriers by working with people in the home countries to determine the needs of the local people, working with translators, and educating local medical providers on how to help their people.
David states that the most rewarding part of these trips is helping people who would otherwise have no access to physical therapy. He shares that, “Managing musculoskeletal pain and limitations by providing physical therapy is a global need. Many of these small villages and towns have no access to care because they are too poor to get it. It is humbling to see people line up for hours to receive care and be so thankful.” David’s advice to therapists who are interested in traveling to work with underserved populations is to connect with local churches, medical or dental associations, and charities that are involved in medical missions trips around the world.
A third way to work with underserved populations is through the development of pro bono clinics. Private Practice Section (PPS) member Jennifer Green-Wilson, PT, EdD, MBA, spearheaded the development of an on-campus pro bono clinic in the physical therapy department of Nazareth College in Rochester, New York, in 2004. Dr. Green-Wilson redesigned the Business of Physical Therapy course to prepare students to run the pro bono clinic. She then served as their “faculty coach” in the running of the clinic. Through this combination of didactic learning, clinical experience, and management experience, students developed fundamental business skills such as communication, empowerment, team building, giving and receiving written and verbal feedback, conflict resolution, day-to-day management skills, adaptive leadership, not-for-profit financial management, project (time) management, and relationship marketing skills. By the end of the second year of the program, one-third of the class said that managing the clinic was their most valuable learning experience as a physical therapy student.
The student-run clinic met the needs of the community by serving individuals with chronic neurological conditions who had exhausted their health insurance benefits. The service volume went from 13 clients during the initial pilot to more than 45 clients with an active waiting list. Dr. Green-Wilson states that, “Our top referrers were physical therapists in the community who were so thankful for having a place to refer their patients who had to be discharged due to insurance reasons, but who could still benefit from care.” The clinic operated on a “suggested donation” policy, finding that over time donations poured in to support the program.
Green-Wilson says that the program ran into some opposition from colleagues in the department who were more focused on the clinical aspect of physical therapy education (versus the business aspect), while others were threatened because it was new and different. She states that all involved in the program overcame the barriers by working enormous hours behind the scenes because they believed in the cause. She states that she learned about transformational leadership from the student physical therapists, and she has a vision for every doctorate of physical therapy (DPT) program in the United States (and perhaps the world) to start a student-led pro bono clinic on campus to serve the underserved populations in their communities. She describes it as a “win-win-win” for all involved. Her advice to anyone interested in starting a similar program is to just start it, work hard to keep it going, and for the faculty to let go and empower the students to be successful.
These are just three examples of ways that physical therapists can work with underserved populations to provide valuable experiences for the community, the successful private practice, and student physical therapists. There are no boundaries on the ways we can creatively serve to optimize the human experience not only in our neighborhood, but around the globe.
Ann Wendel, PT, ATC, CMTPT, is an Impact editorial board member and owner of Prana Physical Therapy, PLLC in Alexandria, Virginia. She can be reached at pranapt@gmail.com.