Members On the Move: The Private Practice Edge

PPS president, Terry Howard, PT, DPT, and Carl DeRosa, PT, PhD, FAPTA, at the 2015 PPS Annual Conference in Orlando, Florida.

2015 Robert G. Dicus Award Winner Carl DeRosa, PT, PhD, FAPTA

I want to express my thanks to the Awards Committee for even considering me for this recognition, and to the Private Practice Section (PPS) Board of Directors for entrusting me to be a representative for all that this award signifies, and to the people who took time from their busy schedules to nominate me and write letters of support. I feel lucky that I am able to share this special moment with my family.

To receive an honor named after one of the founding members of the American Physical Therapy Association’s (APTA’s) Private Practice Section is humbling. While I did not know Robert Dicus, I know his history, and I have been fortunate that several people, especially Michael Weinper, who did know him, have taken the time to share with me what an incredible forward-thinking individual he was. I would be remiss if I did not acknowledge that my own successes have simply been due to the fact that many of you invited me to attach myself to some of your innovative ideas.

When I received the call from Terry Brown that I was this year’s recipient, my wife, Marlene, and I tried to explain the significance of this award to our kids. After listening to our feeble explanations for a while, my son finally said, “Oh, you won the Heisman Trophy of Private Practice.” That is an interesting comment, because the Heisman Trophy was historically developed, not because of someone’s touchdown-making or tackling ability, but instead, it was an award given to those whose performance was seen to best exhibit the pursuit of excellence with integrity. That is a tall order.

And perhaps that is why, when Terry called, my first thoughts were that I would not even have had the opportunity for an award like this in my lifetime if it were not for the dedication, the professional passion, and the example that my wife, Marlene DeRosa, provides every day in our practice. In our house, she gets the Super Bowl Trophy. I will tell you how incredible she is. When I started our practice in 1982 with my good friend Phil Sauer, we really did not know anything about business. In fact, we often said that our business plan was pretty simple. It was simply to try and recruit Marlene from the local hospital because she had built that department into the most respected physical therapy clinic in the community. My kids bet me that I could not do this talk without one Springsteen quote. They win. As the Boss sang, “She’s the One.”

The dichotomy of private practice is that it presents as an incredible opportunity to explore, to be an entrepreneur, to take risks—to actually do something with exhilarating freedom—yet you know that realizing such successes comes with shouldering more responsibility and even more integration of your professional and personal life. Pushing boundaries, creating new paradigms, and entrepreneurialism are the fabric of private practice. It is why private practice has pushed the profession through barriers and to new heights.

I have always believed that you have to keep changing. My colleagues often tease me by saying I keep looking for new mountains to climb. However, I believe you have to keep looking for opportunities in order to initiate change. W. Edwards Deming, when talking about change, probably said it more bluntly: “It is not necessary to change. Survival is not mandatory.” I have been lucky to have been surrounded and influenced by professionals in my life who were always trying to explore and generate change. I believe that we have to instill the culture and value of change in those we mentor, those we work with, those we teach.

When talking about the value of change, John Lilly, who was a physician, a neuroscientist, and a philosopher, described it in one of the most impactful and thought-provoking ways: “The only security that you really have is when you have the ability to change.” Private practice is our profession’s champion of this reality. Because of the chaos in the health care industry, I like to think the profession is relying on us to push new thinking and new paradigms and to detour away from paths that were successful in the past, but may have lost some of their relevance and importance today.

My first exposure to the importance of change and its connection to security was when I was about 12 years old. My father worked for one of the biggest, most stable manufacturing companies in Cleveland, Ohio. He had security, a union shop, guaranteed raises, good insurance, and predictable work hours. Yet he and two other work friends decided they could do what that big company did—just the three of them—but do it more efficiently, effectively, and with a much better customer-centric focus. He gave up all his money. He had four young kids at the time, another on the way. What a gutsy move. What an inspiration for me – I really have never forgotten that image. In fact, I can picture sitting in a little nook in the kitchen where we ate, my dad taking phone calls during dinner during those first months he was trying to build something new. But it never was about a better job. It was about freedom. It was about creating the opportunity to have a lifetime of doing something you love.

It is worth saying again. “The only security you have is your ability to change.”

I am going to close by sharing what I call “the engine of our practice.” It has always been what has driven me to seek that new mountain to climb. The ability to share, to brainstorm with each other, has always been why the PPS meeting has been the best of all our professional meetings. It has largely been about the opportunity for networking and to hear each other’s stories.

We started a model in practice a number of years ago that in an odd way reminds me a bit of the opening line of a popular joke that I am sure everyone in this room is familiar with. The joke always starts like this: ”A guy walks into the bar and asks the bartender . . .” Everyone can probably fill in the rest of the dialogue in a different way. In a similar way, I have always felt that is a way in which our practice could be developed not just to differentiate itself, but to really make a difference. “A guy walks into a building and says, ‘Hey, I heard this is the place where I can get it all!’”

What does “get it all” mean to us in the new world of health care? This person wants help with—you can fill in the next part—the bad back he has, or another patient is talking about the sports injury she has, or another with prediabetes and trending obesity due to metabolic syndrome—the list can go on and on. Yes, they do want immediate help for some immediate need, but in our practice, we wanted them to stay in our wheelhouse, to stay in our system to get all the pieces they need for their health. They are saying that they want to be well. We want them to come to that self-realization point that says, “I need a place where this immediate problem is solved, but where there is a total package of what I need in order to have a better, healthier life.”

So our practice trajectory has always been about continually building the necessary connections, the relationships—to do this. Not as an ancillary service or practice niche. The linkages in the community and within the local medical circles that we worked to involve ourselves with, whether it was buying a health club, integrating ourselves into osteoporosis programs, developing nonsurgical cardiac management, or collaborating with nutritionists, have always been about health. Trying to have the patient understand that their relationship with us literally gives them an “enterprise of care.” That “guy walks into the building” line has always served as a driver to seek out the necessary connections, relationships, linkages—whatever word you want to use—so we really could be the health expert and advocate of our region.

My main reason to share this thought, though, is because I think it is our profession’s best play in this era of vertically integrated systems and population health management. It is what can provide us the most solid and comprehensive footing in the new world order of health care. The physical therapy industry is changing, and it must be understood that it is really a people skill and knowledge-based industry. What that means is that we can no longer leverage physical therapy as a solution set in health care, but rather the physical therapist as the solution set. That, coupled to our freedom and ability to change with nimbleness, is the edge all of us in private practice have.

Thank you again for this wonderful honor and the opportunity to share these thoughts.