Simplify!

How adding a student can amplify growth.

By Anthony Sinacore, ATC, SPT

It is not easy deciding how to add on to your already strong and promising business plan, especially when everything is going well. Your revenue is building, your clientele is strong, and you are marketing yourself well within the community; you have done your homework. But like anything else, you also know that it is not going to stay like this forever and that every day you grow, your competition grows as well. So now you are forced to make a difficult and strategic decision—one that could help set you apart from everyone else, but one that also has the potential of financial repercussions. And let us face it, your chief financial officer, managing partners, or investors will not like the sound of change when your bottom line is beginning to blossom. So what can you do to keep your business ahead of your competitors, even before you feel them as a threat?

There is a way to meet these goals, a simple and safe way that bypasses the “high-risk, high-reward” decisions that practice owners face when on the brink of future growth of their company: Add a student into your clinic.

As a third-year student myself, all of my experience has come from clinical rotations. I may not have the years of wisdom of some of the authors in this issue, but for the last seven years, I have become really good at immersing myself within a variety of clinic settings. You read that correctly: seven years. (Three were from athletic training school where I spent time in physical therapy–based clinics; three from physical therapy school; and one year in between when I worked in an outpatient orthopedic clinic as a certified athletic trainer and rehab aide.)

For 16 to 20 weeks at a time, I have been able to take a glimpse into how each company’s day-to-day operations can bring them one step closer to meeting quarterly goals and showing value within their community. I have experienced good clinics, bad clinics, and great clinics; and I have noticed certain characteristics that tend to separate one from another. Though all of them (aside from the year that I was employed) have taken on a student, it is the way they each utilized their students that was a key factor in this separation.

Benefits to Your Employees

As a practice owner, students can be your safe haven for boosting morale. It is easy to get stuck in a rut with day-to-day practice, and an easy way to incentivize your employees is to have them become certified clinical instructors (CIs). With a little bit of encouragement, all students want to learn how to treat patients. Otherwise, why would they spend so many tuition dollars to be there? So even if it starts with only a few patients per day, a student can be that extra set of eyes or hands you need to help correct faulty mechanics, continue with someone’s treatment diary, or educate on the importance of a home exercise program. This extra bit of help can make all the difference between therapists working only to keep their productivity up versus providing a higher quality of care. One thing I have noticed at almost every clinic where I have worked is that documentation continues to increase, and the workday grows longer because of it. So it might be a difficult transition initially, but having a student in their second or third year of physical therapy school who can take half or one-fourth of your caseload can save you time to work on documentation while maintaining clinic productivity standards.

Improve Patient Outcomes

Another benefit of having a student is that they can keep you up to date with the latest evidence. This idea is no gimmick; it is the truth. Since the transition toward the doctor of physical therapy (DPT) degree, programs have further institutionalized the use of evidence-based practice (EBP) within their curriculum. More importantly, clinicians who have been practicing for more than 15 years and still have only a bachelor’s or master’s degree need to work harder to keep up with current literature.

The American Physical Therapy Association (APTA) conducted a survey in 2002 in which 488 therapists discussed their personal beliefs and utilization of EBP in their practice. Of this sample, 84 percent indicated that they agreed or strongly agreed that they needed to increase the use of evidence in their daily practice. Additionally, 65 percent reported performing fewer than two database searches per month, and 74 percent reported using professional literature in the process of clinical decision making five or fewer times per month. What I thought was significant was that nearly half of the respondents (46 percent) indicated that “insufficient time” was the biggest barrier to using evidence in practice and nearly 67 percent rated insufficient time as one of their top three barriers. The article further noted, “A large proportion of our respondents indicated that they were interested in improving their skills related to incorporating evidence into practice.”¹

We have already mentioned that a common complaint is that there is not enough time in the day. So how is it possible to review and implement new evidence through the week?

Simple. Host a student.

A student will want to prove to their clinical instructor that they know how to take the information learned in school and implement it into practice. Inspire them to teach you something new while with you. As a goal, you can discuss with them the importance of learning from each other. You are obviously there to instruct them and assist them in becoming an experienced professional, but if they can inform you of any practice methods with lacking or no scientific evidence, how can it hurt your practice? This is an opportunity to help build the confidence of the student while endorsing positive and timely outcomes for your patient. Plus, I do not know of any managing director who would dissuade anyone from continuing his or her education relatively free of charge and without taking any paid time off.

It may also be beneficial to have students track patient outcomes using validated measures and compare them to old practice methods. This method can hold students accountable for the care they are providing.

If time is your biggest enemy, you can maximize efficiency by learning and mentoring at the same time. Education. Is that not why they are here?

Obviously, this idea of hosting a student does not have to focus on helping out your bottom line. As is the nature of the job, clinicians enjoy educating people on their skill sets. We teach patients every day about what we do and what they can do to “optimize movement and improve the human experience.”² So naturally, adding a student can be another opportunity to educate and impact someone early on in his or her career. Individuals who are successful in private practice did not arrive at success by chance. With a wide understanding of the human body combined with numerous years of experience, successful clinicians gather their own “clinical pearls” along the way. It would be my guess that these hints of wisdom are a large part of what makes each clinic successful. What better way to create a legacy than to help students practice with the same methods that helped you prosper?

Networking with Their School: A Key to the Future

Let us not forget how the student got to you in the first place. Whether they are attending a university in your general area or not, keeping a relationship with their program can help preserve your clinic’s visibility.

Ideally, you are going to want to continue hosting students at your clinic and an easy way to do that is by gaining a reputation as one of their “go-to” clinical sites. Advertise your clinic’s strengths. Is your practice heavily manual therapy based? Does it offer women’s health services? Do you treat neurological pathologies? These are all qualities that can highlight your company in the midst of a long list of potential clinical affiliations. A 2005 study published through the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) looked at the availability of thrust manipulation training within physical therapy programs’ clinical opportunities. The study found that 70 percent of the directors of clinical education were unsure which sites employed clinical instructors trained in thrust joint manipulation, and 85 percent did not consider whether thrust joint manipulation training was provided when scheduling the experience.³ This study expresses that a relatively untapped resource exists for promoting and marketing your niche practice to schools across the nation.

So simply put: If there is a university in your area with a physical therapy department, reach out to them. Hold meetings with their director of clinical education and discuss how your goals can align with theirs. If they are not in your area, maximize your exposure by keeping in contact with their core faculty. Express the value of placing a student in your clinic and what skills they will acquire during the rotation to advance their skill set. In time, this relationship could even open up opportunities for further collaboration; for instance:

1. Guest-lecturing classes within their didactic curriculum
2. Becoming a clinical faculty member and assisting during lab sessions or site visits
3. Sponsoring a continuing education course (I am sure any program could use your help with the “Pittsburgh-Marquette challenge” hosted by the APTA Foundation for Physical Therapy.⁴)

Creating a partnership in any way will always help promote your clinic. Once you have formed these types of relationships, the opportunities for you and your employees could be endless.

Create a Legacy

You do not need to have a large clinic to host students. I have worked in clinics with only one physical therapist, a physical therapy assistant (PTA) or two, and about two office employees. While most students will not ever get an opportunity to be in a clinic this small, I have found it to be one of my more valuable experiences. It was here where I was largely exposed to the administrative side of private practice. I can attribute the experiences I gained in this setting to being one of the main reasons that I joined the Private Practice Section, as well as to further aspire to open my own practice one day.

I realized that treating patients was only half the battle; the other half was the constant dealing with insurance agencies, physicians, health networks, and collection agencies. This was the first time as a student that I heard terms like “accounts receivable” or “sustainability management,” among other terms and factors that business owners must understand to keep their clinic afloat. Chiropractic institutions have historically done a good job educating their entry-level clinicians on managing and starting private practices. This standard is not as universal among physical therapy programs, which incidentally leads to a vast amount of fresh clinicians entering the workforce with little knowledge of the benefits of private practice. Hosting a student at your clinic can help promote small business and encourage students, such as myself, to push for what they may still consider “the American Dream.”

Who knows, by the end of their rotation you may have been unknowingly training a trustworthy and proficient individual who now understands your practice model. If the time is right and they are searching for a job following graduation, this may be an easy and dependable hire because “feeling out” and recruiting a potential employee who fits into your clinic can be difficult in itself.

References

If you are not capable of hosting a student in your clinic for whatever reason (cash-based, Medicare only, a violation of your policies/procedures) but would still like to offer assistance to students seeking advice on practice management, consider becoming a sponsored mentor to a student through the PPS mentoring program.

To find out more, contact ppsssig@gmail.com.

Anthony Sinacore, ATC, SPT, is a student in the University of Pittsburgh DPT Class of 2016. He currently serves as the vice president of the PPS student special interest group and is an editorial board member of Impact magazine. He can be reached at jsinacor@gmail.com.