On the first day of neuromuscular PT 3, we watched a video where Selma Blair told her story of being diagnosed with multiple sclerosis. She mentioned how she was having symptoms of MS for months – weakness, falls, pain. She brought this up to her physicians, even asking for MRIs to be taken, but time after time they dismissed her claims. At one of her appointments, Selma unfortunately fell in front of her physician, and this is what it took for them to take her complaints seriously
Sadly, this is a story that many women know all too well, even me. Physicians often struggle to judge the seriousness of a woman’s pain, which can lead to fatal consequences. A study in The New England Journal of Medicine found that women are seven times more likely than men to be misdiagnosed and discharged from the emergency room while having a heart attack. Everyone is taught that left-sided chest and arm pain could mean a heart attack, however, women’s symptoms can differ vastly. Some women can experience an increase in fatigue, neck and jaw pain, and shortness of breath when having a heart attack. Many people do not immediately pick up on these female heart attack symptoms because our studies of medicine have predominately been based around male physiology. Research has recently become more diverse, including subjects of all races and genders, but for the majority of the past century that has not been the case.
Chronic pain is another area where the current U.S.
medical system is failing women. 70% of people with chronic pain are women. Musculoskeletal
pathologies such as fibromyalgia and complex regional pain syndromes are often
seen as “made up” diagnoses, likely because the people suffering from them are
mostly women. Stereotypes surrounding chronic pain diagnoses often lead to
women experiencing pain more often and longer than men. Physical therapists can
directly intervene here by listening to and advocating for our patients with
Women are not the only group who experiences disparities in pain management. According to the National Institute of Health, PCP’s are more likely to underestimate pain intensity in African American patients. African Americans are also less likely to receive pain medication than white people. The NIH reports that opioids are more often prescribed to those in a higher socioeconomic status, although low income patients are more likely to report having pain. Reasoning behind these statistics can be due to access to care (geographically and financially) as well as implicit biases.
To progress ourselves as a profession, physical
therapists must be aware of our own implicit biases and educate ourselves on
how to eliminate them. We need to listen to our patients and take their
complaints seriously. One of the books on my reading wish list is Doing
Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed,
Misdiagnosed, and Sick by Maya Dusenbery. In this novel, Dusenbery talks to
physicians, researchers, and women to provide an account of what it’s like to
seek medical help as a woman. From the brief excerpt I read, I believe that
this book would be a valuable read to every student and practitioner in the
health professions. Women deserve to have their pain seen as a priority. I hope
someday we will get to the point where we don’t have another Selma Blair story.
and Inclusion, which are the real grounds for creativity, must remain at the
center of what we do” – Marco Bizzarri
For this Monday Memo, I was inspired by Dr.
Gregory Hicks, Chair of the University of Delaware Physical Therapy Department. On October 15th, 2019, Dr. Hicks
visited the University of Pittsburgh to give the 2019 Endowed Scully Lecture
entitled “Who Do We Want to Be? Responsible Stewardship of our
Profession”. Dr. Hicks spoke of the
diversity of the Physical Therapy profession… or should I begin by noting, a current
and persistent lack-thereof diversity in both practicing physical therapists
and the present student body. To premise,
I am writing this as a Caucasian Female, the most prevalent statistic according
to the APTA member demographics profile.
To some readers, this may be viewed as a “taboo” subject but increasing
the diversity of the PT student body and workforce plays an integral role in
the future direction of our profession, and our patient outcomes alike. The intention of this Memo is to educate
about the underlying issues regarding a lack of diversity and pose suggestions
for what we, as students, can do!
First, we’ll begin with some statistics. According to the WebPT Industry Survey of
2019, 79.4% of PTs are White, 4% are Hispanic or Latino, 2.2% are Black or
African American, 5.7% are Asian, 0.7% are American Indian or Native Alaskan,
0.4% are Native Hawaiian or Pacific Islander, 1.6% are “Other”, and the
remaining 6% preferred not to report their race or ethnicity. From this statistic alone, it is clear to see
that there is an apparent lack of diversity across the Physical Therapy
profession. Based off of APTA Membership
in 2015, only 15.5% of members reported being of a minority race or ethnicity,
whereas at that time, the US population of minority races and ethnicities was
33%. Regarding diversity in PT academics,
the disparities are also clear. According
to the American Counsel of Academic Physical Therapy, the following populations
are currently underrepresented in PT programs as compared to the US population:
Hispanic/Latino, African American/Black, American Indian/Alaskan Native, and
Hawaiian/Pacific Islander. From this
information, it is clear to see that there is an apparent lack of diversity in
both the current PT workforce, and within the student-body.
So, why is
diversifying the profession so important?
According to Cohen et al, it is argued that achieving greater diversity
will lead to a more culturally competent workforce, improve access to
high-quality care for the medically underserved/underrepresented, increase the
scope and depth of the United States’ health-related research agenda, and diversify
the population of medically trained executives and policymakers taking on leadership
positions in the health care system in future years. One frequently cited consequence of
inadequate minority representation within the healthcare professions is reduced
utilization of preventative care and increased utilization of emergency
services. Increasing utilization of
preventative services is particularly important for our profession, as upwards
of 90% of patients with musculoskeletal injuries choose NOT to seek formal care
from a physical therapist. It is important to note that it is widely accepted
that health care outcomes are improved, especially for minority patients, when
the healthcare providers and staff in a hospital or clinic resemble the patient
populations they seek to serve. To add to this, in 2013, Yeowell conducted a
qualitative research study investigating physical therapists’ perceptions,
views, and experiences of ethnic diversity in relation to the profession. Yeowell,
too, argues that it is important for the workforce to reflect the patient
population it serves, so they are better equipped to understand and respond to individual
patient’s needs. This is NOT to say that
a therapist with a differing background from a patient is incompetent and
unable to treat them effectively. According
to Dave Kietrys, PT, PhD, “We live in a
diverse world, and our clients and patients come from diverse communities. We should be mirroring that. We also should
be welcoming people from all backgrounds into our profession. The greater our
diversity, the deeper and richer our understanding will be of the needs of a
varied population. We’ll naturally be more sensitive to underrepresented
communities—what they’re going through and how they might have been
marginalized, stigmatized, or treated with bias.”
There are many speculations to why a lack-of
diversity is persistent in the field of PT, such as the astronomical cost of
higher education, implicit biases of interviewers/directors, lack-of exposure
to the Physical Therapy profession, and several other potential reasons. As a physical therapy student, it may seem like
we do not have control over this aspect of our future profession at this point
in our careers. Luckily, the APTA does have some suggestions of what can be
done to aid this pertinent issue while we are still students!
to our chapter delegates! Discussing these pertinent issues while we are still
students gives us an opportunity to become “responsible for the stewardship” of
our future profession!
to faculty and staff in the program that you are attending. Determine if there are any programs/policies
that are currently enacted, or work diligently to establish a program to
support future students. For example, at
the University of Delaware, there is a mentorship program in place for minority
undergraduate students interested in the field of Physical Therapy. Qualifying students have the opportunity to
take classes alongside of PT students, meet with advisors directly in the
program, and receive access to study resources.
This assures that these students are receiving support to function
academically at their highest potential and remain solid, competitive
candidates for Physical Therapy school programs nation-wide.
Educate children in
underrepresented minority, gender, and socioeconomic groups about what physical
therapy is and how they can be part of our profession. A program that was enacted
once within Pitt Physical Therapy with this goal in mind was referred to as the
“Homestead Community Sports Medicine Exposure”.
Pitt PT students met with athletes from the Homestead area of Pittsburgh
and showed them various exercises, as well as educated them about the field of physical
therapy! These are the fun, rewarding
experiences that students will remember when they are choosing a career
path. This shows that having physical therapy
exposure is not limited to patients walking into your clinic alone. Exposure to the profession
was identified as a more influential factor in career choice among minority
students compared to white non-Hispanic students. However, Caucasian students
are five times more likely to have had direct (being a patient) or indirect (family
member/friend being a PT or being seen by a PT) personal experience with a
physical therapist than their minority counterparts.
am hopeful that, as time progresses, diversity in the field of Physical Therapy
will increase. The future of our
profession, student-body, and patients are counting on us to do so.
A special Thank You to Dr. Gregory Hicks for bringing this pertinent information to the University of Pittsburgh.
Death, Taxes, and Distance Runners Training Through Injury
I’ll start with a simple question that most runners get on a daily basis: “why do you run so much?” A good question nonetheless, but one where the answer truly never satisfies, nor is it one size fits all. Understanding this point is the key to treating the stereotypical distance runner.
I played basketball, soccer, and swam competitively all
throughout my childhood, but gave it all up to focus on running track and cross
country to earn a college scholarship at Pitt. To me, it was a sport first and
foremost, a means to an end that would hopefully evolve into a lifestyle or a
hobby that would stick with me through my adult life. To others, running can be
an escape, a way to de-stress and retain focus and clarity. It is a form of
community; it encourages healthy social interaction for many, and welcomes any
individual no matter the experience or ability level. Exercise, weight loss, and
various other health benefits also draw people in, but to understand the
athlete, you must first ask the question: “why do you run so much?” Without the
answer to this question, without understanding the motivation behind the athlete,
you cannot understand and appreciate the method to our madness.
Many of us have experienced this exact scenario: runner
comes in after initiating a program, they express concern over something they
clearly feel is important enough to dedicate their time to looking into, and
when you provide your analysis and utter the words “I think you should think
about taking some time off,” you’ve lost them. I’d like to play a little unpopular
devil’s advocate, as someone who has been told to take time off, and as someone
who tells others to take time off. After the dust settles, instead of placing
the blame on the runner for not following our recommendation, what if it is our
fault for having the conversation the wrong
way? Einstein said that insanity is
doing the same thing over and over and expecting a different result, so knowing
the chances of success with this particular conversation, why do we still try
to shut a runner down six weeks before the marathon?
I don’t have an answer, because the approach will not be a
“one size fits all.” When it is definitive that an injury is too severe to run
on, and it is evident to the therapist but not the patient, it is our
responsibility to not allow that patient to be put in a situation where they could
do potentially irreparable damage. When on the fence about shutting them down
completely, I firmly believe airing on the side of caution can be as
detrimental as running on a muscle strain or tendonitis. Physically they may
feel better in a week or so if they take the therapist’s advice, but does that
athlete want to come back when they have another set back only weeks from
competition? Learn about your athlete and what motivates them, determine how
you can help them achieve their goal/motivation, and develop a plan that works
for you and the patient.
Just like all your patients, start with the goal, “I want to
run the marathon.” If they are running because this race is the opportunity to
run with their family member or for a cause they are passionate about, asking
them to stop running may be the worse news they have heard in months. If they
are trying to qualify for a bigger race or meet a certain time, they have
invested countless hours into training and will probably not allow knee pain to
keep them from achieving their goal until they are literally unable to walk. In
my experience, knowing that my PT wants me to run my race, and understanding
they are tailoring our sessions with the goal of getting me to the race, opens
doors that can get forever shut simply by immediately suggesting time off.
I am not saying we should allow all our injured runners to
run, I simply wanted to provide some perspective as to what the conversation
might be like from the other side of the table. Running is a sport that
involves a lot of pain and sustained discomfort, so it should come as no
surprise that running through injury is very much a part of the sport. In my
time at Pitt, I have had two navicular stress fractures, one femoral neck
stress fracture, two hamstring strains, a quad strain, a partially ruptured
Achilles Tendon, a torn labrum and FAI that required surgery, a concussion,
back spasms, and just about every lower extremity tendonitis under the sun. I
plan on going out for a 6 mile run later this afternoon, and I fractured my
twelfth rib only three weeks ago. Why do I run so much? I run so much, simply
because the work isn’t finished yet. I have the same level of dedication as the
runner on your treatment table later today. I may be one of the more extreme
cases, but just like the majority of your patients who are runners, every
running injury I have ever had has come with the goal of getting right back on
For 3rd year students and fastly approaching for 2nd years, there is the unavoidable topic of taking the National Physical Therapy Exam (NPTE) and applying for state licensure after graduation. However, these processes can be very confusing especially if you don’t know what state you want to practice in. After all, many of us are not originally from Pennsylvania or do not plan on practicing here following graduation. Below is a ROUGH (very rough) guideline and information of taking the NPTE and applying for state(s) licensure.
What is the process of taking the NPTE?
In terms of taking the NPTE, there is a whole process that must occur prior to taking the exam that requires multiple agencies and accrediting bodies. For the most part, this process is relatively consistent state to state but there are some minute things that may differ. When registering for the NPTE, your school must validate your graduation, and you must meet all eligibility requirements before the state’s jurisdiction grants permission to allow you to take the test. All of this must happen before you schedule to actually take the exam. Along with the NPTE, there are a few states that require a jurisprudence exam for licensure. This exam is specifically aimed at assessing your knowledge on specific PT practice legislation in your respective state.
After passing the NPTE, am I automatically licensed in that
For the most part, yes. By meeting eligibility requirements to take the NPTE, you essentially receive licensure upon passing. But keep in mind that this license is only valid in THAT state. For example, if I took my test in Pennsylvania, I can only practice in Pennsylvania. Let’s say that I wanted to move to Philly but wanted to commute to New Jersey for work, I would still have to apply for licensure in the state of NJ.
What if I plan on doing travel PT? Do I need to apply for
licensure separately for all those states?
Unfortunately, yes. And all the application fees that come along
with it. BUT there is hope. Recently, many state legislatures have introduced
the idea of “compact privileges” for PT licensure. This system allows you to
practice in any of the states within the agreement while holding only one
state’s licensure. This acts very much like a driver’s license. I may hold a
Pennsylvania driver’s license but if I am driving through Ohio, I must adhere
to Ohio’s driving rules and regulations. The same holds true for PT licenses as
part of this compact agreement.
As of right now, there are 16 states that are officially a part of the agreement, 11 states that have enacted legislation to become a part of it, and 4 states including Pennsylvania, that have introduced compact agreement legislation as a topic. Soon I could work in New Jersey while holding only a PA license. Cheers to no more application fees!
This only begins to scratch the surface of what must be done between now and working a real adult job. But if you are like me and get anxious thinking about all the tedious processes and confusing licensing rules, this is a good foundation to build upon as we approach graduation!
like human medicine, veterinary medicine is seeing a shift in practice to more
preventative care versus reactive treatment. In 2003, the Canine Rehabilitation
Institute established a program of Canine Rehabilitation offering a Canine
Rehabilitation Therapist Certification (CCRT) that requires one to be a
licensed physical therapist in order to qualify for enrollment. Today, there
are two places where you can become certified in canine rehabilitation, the
Canine Rehabilitation Institute and the Univeristy of Tennessee. UoT also has
certification programs for equine rehabilitation, equine taping, canine fitness
training, canine osteoarthritis case management, canine pain management, and
nutrition case management
Therapist, Francisco Maia, PT, DPT, CCRT offered practical insights for those
interested in pursuing canine rehab in an interview published by Emma Lam of
CovalentCareers. His advice included: If possible, shadow someone who
already works in the field to learn more about animal rehab. Additionally,
successful animal rehabilitation therapist needs to know how to educate the
family/owner about diagnosis, rehab programs, prognosis, and HEP. Lastly, the
rehab concepts are more or less the same as human physical therapy – you just
need to learn how to integrate animal anatomy and physiology with your physical
Lee, Emma. “How to Become an Animal Rehabilitation Therapist.” CovalentCareers, 17 May 2017, https://covalentcareers.com/resources/animal-rehabilitation-therapist/