A History and Reflection by Annie Fleming
December 18th, 2020
Another semester of DPT school completed, and as the class of 2022 and 2023 take a well-deserved break, it also provides us with time for reflection. 2020 has been a whirlwind for us all, between the pandemic and the Black Lives Matter movement, we have all been given the opportunity to reflect on the world as we know it, and also time to question it. My time in the clinic was invaluable and throughout my five weeks of learning, I began to notice an inexplicable fact about our profession. I look around and see a profession predominantly composed of white women. I began to wonder why I look around a clinic, my classroom, and our faculty, and see a majority of people who look exactly like me. To better understand this, I thought it best to understand the origin of our profession. After all in order to understand where we want to go, it’s best to understand where we’ve been.
We can trace the origin of physical therapy in the United States back to two events: the Poliomyelitis epidemic and World War II. The spread of poliomyelitis, which is a viral disease that affects the central nervous system and can cause paralysis, was combated through quarantine and isolation (sound familiar?). To treat the effects of the disease, individuals were fitted for long-term splinting and casting to immobilize the limbs and spine. This led to muscle atrophy and decreased flexibility. To combat these effects, female healthcare providers began to specialize in musculoskeletal disorders and provide treatment to those combatting musculoskeletal impairments related to polio.
Along with the poliomyelitis epidemic, World War II increased the need for medical personnel who specialized in musculoskeletal disorders. Medical advancements increased the number of soldiers surviving war, but there was an increasing number of soldiers living with disability. The same group of female healthcare providers, now named the American Women’s Physical Therapeutic Association, who were treating individuals with polio, stepped in to treat soldiers living with disability. The problem was that this new group of specialists was not being given the benefits of other medical professionals in the army. The Hill Burton Act of 1946 changed that. This Act granted the level of officer to female dietetic and physical therapy personnel of the Medical Department of the Army.1 This distinction of officer was not only important in that it recognized physical therapy as a legitimate profession, but it also allowed these providers to retire under the law providing for the retirement of members of the Army Nurse Corps.
So why is it important to understand this? Well let’s look at the current demographics of physical therapists in the United States. The APTA’s most recent data from 2016 indicates that 69.4% of APTA members are female and 88.5% are white. Can we really be surprised? From the beginning of the physical therapy profession, it was basically mandated as a female profession because only females could receive benefits under the Hill Burton Act. The profession being predominantly white is due to the influence of segregation and discrimination of the Army Nurse Corps. Although no laws excluded nurses and medical professionals from joining based on race, the requirements to join involved completion of training at a hospital with more than 50 beds. This type of training was nearly impossible for Black nurses specifically, as most were not allowed entry to training programs at a hospital of more than 50 beds, but instead completed training at small, segregated hospitals.2
I recognize the irony in this, I, a white female student physical therapist writing about how the profession is predominantly white and female. However, I also recognize the power my voice has in acknowledging the inequities in our profession. Change happens when the majority fearlessly speak out and then give that platform to those most affected. As I look around at my classmates, whether it’s in Peter Claver Hall or a Zoom room, I have recognized that the majority of my classmates look like me. I can’t help but wonder, is that what is best for the profession? More importantly, is that what is best for our future patients? Is the population we serve predominantly female and white? No. We treat individuals of all sex, gender, race, religion, sexual orientation, etc. (Unfortunately that’s also dependent on issues of access for these populations, but that’s a blog post for another time). Patients should be able to look around a clinic and see a clinician who looks like them.
The APTA recently announced new efforts and investments to support diversity, equity, and inclusion through expanding fundraising efforts, the creation of a standing committee on diversity, equity, and inclusion, and establishing a new APTA staff position of director of inclusion.3 These are all great steps in the direction towards diversifying our profession, but there is a lot more work to be done. As students and future clinicians we must actively work to change the demographic numbers I mentioned above. It is unacceptable for there to be such a stark contrast in the demographics of our profession and the populations we serve. We can work to change these numbers by participating in outreach to local communities, supporting organizations aimed at diversifying our profession (like the National Association of Black Physical Therapists), and most importantly listening to the trailblazers in this profession. Those who saw the statistics of the white female majority and encountered barriers many never have to, and still achieved their goal. What can we learn from them about how to make this profession more diverse, equitable, and inclusive.
Here at Regis, I’m proud to say we are continuously taking steps in this direction. We are doing our best to listen and learn and most importantly take action. But there is more to be done. Challenging the process, a leadership value we are reminded to develop within our curriculum, will serve us well in changing this profession to be more representative of the patients we serve.
By Annie Fleming, Community Service Chair – Class of 2022