Faculty Spotlight: Dr. Ira Gorman discusses healthcare policy and PT advocacy

Like most physical therapists, my passion for PT arose from the desire to empower people to achieve their greatest state of well-being and functional independence. However, as I progress in my education, I am learning that the simple goal of helping people can be far more complex in our convoluted healthcare system. Furthermore, if I want to truly serve society, I cannot simply treat individual patients. I must advocate for larger changes through public health.

To elucidate some of the confusion around healthcare,  Dr. Ira Gorman speaks today about the current healthcare system, the need for awareness and advocacy to advance public health policies, and recent changes in the practice of PT.

-Priya Subramanian, SPT- Regis University

2019 APTA Federal Advocacy Forum – “Day on the Hill”

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Colorado members at the Forum representing and advocating for the #ChoosePT campaign.

Last week,  the APTA Federal Forum in Washington D.C. took place to advocate for important topics to physical therapists. The Forum brought together APTA members, speakers from the field, and stakeholders on the discussion of regulatory affairs and federal priorities that impact the physical therapy profession and its patients, as well as on learning about new information that comes with a new Congress. Attendees had the opportunity to speak with their representatives in person about issues facing their state and the profession as a whole. Among those in attendance were our very own Regis DPT students and faculty members. Second-year DPT student Hannah Clark reflects on her experience on the Hill and why it is crucial to not only advocate for our profession, but to be involved as a student, in her following essay:

“Issues Discussed at the Capital”

Hannah Clark, SPT – Regis University

To fundamentally agree with the policy positions held by the APTA is an exceptional feeling. As a DPT student who is hoping to delve headfirst into pain management and advocacy for marginalized communities in healthcare upon graduation, my decision to pursue this profession has been deeply validated by attending the Federal Advocacy Forum (FAF). Witnessing leaders within the APTA address topics related to population health, patient choice and access, value-based care and practice, and research and innovation helped me to fully recognize the crucial role the APTA has in influencing the policies that impact our ability to serve society. For these reasons, it felt important for me to join the GAC team advocating at the capital and I was deeply honored to be selected.

Due to the recent success regarding the removal of the Medicare cap, we were able to spend more time becoming educated and advocating for the field of physical therapy in a broader sense. On Monday, we spent the entire day learning about the current political climate in congress from Nation Gonzalez at CNN, the societal impact of healthcare policy from Sarah Kliff at Vox, and attended breakout sessions that detailed information regarding federal policy, payment, the ACA, Medicaid, and IDEA. One of the most emphasized topics throughout the day involved the #ChoosePT campaign. The APTA reminded those attending the FAF of the real impact physical therapists can have on the opioid epidemic through offering vulnerable populations access to non-pharmacological pain management. Clear objectives were presented that tackled this issue in addition to intra-professional issues such as student loan repayment. Several policy priorities were presented for every state to choose from when planning their congressional meetings.

The following topics were addressed by the Colorado GAC team when meeting with legislative assistants:

  • Our geriatric specialists spoke to the vital role in we play in exercise promotion and fall risk reduction in the community. Conversations were also had in the valuable perspective physical therapists can bring to park and recreational center design.
  • Our pediatric specialists asked congresspeople to consider expanding the budget for IDEA as they have witnessed the impact this program has on the lives of children.
  • Our outpatient clinicians provided examples of how they have successfully treated patients experiencing chronic pain and assisted them in weaning off opioids. These individuals also spoke to the measurable reduction in opioid use they have made in their local hospital system by implementing early access to physical therapy services.
  • Our students asked our congresspeople to cosponsor SB970 (and eventually the same bill when it is brought to the house) that would add physical therapists to the National Health Service Corps. This would allow graduates to serve rural populations, often most impacted by opioid addiction, and would offer student loan repayment as an incentive.
  • Our long-time advocates requested that physical therapists be added as community health center providers, as we are a vital element of the primary care team.

In addition to the invaluable time spent at the FAF learning about how physical therapists can impact healthcare quality and access in the U.S., one of the most important aspects of the weekend for my professional growth was getting to know the GAC members I accompanied. The people I spent time with exemplified everything I love and respect about our profession. They spoke with genuine care for their patients, integrity in leadership opportunities, intelligence in considering the complexity of pain, passion for their interventions, and commitment to social responsibility. Our conversations had a large impact on my personal development.

I returned to class following the Federal Advocacy Forum with a fresh perspective. I felt focused and calm as I approached coursework and simulation labs. Attending FAF granted me the opportunity to further shape who I aspire to be as a professional and world citizen. I am beyond grateful for this opportunity and truly believe that if any student were to have the chance to participate in this event, they would foster a deeper appreciation for the APTA and for healthcare advocacy at large.

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Hannah (pictured second from right) was all smiles with fellow members of the Forum at the 2019 APTA Federal Forum in Washington D.C. 

Presenting At CSM 2019, Washington D.C.

It was a cold, rainy national Combined Sections Meeting (CSM) this year in Washington D.C., but that did not stop almost 17,000 people, including several from Regis University, to attend! Regis students and faculty not only learned the latest happenings from others in our field of physical therapy, but also took roles in presenting their research and/or speaking during educational sessions to inform our profession. Below are some highlights of their experiences.

 

 

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DPT students Amber Bolen and Grace-Marie Vega with Dr. Andrew Littmann

“Going to CSM as a student researcher was a wonderful experience! Discussing our narrative review with PTs, students, and other researchers who shared our passion for regenerative medicine will always stand out as a highlight of my time at Regis.” — Grace-Marie Vega

“I loved working as a team with my research partner on our narrative review (the PT’s role in stem cell research for spinal cord injury). Presenting research at CSM was something I never expected to do when I first entered PT school, but Regis faculty encouraged our class to submit for review. We decided to give it a shot and we made it! Being able to speak with people interested in our field of research was an amazing feeling. We even attended a lecture in which one of our cited authors was present. It was also humbling to see how many research posters and lectures came out of Regis and its faculty and students. I look forward to seeing more as a proud future alumni!” — Amber Bolen

 

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DPT students David Cummins and Katherine Heller with Dr. Andrew Smith and Dr. Denise O’Dell

“Attending CSM in Washington, D.C. was an amazing experience. I had the opportunity to share my team’s research, chat with leaders in the profession, and meet dozens of potential employers. The energy and passion at the conference was infectious and I left feeling reinvigorated and excited about the future of our profession.” — David Cummins

 

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DPT students Hannah Clark, Vivian He, Felix Hill, and Erin Lemberger with Dr. Karla Bell, Dr. Melissa Hoffman, and Dr. Nancy Mulligan

“I think that getting to present an educational session at CSM is a fairly rare opportunity, and our team definitely bonded through the intimidating experience of presenting to almost 300 people! In presenting our research on LGBTQ+ related cultural competency, we were also able to identify barriers and build broader awareness of LGBTQ+ issues in our profession. I feel so grateful to our lead researcher, Dr. Melissa Hoffman, for getting me involved in research and making it possible for us all to have this experience!

In addition to the educational session, many members of our research team are involved in PT Proud, an LGBTQIA+ committee in the Health Policy Administration Section of the APTA. As part of that group, we held a membership meeting and happy hour event, which provided a powerful space for LGBTQ+ people and allies in our profession to come together.” — Felix Hill

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Pam Soto, a third year DPT student, presented a platform on “The Impact of Leadership Development Curriculum Through the Eyes of the Physical Therapy Student.”

 

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Class of 2018 graduate Dr. Amanda Rixey presented on preferred method of feedback after simulation experiences for DPT students.

 

And even more!

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Leadership Through Service: A Student Perspective

Name: Amber Bolen, Class of 2019 Service Representative

Undergrad: University of Oregon

Hometown: Eugene, OR

Fun Fact: In college I spontaneously gained the ability to wiggle my ears.

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Hi everyone! My name is Amber and I am the Regis DPT Class of 2019’s Service Representative. Being the service rep for my class means that I work with people and organizations in the community to plan and implement service projects for my class to participate in. I have also had the wonderful opportunity to be Regis’s PT Day of Service Representative for 2017, a title that has now been passed to Austin Adamson, the service rep for Regis’ class of 2020.

The prospect of serving others was one of the main draws for me to attend Regis University’s DPT program. One of the first questions I would ask my prospective schools was “what opportunities do you provide for students to be involved in serving the community?” Regis was by far the most equipped to answer this question. With service learning projects being embedded into almost every semester, domestic and international service opportunities through the Global Health Pathway, and countless opportunities and contacts for students to find more to be involved in, I was hooked.

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Regis DPT Class of 2019 students pose with Denver Parks and Rec employees after working hard mulching trees and raking leaves at Sloan’s Lake Park.

Before beginning my journey as my class’s service rep, I wanted to determine what my fellow classmates were really interested in. Being people who all made the conscious decision to live in Colorado for 2.5 years, outdoor projects were high on the list. In the past, I’ve organized day projects cleaning and keeping up parks surrounding Regis. For example, for PT Day of Service we worked at Berkeley Park to restore the playgrounds, repaint picnic tables, clear trash, and unearth perennial plants.

Another trip involved collaborating with Volunteers for Outdoor Colorado to provide trail restoration work at the Anna Mule Trails near Georgetown, Colorado. The trail restoration project was a weekend endeavor that resulted in sore muscles, a more refined grasp on what goes into creating a trail, great food, and excellent classmate bonding time.

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Regis Class of 2019 students take a break for a photo op while they work on the Anna Mule Trail near Georgetown, CO.

Being the service rep for my class has truly been an honor and I would be remised not to reflect on what I’ve learned in the process. Here are some “pearls of wisdom” I was able to collect:

  • You don’t have to be outgoing to be a student representative, but in my case I did have to be comfortable reaching out to community partners I hadn’t met yet.
  • Sometimes what you think an individual or a community needs is not actually what they need. Our job when providing service is to listen and respond in kindness if we are to do anything tangible.
  • While direct service (working with people face-to-face) is valuable and rewarding, indirect service, such as maintaining community areas, has merits too. I can’t count how many people thanked us during our park clean ups!
  • An act of service does not have to be a huge, momentous task. Small acts of service are appreciated more than we think.
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Regis Class of 2019 and 2020 students and friends take a group photo in Berkeley Park on PT Day of Service.

The fact that so many Regis DPT students are willing and excited to take part in service projects beyond what is expected by their classes speaks volumes about the type of people that our program attracts. I have never met a group a people, students and faculty alike, that are so committed to doing more for others. Service is so inextricably linked to the curriculum, values, and culture here at Regis that it has become part of who we are. As my classes at Regis come to a close and I am getting precariously close to “real world PT,” I know that the emphasis placed on these values will make us excellent physical therapists. We have learned to be sensitive to the needs of our patients and our communities and understand that physical therapists have a unique position to advocate for and implement change on individual, community, and societal levels. My hope as we all eventually graduate is for us to take everything that we’ve learned and apply it to our own clinical practice. I hope for all of us to listen, ask questions, create connections, and take initiative to make a meaningful impact in the lives of others.

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Cleaning up trash at Berkeley Park!

Please stay tuned for PT Day of Service this year, happening in early October of this year! Look for announcements from Austin Adamson, the Regis DPT Class of 2020 Service Rep and PT Day of Service rep for 2018! If you have questions about anything involving student service at Regis, please feel free to email me at abolen@regis.edu. In addition, if you have any questions about PT Day of Service 2018, Austin’s email is aadamson001@regis.edu.

 

Regis DPT Students Present: “LGBT+ 101”

 

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Taylor Tso, Hannah Clark, Felix Hill (left to right)

Regis University first-year DPT students Felix Hill, Hannah Clark, and Taylor Tso recently held a session for their classmates entitled “LGBT+ 101 for Student Physical Therapists.” The presentation covered foundational terminology and concepts related to LGBTQIA+ communities, a brief overview of LGBT+ healthcare disparities, as well as tips for making clinical spaces more inclusive. Here are some thoughts from the presenters related to key foundational concepts, what motivated them to present on this topic, and what their plans are to expand on this work in the future:

What does LGBTQIA+ stand for?

LGBTQIA+ stands for Lesbian, Gay, Bisexual, Transgender, Queer and/or Questioning, Intersex, and Asexual.

 

What is the difference between gender and sex?

Both sex and gender exist on spectrums. A person’s sex is assigned to them at birth based on their genitalia, typically as either male or female. Intersex people are born with a unique combination of sex traits such as hormones, internal sex organs, and chromosomes. Gender involves a complex relationship between our bodies (think biology and societally determined physical masculine and/or feminine attributes), identities (think inherent internal experience), and expressions (think fashion and mannerisms). While gender is commonly thought of as a binary system (men and women, boys and girls), there are people whose identities do not fall within either of these categories exclusively, or even at all. While many people identify with the gender often attributed to the sex they were assigned at birth (cisgender), there are others who do not share this experience (transgender).

 

Does gender identity have anything to do with sexual orientation?

No! You cannot make assumptions concerning someone’s sexual orientation based on the way they express their gender or based on their gender identity. Sexual orientation simply has to do with whom someone is sexually attracted to or not. It also has nothing to do with how sexually active someone is!

 

Why did you feel it was important to present on this topics?

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 “In spite of our community’s unique healthcare needs and the stark disparities that affect LGBT+ people’s access to healthcare, typical DPT programs offer little to no education that would prepare you to treat LGBT+ patients. We wanted our cohort to be competent and confident in treating this population.” –Felix

“Felix recognized this need at Regis early on and has been working closely with our faculty to develop more inclusive and comprehensive educational materials. As an ally, I have been honored to work with Felix and other members of PT Proud (the first APTA recognized LGBT+ advocacy group) in this process of educating ourselves and others. I believe that the field of physical therapy can do a better job of caring for LGBT+ patients and I want to be a part of the solution.” –Hannah

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What do you believe was the main impact of this presentation?

 “Facilitating educational exposure to LGBT+ topics that people may or may not have had knowledge of before. This presentation sparks curiosity and lays down a baseline understanding for healthcare professionals to better their communication, and thus, quality of care for their LGBT+ patients.” –Taylor

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So you have given this presentation—now what?

 This was just the beginning! Due to negative past experiences and fear of discrimination, many LGBT+ people will go to extremes to delay care. Even if someone has access to health insurance and can afford to come see a PT, which many do not, people are likely to wait until their condition is very serious, which then contributes to poorer outcomes.

We will work to share our knowledge widely throughout the U.S., starting with a presentation at CU in August. But ultimately, workshops are not enough! As board members of PT Proud, the LGBT+ catalyst group in the HPA section of the APTA, we want to ensure that physical therapy professionals across the country receive a basic level of LGBT+ competency training, which will ultimately require changes to DPT and PTA curricula. We will also be working with PT Proud’s Equity task force to influence laws and policies to increase LGBT+ healthcare access.

Felix, Hannah, and Taylor all look forward to the prospect of future presentations.

 

How can I learn more?

Follow PT Proud on Facebook! https://www.facebook.com/PTProud/

Feel free to leave a comment on this post with any questions or thoughts as well!

Mental Health Wellness in DPT School

Name: Abbey Ferguson

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With all of its incredible opportunities, graduate school, especially a doctorate program, also brings a new amount of stress and anxiety. It is a pressure cooker for bringing out both the best and the worst in us, and as my first year came to a close, I found myself drowning in mental illness and anxiety. I realized I wasn’t alone as we embraced vulnerability in our summer Psychosocial Aspects of Health Care class, and many of us found the courage to admit how exhausted we were with life, finding relief in common ground.

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We are literally on a common ground 🙂

Our Psych-Soc. class was one of the many resources I began to take advantage of in order to regain mental wellness. Regis’ counseling center provided free counseling, all of the advisors had their doors open, and with time many of my classmates became close friends as we continually showed support for each other. However, there was still a nagging sense that I couldn’t pursue full wellness in our program without bringing some sort of awareness to mental health issues that permeated our program.

 

When I was 19, I was diagnosed with Anorexia Nervosa. After years of treatment, bouncing in and out of recovery, I arrived at Regis ill-prepared to ward off another relapse. Being in a healthcare field is difficult as an individual trying to fight health and diet culture which often triggers eating disorder behavior. I found myself getting angry with some of the comments people would say or the culture that was fostered in the general population, and I felt helpless.

 

However, thanks to the community at Regis and within our DPT program, I was encouraged to do something about my feelings of anger and helplessness. I began to formulate an education program to advocate for those in recovery from eating disorders, and to educate the program on how to foster a less triggering environment. We had one of Regis’s counselors come and speak about the language health-care providers use and how these words can affect an individual’s perception about themselves. We also had a panel of three second-year DPT students who shared their own experiences recovering from an eating disorder in graduate school.

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I was overwhelmed by the support. As I looked out at the crowd that had showed up to my small education session, I grew misty-eyed and almost cried in front of everyone. My frustration dissipated, and  I was instead filled with pride for the program I am a part of. Fellow students asked questions, attempted to understand, and showed overwhelming empathy as the session continued. After the session, dozens of fellow DPT students came up to me, expressing similar experiences of recovery and wanting to continue the conversation. Weeks later, another DPT student came up to me at our national conference in New Orleans, excited and passionate about the topic and wanting to team up with me to advocate for mental health as well. I found it encouraging and exciting to see like-minded, future health care professionals so interested in becoming more familiar with these issues in order to properly care for individuals plagued by these illnesses.

 

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There is no question: graduate school is hard. It is intense, exhausting, and often times it feels like I am just crawling along. But, I have never been more thankful to be a part of a program that allows its students to own their mental health by advocating and educating the community.

Dry Needling…Not a Type of Craft that Your Grandmother Does

Name: Katherine Koch

Undergrad: The Ohio State University

Hometown: Cleveland, OH

Fun Fact: Last summer, I climbed six 14ers

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Dry needlingnot a type of craft that your grandmother does. This type of treatment uses thin filiform needles inserted by a physical therapist into myofascial trigger points, or a tight band of muscle that might be causing pain (1). Dry needling is based on physiological evidence supported by research that is usually part of a broader treatment plan (2). If this needling sounds familiar to you, you’re not alone. Acupuncturists use the same type of needle to adjust the flow of energy, or chi, throughout meridians in the body. Acupuncture is an ancient Chinese medicine and operates based on the belief that these thin needles can relieve tension, stress, and pain when inserted by an acupuncturist (3). While you won’t be getting an itchy sweater from this treatment, it can lead to pain relief for many people. 

However, there is still confusion and debate among physical therapists and acupuncturists concerning the rights and responsibilities of physical therapists in performing dry needling on their patients. This debate of dry needling by physical therapists was recently taken to a Denver district court when the Acupuncture Association of Colorado (AAC) challenged the Colorado State Physical Therapy Board (Board). The AAC claimed that physical therapists had not undergone enough training to perform dry needling and requested the Board reverse the rule that allows physical therapists to practice this method of treatment. The AAC argued that physical therapists only perform 46 hours of training to be certified to practice dry needling, while acupuncturists train for almost 2,000 hours. The association claimed this made dry needling by physical therapists an “unsafe practice of acupuncture” (4). However, this statement is strongly misleading due to the additional 3,400 hours of doctorate level schooling that physical therapists already have behind them before they complete those 46 hours specific to dry needling training. Physical therapists spend three years in graduate school learning how the human body works, what can go wrong with it, and how to fix it within the realm of physical therapy. Additionally, doctors of physical therapy are required to take continuing education courses throughout their careers.

Additionally, the AAC made the claim that dry needling is just a misnomer for acupuncture, while the two are fundamentally different practices. They may look similar to the untrained recipient, but physical therapists and acupuncturists perform their respective treatments with fundamental ideological differences between the two. This is not to say that one is better than the other, and patients may make the informed autonomous decision to receive either or both treatments. However, as the Denver District Court decided, there is no need to prevent members of one profession from performing treatments all together. In December 2017, the court recognized that physical therapists are acting within the Colorado Physical Therapy Practice Act when they perform dry needling.

As the Colorado Chapter of the APTA President Cameron MacDonald put so eloquently,

“this legal debate was brought forth by those who wished to restrict the practice of another profession from their own. This debate could have been about any intervention utilized by physical therapists, and not just dry needling. It is imperative to consider this legal challenge and the lawsuits brought against the Colorado PT Board through the lens of the Colorado consumer of healthcare. Consumers in Colorado are provided access to health care providers which have a defined scope of practice under which to deliver patient care. Health care professionals are expected to provide the best care they can, and to practice under a scope flexible enough to both protect the consumer and not limit the development of practice by health care providers.”

When physical therapists perform dry needling, they are practicing within their professional scope. When acupuncturists perform acupuncture, they are practicing within their professional scope. Both professions can live harmoniously alongside each other while helping patients within their respective realms.

Why does any of this matter? First, any judicial ruling or legislative rule concerning a profession as a whole likely has implications that affect many of its members. In this case, physical therapists that perform dry needling in Colorado were in danger of losing their legal right to treat patients in this way. Further, patients were in danger of losing out on a treatment that can benefit them. To be effective health care providers, it is imperative that physical therapists are informed practitioners in order to best advocate for their profession and best treat their patients. Denying to inform themselves and take positive action does a disservice to future physical therapists and patients who will benefit from the work done to advance the profession today. In order to practice as autonomous providers, physical therapists must continue to advocate for their profession and understand the issues surrounding it. It also stands to reason that since the American Physical Therapy Association participated in this case as an amicus party and presented information that no doubt helped sway the case, physical therapists should support and be members of the organization that advocates for them on this broad level.

This debate is not in Colorado alone; lawsuits in three states have gone the opposite way and the state boards have been forced to remove dry needling provisions from their practice acts.4 Since each state has their own physical therapy act, it is important that the Colorado practice act, which will be revised next year, continues to maintain its inclusive language that provides “for new developments in physical therapy practice, which includes dry needling” (Caplan and Earnest, LLC, personal communication, January 9, 2018). For the good of physical therapists, patients, and the future of physical therapy as a profession, this particular case is closed.


If you are a student physical therapist, like myself, who hopes to perform dry needling as a professional one day or if you simply would like to learn more about its practice, please refer to the references below.

  1. Dry Needling by a Physical Therapist: What You Should Know. American Physical Therapy Association. http://www.moveforwardpt.com/Resources/Detail/dry-needling-by-physical-therapist-what-you-should. Published December 25, 2017. Accessed January 28, 2018.
  2. Gattie E, Cleland JA, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017;:1-41.
  3. Miller J. Physio Works – Physiotherapy Brisbane. Acupuncture and Dry Needling. https://physioworks.com.au/treatments-1/acupuncture-and-dry-needling. Accessed January 28, 2018.
  4. Migoya D. Acupuncturists sue Colorado’s physical therapy board over the very definition of their craft. The Denver Post. https://www.denverpost.com/2017/04/05/acupuncturists-sue-board/. Published April 7, 2017. Accessed January 28, 2018.