Hello Winona,
I appreciate the views expressed by Shai- renewal of the specialties becomes
expensive over the years and sadly some of the weakest clinicians I've
encountered in my 35 years of clinical practice were board certified. Great
clinicians with specialized knowledge may or may not be board certified; but
not all board certified PTs will be great practitioners, making the value of
the specialization less of an indicator. Our profession requires such holistic
care with all of its emotional, psychological, physical and intellectual
demands, it is a challenge to find a test to certify achievement across all
those domains.
AND I appreciate the points Cindy and Nicole raised here too- we need to
establish ourselves as oncology providers and this official channel creates one
avenue. Personally I'd like to see the APTA overhaul its entire structure
eliminating the Academies and Sections siloed competitive approach to
interacting, streamline the politics and bureaucracy, revise the education
standards and incorporate the Residencies into the final year of PT school, and
focus much more attention on advocating for our role with the chronic
population Cindy discussed in her reply. Our profession has the power through
sound clinical reasoning, to restore lives and provide value to any healthcare
system, A PT salary can be offset by hospital savings when we reduce length of
stay and iatrogenic harms. We accomplish this all the time, but have not
focused enough attention on how to consistently make that happen and track it
with data.
Meanwhile Winona, I am currently revising some of the content for our Oncology
mentoring series given as part of our Acute Care residency program.
Here are 3 take away points illustrated by case studies from our medical center
this year. (It will be 5 or 6 cases and all are oncology patients who walked
into our hospital for complex cancer treatments and during their care needed
our Medical ICU due to a crisis occurring while they were on the oncology
floor):
1. The PT will recognize patients change of status unique to oncology treatment
side effects or disease progression and understand how/when to alert the
Medical team (MD, NP)
2. The Acute Care PT will recognize the comprehensive Rehabilitation needs of
oncology patients and appreciate that we serve as Acute Rehab and Outpatient
Rehab for these patients while they are in the hospital. Oncology patients as
Nicole and Cindy wrote about, need these long term and pre-hab services they
are unlikely to receive. Let's learn to provide as much of those services as
possible, let's teach more about preventing and monitoring for lymphedema
BEFORE it occurs and needs the robust outpatient practice in the hospital for
example.
3. The PT will recognize when patients are receiving futile care or end of life
care that we cannot provide any palliative service or benefit to and
discontinue PT services for those patients- including when MDs re-consult you.
The PT will avoid providing futile care to avoid contributing to prolonged
patient suffering and to free Acute PT time for other patients who need our
restorative skills.
Perhaps experts in our field such as Cindy and Nicole can create a round table
forum or committee or expert consensus or just an APTA CSM seminar on knowing
when to push and when not. It took me years to figure that out for myself by
reviewing case studies of patients I had treated on my own, reading research
articles on prognostication measures and frailty and learning as much as I can
about the person who is my patient..., one patient at a time, over and over.
On top of all that, the fundamentals in our power point slides for this
oncology mentoring series were created in 2019 and are already woefully out of
date. Oncology specialization will need to be a perpetually evolving process
as the treatments are changing so fast.
-heidi engel
On Sunday, May 1, 2022, 07:22:54 PM PDT, Winona Ross <wmw1972@xxxxxxxxx>
wrote:
To all who have responded, thank you!This has gotten more discussion than I
had ever hoped for. I am not considering specialization for a wage increase,
although my employer does provide that. I was very surprised to see how few
were given a raise for gaining their specialty certification. My reason for
looking into the Oncology Specialty is not for an increase in pay but rather to
better serve the oncology population in our hospital. Our onco patients have a
designated floor but there are also many scattered throughout the hospital. I
don’t feel as though I can treat them as all the other patients such as ortho
or just general med but I don’t know enough to be able to tailor a specialized
treatment plan for them. I want to provide much more for the patients as well
as provide some insight for the team I work alongside each day. I feel like our
oncology patients are very underserved. The acute setting is unique as we don’t
have these patients as long, unless they are there for inpatient chemo when
they may be there for a month or more. Many patients in the acute setting are
tired and hurting. I don’t know how much I can push or whether I need to just
leave them alone. That’s one reason I reached out. I didn’t know how much we
really could do for patients in the acute setting. I want to be able to use the
education I gain from studying for the exam(and Shai, I do not enjoy taking
tests!) and want to make sure there are opportunities for acute care. My
manager is very interested in me pursuing my speciality in oncology as she has
someone interested in the outpatient side of oncology and she wants to have the
ability to offer a full program from acute to outpatient and lymphedema(we have
a very strong outpatient lymphedema program). Again, I just want to make sure
there’s a place for acute PTs to flourish with this specialty. Thank you all
for your discussions thus far.
Winona Ross
On May 1, 2022, at 5:16 PM, Lucinda Pfalzer <cpfalzer@xxxxxxxxx> wrote:
Sara,
You raise many points worth some additional discussion, but I will tackle the
one that has had me scratching my head for many years. Chronic disease is the
bread and butter of healthcare and where a lot of the profit comes from. Yet
this is not seen as the case in rehab.
One classic example is big pharma quit developing antibiotics for infections as
they are only used for a relatively short period of time and instead 30 years
ago began to focus on drugs to manage chronic diseases such heart disease, high
cholesterol, high blood pressure, type IIDM as people tend to have to use these
drugs for decades until they die. Lots of profit. The same can be said of
cancer survivors whom often deal with the impairments from their cancer and
it’s treatments for many years if not decades and so have a life-long need for
Rehab services.
The same is true for the need for many of these patients with chronic disease
for rehab services and yet we did not and do not build our models of care and
services for this. They will utilize rehab services for many years and it
seems counterintuitive to think all those visits do not make money. Still
scratching my head:)
Cheers,Cindy Pfalzer
On Sun, May 1, 2022 at 5:58 PM Sara Nelson <healer@xxxxxxxxxxxxxx> wrote:
Very interesting discussion on specialization. I love our profession and the
passionate people who are a part of it.
The system of healthcare is in a downward spiral for a variety of reasons
including dwindling reimbursements as more of the pie goes to EMR, insurance
companies and data miners; and being too top heavy with very sick people and
relatively little being done in the way of public health and prevention.
Until that changes, employers do not have the money to raise wages for
frontline workers. PT used to be the money maker for organizational health
care. It is callous to say but care of the chronically ill and oncology
populations is a financial drain. Bean counters do not understand paying extra
to make less money.
Sara Nelson, PT, DPT, WCS, CLT-VodderTherapy Solutions 1455 Columbia Park
TrailRichland, WA 99352509-539-0549
On May 1, 2022, at 1:39 PM, Lucinda Pfalzer <cpfalzer@xxxxxxxxx> wrote:
Nicole (and Shai)
Thank you for your thoughtful response. I concur and will add a couple more
tree/weed issues versus the forest issues Nicole has discussed already.
Residency programs must have board certified clinical specialists on their
faculty and clinical mentors - this is true for all residency and fellowship
programs. Acute Care and Oncologic Residency programs are growing as the need
for advance practice has become obvious over the past 30 years+. You get 2 for
the price of 1 as Oncologic Clinical Specialists practicing in acute care are
able to serve as faculty/mentors in both Oncologic and Acute Care residencies
and there is no doubt the profession and patients we serve need advanced
practitioners in both these areas of PT practice. Clinical Specialists serving
in these roles, I would hope, are negotiating appropriate compensation for
serving in these roles. In addition, these clinical specialists are recognized
by CAPTE for the vital role they play in evidence base didactic and clinical
teaching in professional DPT (entry-level) education and again need to be
compensated appropriately for these contributions to the Acute Care and
Oncologic components of the DPT curriculums. Lastly, it does take a village to
build the specialist examination that only clinical specialists can fulfill.
This is another critical role and while the examination has to cover the blue
print from the survey of Oncologic PT practice which gets updated every 10
years. These board certified clinical specialists are needed to serve as item
writers, to serve on the Specialty Council and serve on the ABPTS Board. I
know these roles are included in the article we authored, but feel these roles,
in addition to the critical roles they play in patient care delivery and
clinical trials at the cancer centers, that these specialists perform is worthy
of recognition and compensation as the future depends on leadership and service
in these roles, also.
Cheers,Cindy Pfalzer
On Sun, May 1, 2022 at 3:56 PM Nicole Stout <nlstout90@xxxxxxxxx> wrote:
I would like to thoughtfully respond to Shai’s comments and offer some
suggestions regarding the value of specialization and a bit of a call to action
for each of us to consider.
First, Shai, I agree with many of the comments that you make. The decision to
specialize or not is certainly an individual choice. Some employers have high
regard for a board certified specialist but many do not. I will be the first to
admit, and I think my coauthors from the study cited below will agree, we were
VERY disappointed with the survey results regarding employer
benefits/comp/recognition regarding the speciality certification. My assumption
is, if you are in a hospital or health care system that currently has a career
ladder, incentivized by speciality certifications, then there should be parity
for individuals with Onco specialization to other board certified PT
specialist. If there is not parity, you need to bring this to the attention of
your administration.
The larger issue that Shai brings up, and again I agree, many, many employers
do not offer any type of incentive/advancement or reward for specialization. As
disappointing as we may find this, I would suggest that we should explore ways
to show the value of the role of a specialist. If our only response is to say
that we studied hard and passed an exam, (that we voluntarily elected to take)
then there is no value proposition in that argument for the employer,
especially at the level of a cancer institute. (Everyone is a specialist,
right?)
A value proposition comes from our ability to show that we improve the quality
of patient care, improve patient throughput, change downstream sequelae, and
(importantly for the oncology realm) show that our interventions matter to what
happens with cancer treatments.
The argument about “specialty certified therapists don’t produce better
outcomes than other experienced therapists without the certification” is as old
as specialty practice in the profession.
I would encourage us to think about how we can change the conversation in
oncology PT. We have an edge in oncology, it’s not like ortho or neuro etc
where there is a large volume of PTs out there with these skills and abilities.
Some Onco PTs are still fighting the fight in acute care that Onco patients
should even be seen, when post-op ortho, discharge pending, and placement
dispos are regarded as priority. Inpatient rehab facilities are fighting the
payment and 60/40 Medicare rule issue, which again, disincentivizes priority
care for Onco patients and may even deter an employer from considering
developing a robust program.
If I can be bold and speak on behalf of my coauthors, I would suggest (hope)
that, if you do read the cited article, that you focus on Table 4.
Interventions to promote oncology specialist engagement in cancer care
delivery. We need to think about multi-level approaches to integrate ourselves
into oncology care delivery. We should be looking to implementation science for
methodic approaches to implementing Onco PT into cancer care delivery. What
does our implementation roadmap look like? Training and education are but one
strategy to help us implement our services…what is the cancer center workflow
and how can we fit? Who are our champions on the cancer care
team/administrations? How do we adapt a PT eval/treat model, to work in a
cancer center as a consultative service that drives in-house referrals
(VALUE!)? What are our communication strategies, tech infrastructure? When we
identify the broad array of barriers, only then can we start to develop a
roadmap to overcome them.
The more we can advance on these various fronts, the greater our skills and
abilities are disseminated to influence cancer care, and the more likely we are
to demonstrate a value proposition related to our position and expertise.
Yours, Nicole
Nicole L Stout DPT, CLT-LANA, FAPTAnlstout90@xxxxxxxxx
On Apr 30, 2022, at 12:01 PM, Shai <ssewell1989@xxxxxxxxx> wrote:
I’m late to the party here, but I may be one who disagrees that specialization
is crucial for acute onc. The test itself does not focus much on the acute
side, and the research in general is lacking. I work in acute onc and have been
for over 4 years now. In general you can learn a lot from the information
provided by the board for what is important for the exam. But the
specialization itself is just another money making ploy. Not to say it’s not
beneficial, but below are some of the few reasons it is.
Where I think it’s beneficial:
1) if your job or future job guarantees compensation for the exam (mine does
only partially)2) if your job or future job will compensate you greater for
getting specialized, or if you have room for growth within your department
(mine does not on either account). 3) If your ultimate goal it to have “Board
Certified” after your name and enjoy test taking.
The new research by Stout et al demonstrates the lack of benefit on quite a few
levels from specialization (see figure 3)
https://journals.lww.com/rehabonc/Fulltext/2022/01000/Professional_Roles_of_Oncologic_Specialty_Physical.5.aspx
I do think some providers and staff will respect you more for the
specialization, but since most don’t even know it exists, I think it could be
hit or miss.
I believe it’s a great way to educate yourself on many levels, but it is far
from necessary, especially in the acute setting.
Feel free to reach out to me, an outlier, at ssewell1989@xxxxxxxxx
Shai Sewell
On Apr 16, 2022, at 11:10, chitra Srinivasan <chithrats@xxxxxxxxxxx> wrote:
Hi
I work acute and I feel this is where Onc Specialisation is most useful.
However it depends on how big of an Onc program the hospital has.
Glad to help!
C. Srinivasan PT, DPT, CLT-LANA
Board Certified Oncology Clinical Specialist
On Apr 16, 2022, at 9:39 AM, Jennifer Bernstein <bernsteinj18@xxxxxxxxx> wrote:
I work acute care peds and have my oncology specialty certification! Would
love to talk to you more!
Bernsteinj18@xxxxxxxxx
Jen Bernstein :)
Sent from my iPhone
On Apr 16, 2022, at 10:30 AM, Winona Ross <wmw1972@xxxxxxxxx> wrote:
Hi! My name is Winona. I work in Ft Worth in acute care and am considering the
oncology specialty certification but I don’t know how much use it can be in the
acute setting. Obviously I know it will help me with all the education but I am
interested in hearing from, and possibly, meeting some who are currently
working in acute care. I’d love to be able to serve my patients better. Please
help. Thank you!
Winona Ross PT, DPT
Texas Health Downtown Ft Worth
--
Lucinda (Cindy)Pfalzer, PhD, PT, FACSM, FAPTA
Professor Emeritus, Physical Therapy Department
College of Health Sciences, University of Michigan-Flint
Email: cpfalzer@xxxxxxxxx
Cell phone: 360-621-7448
--
Lucinda (Cindy)Pfalzer, PhD, PT, FACSM, FAPTA
Professor Emeritus, Physical Therapy Department
College of Health Sciences, University of Michigan-Flint
Email: cpfalzer@xxxxxxxxx
Cell phone: 360-621-7448
