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-Vodder
Therapy Solutions
1455 Columbia Park Trail
Richland, WA 99352
509-539-0549
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, FAPTA
nlstout90@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>Hi
wrote:
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
