This year, the American Physical Therapy Association’s House of Delegates will meet June 25-28th in Orlando, Florida. Despite the sweltering heat and humidity, the air conditioning will make every one wear sweaters, and the jackets of the seersucker #bettertogether movement will be a necessity. In a civilized, Robert’s Rules driven format, 400 some odd delegates will discuss issues relevant to shaping the profession, solidifying our values into policy, discussing administering vaccines as part of our practice (hold on don’t let me lose you), pursuing advanced practice, the role of physical therapists in disaster management, clinical mentorship, repping the improvement standard, and clinician well-being. The docket is full.
The House of Delegates is often a difficult concept to grasp or explain, simply because of its indirect relationship to practice. The motions passed by the House have a trickle down effect to practice, or may directly affect legislative or marketing efforts. Unfortunately, this ensures that the ongoings of the House are poorly translated to the rest of the profession. There are few motions that are easy to understand without extensive background. This year, the House will deliberate one motion that needs no introduction or lengthy explanation: the charge to investigate factors that challenge clinician well-being and resilience.
Other professions have spent a great deal of time researching burnout and how it affects their profession. There is extensive literature regarding physician burnout; in addition to high burnout rates, physicians also have a high suicide rate. The phenomenon has gotten increasing amounts of news coverage. The American Medical Association has climbed on the burn out train, with multiple publications over 2017, and the launch of their STEPS Forward program. The program targets managers of practices, and encourages strategies to promote a healthy workplace environment. Hospital systems are concluding that physician burnout is significantly affecting patient care–and telling docs to eat healthy and do yoga won’t get them very far.
Burnout is a problem in the profession of physical therapy. Meredith Castin, founder of The Non-Clinical PT, wrote an excellent article on the factors that influence burnout within the PT profession.
We can all agree that several factors contribute to clinicians leaving the field or struggling with burnout. What I don’t think we can agree on, and what I don’t think the APTA will figure out, is how to act on this charge.
The motion before the House this year, RC 48-18, if passed, charges the APTA Board of Directors to investigate the impact that burnout has on our profession. The motion would have 3 goals:
- Improve understanding of clinician well-being
- Raise visibility of clinician stress and burnout
- Use evidence to help mitigate the problem.
Broad, sweeping motions calling for investigation have passed before, and fallen woefully flat. We are accustomed to hearing the argument: “It’s a big issue, and we can’t do anything about it.” It’s a shoulder shrug. It’s the “my mom told me to pick up my floor, so I moved everything to my bed.” Check check.
To find an example, one only has to look back to 2016 to RC 11-16. The student debt motion. Incidentally, this motion could be considered tangentially related, if not crucial, to RC 48-18. RC 11-16 charged the APTA Board of Directors thus:
“That the American Physical Therapy Association evaluate existing and emerging data available from internal and external sources, such as the American Council of Academic Physical Therapy and the Commission on Accreditation in Physical Therapy Education, to identify potential effects of student loan debt upon the physical therapy profession, and develop a plan with feasible options to address the identified issues, with implementation initiated no later than June 2018.”
This motion garnered significant popular support; a petition circulated online, gathering over 2,000 signatures indicating that yes, physical therapists would like student debt to be considered a significant problem. (You can read the full story here.) This seems like a no-brainer. Even those in academia will admit that student debt is a major issue. On a recent Healthcare Education Transformation podcast on the topic of DPT clinical education, John Childs, PT, PhD, MBA, CEO Evidence in Motion, Associate Professor & Director of Research, U.S. Army-Baylor University Doctoral Program in Physical Therapy, goes so far as to say, “Until we really do something more substantial with student debt loads, most students cannot afford to go through residency… even if those opportunities were available, in good conscience, I cannot counsel that it makes any sense for them to go to residency when they’re coming out of school with $200,000+ debt. They need to go get as high paying a job as possible, and frankly, in whatever setting…there’s a lot of students who just need to go make money because they’re never going to get out of debt otherwise…”
Gail Jensen, PT, PhD, FAPTA, Dean of the Graduate School and College of Professional Education at Creighton University and Bob Rowe, director of the Brooks Rehabilitation residency programs and APTA Board of Directors member, agreed. This podcast was released Feb 10, 2018. RC 11-16 has been in play for two years, and was never mentioned.
Which brings us to the question, what has happened? According to a statement given to Talus by APTA (read the statement in full here), the following actions on RC 11-16 have been taken:
- Partnered with Laurel Road, a loan refinancing company, to offer a .25% rate discount for APTA members.
- Collaborated with Enrich, a financial education company, to offer financial education in an online platform. This is not a member exclusive; Enrich is free to both members and nonmembers.
- Surveyed student members on debt and impact. 4 focus groups were held at CSM and NEXT 2017.
Additionally, APTA also detailed these accomplishments:
- Representatives from Enrich and Laurel Road spoke at NEXT 2017, gave interviews via Move Forward Radio, and spoke with attendees at the APTA Pavilion.
- Enrich conducted a WebEx on student loan debt for physical therapy students at George Washington University.
- APTA staff spoke at the New York Physical Therapy Association Student Conclave about financial literacy and student loan education.
- Representatives from Enrich and Laurel Road were featured in a recent APTA Student Assembly #XChangeSA chat on financial literacy.
- Perspectives magazine, APTA’s publication for physical therapists and physical therapist assistants in the first 5 years of their careers, featured articles on the Financial Solutions Center and various aspects of financial literacy in the May and November 2017 issues and the May 2018 issue.
- APTA and Enrich are collaborating on a future course module for physical therapy educators on financial literacy.
I have fielded questions from several different people asking why Will Butler or FitBUX wasn’t chosen for the education task. I don’t know. A Request for Proposal (RFP) was put out; many answered the call, Laurel Road came out on top. What decision making went into choosing Laurel Road? I don’t know. Where are the responses to the survey? I don’t know (and the results have not been released).
This motion was a sweeping “let’s get sh*t done in the APTA” that seems to have lost luster as 2016 becomes the past. It’s a personal issue–loans affect our decision-making in every aspect of our lives, from where we work to taking a simple vacation. We’re relying on the .25% rate discount and the less-than-engaging educational platform to band-aid the situation for now. Band-aids are useful, but not a long term solution. The APTA states: “Student debt is one of APTA’s legislative priorities and we have a bill in Congress to add PTs to the National Health Service Corps so they can obtain debt relief in exchange for working in medically underserved areas.” Unfortunately, the NHSC legislation has been introduced multiple times and has failed to make headway. There are other pieces of legislation that could significantly impact student debt; the PROSPER Act would significantly restructure student loan borrowing, but the APTA has yet to put forward information or advocate on this critical legislation. The American Medical Association made its views known. The NHSC is yet another band aid for a situation that is rapidly spiraling out of control. Even the current chairman of the Federal Reserve, Jerome Powell, doesn’t understand why student debt cannot be discharged in bankruptcy, and states that it could hold back economic growth.
So why does a motion on student debt matter? How could it be crucial to RC 48-18? We asked.
On average, across all of our social media platforms, anywhere from 70-80% of respondents, from a pool of about 400 responded that yes, student debt does significantly contribute to burnout. Comments indicated that it affected everything from what setting they chose to start their careers in to buying a house. Those who weren’t affected noted it was other elements, like productivity requirements or documentation that significantly stressed them.
To quote Bob Rowe, again from the HET podcast, “It is a crisis, and we absolutely have to do something about it. I hope there’s ways we can do something about it now rather than later…”
Student debt is not the whole picture, by any means. But if past performance is any indication of future results, the burnout motion is in trouble, whether it passes or not. If the APTA can’t learn from one piece of the picture, how is it going to tackle the behemoth of burnout? The argument that problems are too big to handle is overplayed–everyone contributes something, or we would have given up fighting world hunger and homelessness long ago. The Board should cease trying to apply band aids to the comminuted fracture that is clinician burnout and recruit the people who can make the most difference: the masses. Once motions pass, the process behind them and the actions taken are hidden behind a veil of secrecy, and there are very few opportunities for the average lay person to intervene, beyond a coveted place on a 7-person task force.
There are several micro-actions that can take place, that might help both the burnout motion and the student debt motion:
- Take a stand. Say you care–and then shout it on every channel you have.
- Be transparent. Why are the survey results for RC 11-16 not published? Why hasn’t there been a PT in Motion article on the motions the House will face this year? What is ACAPT doing? What can CAPTE do about this issue, if anything?
- Transparency means meeting people where they are: on social media, through newsletters, podcasts, every channel you have.
- Crowdsource. Smart people on committees (of which we have many) don’t create change unless they transmit their message. Many people, saying the same thing, at the same time, make things happen. Simplify the message and share the load. The quickest way to get someone to burnout is to get them fired up and then leave them hanging. What could be done differently?
- Education on the PROSPER Act–this is an incredibly important piece of legislation that, yes, has stalled, but would change the way federal student loans work. This is HUGE. This needs to be repeatedly pointed out to people.
- Provide education on student debt to income ratio. Not Enrich. Make it easy to find. Put it in front of people’s faces, constantly. We live in the age of social media. A tweet lasts 20 minutes and a Facebook post might not even see the light of day. Repetition matters.
- Give us the tools to stand up and say something matters. It will make us feel legitimized in the association, and empower us to be our own best advocates.
- Create partnerships with organizations that might actually have some leverage. This is in the works–APTA has met with the National Association of Graduate-Professional Students, and anticipates follow up discussions in the fall.
It’s 2018. RC 11-16, by all accounts, could potentially be seen as completed. Checked off the board’s to do list. But what did we learn? If we learned nothing from RC 11, then we will again fall flat on RC 48. The factors of burnout are well researched, and we have acted and voted on them before.
If I had to summarize the story of this year’s House of Delegates, it would go like this:
The profession wants to move forward in primary care, population health, providing relief services in disaster management, and promote advanced practice by changing internal policies. While we’re not quite to mandatory residency, we agree that our new grads need mentoring and advanced practice should be a goal. We’re also not getting reimbursed for maintenance care to help patients stay living in their homes. We’re altruistic, and we want the world to know it. We put our patients above all else…including ourselves. And we just *might* have a burnout problem.
To put this story in perspective, the American Medical Association just completed their annual meeting. Their initiatives include, but are not limited to, taking a stance on gun violence, the current situation at the border, supporting the Affordable Care Act exchanges, removing barriers to care for opioid addiction, and combating the pay gap.
What story do we really want to tell?
Rachel Jermann, PT, DPT, founder and president of Talus Media, loves hunting for PT news and broadcasting it. Also, Ben & Jerry’s. Find her on Twitter here.
(Huge thanks to Ian MacMurdie, editor, for sticking with me through several iterations of this.)