They say there’s no such thing as magic. Well, “they” must not have been to New Orleans. As you walk down the narrow cobbled streets of the French Quarter, flanked on either side by brick facades and three-story porches, you’ll likely hear a street musician’s melody weaving through a crowd of curious travelers, against the steady clip-clop of a horse and buggy. “N’awlins” often feels like the city that time forgot. It’s a beautiful tableau of history, art, and culture—all woven together to create a rich and multidimensional tapestry. So, it was a fitting backdrop for this year’s Combined Sections Meeting, where cultivating a more diverse, inclusive, and global PT profession was one of the top emerging objectives. Here are a few of the biggest takeaways from CSM 2018:
1. We need more dialogue around diversity.
Diversity isn’t a new topic of conversation in the physical therapy profession. And yet, despite various industry efforts to increase the presence of under-represented groups, the demographic landscape has remained more or less unchanged over the past 10 years. In fact, the APTA’s member demographics have remained largely disproportionate in comparison to those for the overall US population. Since 2000, the percentage of women PTs has held steady at 70%. Furthermore, more than 90% of physical therapists are Caucasian—a trend that has remained virtually unchanged since 2008. During a session on expanding diversity in the profession, presenters from the University of Colorado’s School of Medicine suggested restructuring the admissions processes for DPT programs in order to address this disparity.
A holistic admissions approach fosters cognitive diversity.
The speakers presented findings they collected after employing tools in their admissions process that:
- accounted for both cognitive and non-cognitive factors, and
- fostered a more holistic approach to admission selections.
They noted that an applicant’s test-taking ability or cumulative GPA was not necessarily an accurate representation of the kind of PT he or she would become. (They did, however, note that academic performance in math and sciences is highly valuable when assessing an applicant’s potential for success as physical therapist.) So, in addition to test scores and GPA, the admissions staff also considered non-cognitive assessment methods such as emotional intelligence, grit score, and holistic review in order to cultivate cognitive diversity.
Recruitment efforts should start as early as possible.
This session spurred a whole lot of discussion around the need for a more diverse applicant pool. One commenter—a faculty member at Northern Illinois University—mentioned that it’s hard for diversity initiatives to be successful when you’re pulling from the same pool every year. She recommended working with local professional chapters to assist in recruitment efforts. Another commenter from the University of Arkansas said we need to get adolescents in the PT pipeline from the moment they become interested in health care (as early as high school, middle school, or even elementary school). Far too often, when high school students speak with guidance counselors about careers in health care, those students are funneled into a physician path—unless they specifically express an interest in PT.
The presenters also noted the need for inclusivity across all stages of the PT career, not just during the school admissions process. Lara Canham, a faculty member from the University of Colorado, put it best when she said, “[Diversity] can’t be a program-level effort. It needs to be national effort, a societal effort, if we want to see change.”
2. Biases stand in the way of patient care.
During the session mentioned above, Lisa Dannemiller, PT, DSc, PCS, noted that “our work environments are enhanced by differences in thoughts and differences in experiences.” That said, it’s hard to get serious buy-in for diversity initiatives when people don’t see or understand existing disparities. To address this issue, Dana B. McCarty, PT, DPT, PCS, C/NDT, and Laurie Ray, MPT, PhD—both from the University of North Carolina’s School of Medicine—discussed the challenges stemming from implicit biases as well as the importance of fostering cognitive and cultural diversity in the physical therapy setting.
During their session, the speakers explained that implicit biases—a.k.a. the unconscious biases every person has based on stereotypes or social norms—affect the way PTs interact with not only each other, but also their patients. (Some studies have even found a correlation between bias and patient outcomes, although this pattern requires further exploration.)
Everybody has implicit biases.
As one might expect, this session also incited much discussion. At the start of the session, the presenters asked all attendees to complete an Implicit Association Test (IAT) that measures implicit bias either for or against disabilities. (You can take the test yourself here.) Much to everyone’s surprise, about one-third of session attendees had a strong preference for abled people compared to disabled people; a little under two-thirds had a moderate to slight preference for abled people; and the remaining test-takers showed either (1) no preference or (2) a preference for disabled people over abled. Dr. McCarty noted that a strong preference for one group over another does not imply conscious prejudice against one group, but instead implies unconscious acceptance of societal norms. In fact, our group’s results of the IAT were pretty consistent with results from non-PT groups.
As for addressing biases, the presenters gave several action items attendees could implement to mitigate their own biases as well as reduce the impact of bias in a clinical setting:
- Try out different IATs and reflect on potential biases.
- Make a list of scenarios that could potentially elicit bias.
- Think critically before reacting or responding when those scenarios arise.
- Gain experience and connect with populations that elicit bias.
- Avoid categorizing individuals.
- Remain humble.
3. Physical therapists must own their roles as primary care providers on a global scale.
As the conference continued, it became clear that there’s a real need, and even a desire, for physical therapists to connect across boundary lines—whether that means fostering connections among social, ethnic, or economic groups across town or across the globe. One highly attended session covered the World Health Organization’s Rehabilitation 2030 meeting held in 2017 in Geneva, Switzerland.
According to the WHO, more than a billion people worldwide live with a permanent disability, and 200 million experience functional issues. To put that into perspective, if you put all of those people in one country, it would be the third largest country in the world.
On top of that, 71% of those people currently live in low- to middle-income countries, meaning they are less able to access expensive forms of treatment (e.g., surgery and pharmaceuticals). Additionally, according to the WHO, “the population aged over 60 is predicted to double by 2050 while the prevalence of noncommunicable diseases has already increased by 18% in the last 10 years.” The evidence is clear: physical therapy is positioned to play a crucial role in not only treating widespread functional health issues, but also reducing the global impact of non-communicable disease.
There’s major disparity in access to therapy services.
Unfortunately, the physical therapy community has a lot of work to do. Many misconceptions about physical therapy stand in the way of bringing it into the global health limelight. During her global health session, Emma Stokes, the president of the World Confederation for Physical Therapy, spoke to this issue. According to Stokes, “We need to increase awareness through advocacy.” As she put it, everyone should have access to high-quality rehab care. And that doesn’t just apply to low- to mid- income countries; we should look at our own countries, too.
Of course, almost every physical therapist in the United States is painfully aware of the issues surrounding access to affordable health care. However, in Ireland—a country that has a one-payer system and is Stokes’s country of residence—if a patient has private health insurance, he or she can access a major procedure (e.g., a total knee replacement) within a month. Patients who go through through the public system, on the other hand, could be on a waitlist for two years. Simply put, that is not healthcare equality.
Global health is population health.
In another session that tackled global health education initiatives, Dr. Celia Pechak of the University of Texas El Paso pointed to global health as a way of bringing relevance to the PT profession. In her words, “If you want to play with the big dogs, you have to be a part of the global health arena.” Furthermore, she noted that integrating a global health perspective will directly affect population health. After all, widespread health issues such as diabetes and cardiac arrest aren’t restricted by borders, so by focusing on global health, PTs are focusing on population health.
When you’re in a city as inspiring and romantic as New Orleans, it’s hard not to think of it as a metaphor for whatever brought you there. (In my case, it was the largest physical therapy conference this country has to offer.) But considering the city’s resilience in the face of hardship as well as the great passion it instills in its inhabitants, it’s hard not to compare it to the PT profession. After all, it feels like PTs are constantly fighting an uphill battle in the face of rising healthcare costs and a lack of cohesion across the profession. Still, I’ve never met a group of people who are more passionate about their work than physical therapists. And if CSM 2018 was any indication, that passion can—and will—translate into a brighter future for providers and patients alike.