Recently, Lauren Jarmusz -- a Doctor of Physical Therapy Student at Northeastern University graduating in May 2016 -- and I interviewed Sue Falsone, who is nationally and internationally recognized in the field of sports medicine and physical therapy. Sue holds the distinction of being the first female head athletic trainer in any of the four major sports in the United States (MLB, NFL, NHL, NBA). Her impressive professional experiences include: Vice president of Performance Physical therapy at Athletes' Performance, head athletic trainer of the Los Angeles Dodgers, and head of athletic training and sport performance with U.S. Soccer's Men's National Team. Sue is a Board Certified Clinical Specialist in Sports Physical Therapy (SCS), a certified athletic trainer (ATC), certified orthopedic manual therapist for the spine (COMT), a certified strength and conditioning specialist (CSCS) through the National Strength and Conditioning Association and a registered yoga teacher (RYT-200) through Yoga Alliance. See our interview below:
Marquis Cabrera: What do you believe are some persistent problems impeding innovation in the physical therapy field?
Sue Falsone: Turf wars, which stem from insecurity. It is hard to be innovative and elevate your field when the major playmakers are in court fighting turf wars. Acupuncturists are trying to stop physical therapists from dry needling. Chiropractors have tried to stop physical therapists from manipulating. Physical therapists have tried to stop Athletic Trainers from billing for services. There are plenty of patients to go around, and there are bigger health care issues in this country. Needless fighting over who owns what technique gets healthcare as a whole nowhere.
Lauren Jarmusz: How do we create interprofessional healthcare collaborations between musculoskeletal providers?
Sue Falsone: Manual therapy techniques will never be outsourced to a computer and that musculoskeletal providers will always have a flow of patients and in order to maximize clinician's skill sets and elevate the professions, they need to learn to work together. acupuncturists, physical therapists, chiropractors, athletic trainers and massage therapists should be working together to provide integrative care. Financially, it makes more sense for clinicians as well.
Traditionally, one clinician will not get reimbursed by insurance for more than about 30 minutes of care, (this is a broad generalization and is dependent on the health care company and state of practice) however, many patients would benefit from more than 30 minutes of hands on care. By working together, interdisciplinary musculoskeletal health clinicians would have the ability to increase the volume of patients they see by "splitting up the work" all the while providing patients with the care they need. For instance, a patient may see four providers each for 20-30 minutes. One provider doesn't have the time to provide all the treatment techniques a patient may need, but in a collaborative care model, the patient has the ability to receive all the care at need utilizing all clinicians on the team. It is a win-win situation for both the patient and the team of clinicians.
Lauren Jarmusz: What do you think of the move towards preventative based care versus reactive care in the physical therapy space?
Sue Falsone: I love it! It is the only way to go. We will never control health care costs as a country by being reactive. We must be proactive and reward those for doing so. Dentistry has done it for ages. If you have dental insurance and need a cleaning, it is usually covered 100 percent. If you need a root canal, you are going to need to pay more money. Premiums are low. Preventative care is rewarded. It incentivizes the patient to stay on top of the bi-annual cleaning visit. Medical care, including physical therapy, should move to that model.
Marquis Cabrera: Do you think an annual physical exam for muscles and bones designed for the general public would increase patient education and decrease prevalence of musculoskeletal disorders and diseases?
Sue Falsone: Absolutely! Small problems turn into big problems when left alone. I believe that direct access for physical therapists for musculoskeletal issues is a must in all 50 states.
Physical Therapists are trained to identify red flags: life threatening conditions or conditions that should not and cannot be treated by physical therapists. If a patient is experiencing back or knee pain, their first stop should be a physical therapist, not their primary care physician. Not only would this cut down on healthcare costs by cutting out unnecessary medical visits, but it assists with making the entire healthcare system more effective. By cutting out unnecessary visits, PCPs have more time to see the patients they should be seeing, and patients receive the care they need quicker than having to work through the entire medical system.
Taking it one step further, patients should not only being seeing physical therapists when they have a musculoskeletal problem -- such as neck, back, or knee pain -- but going for regular check-up to prevent these unfortunate aches and pains. As the rest of the healthcare system is learning, preventative care is much cheaper than reactive based care, and physical therapists should be playing a part in preventative neuromusculoskeletal care.
Marquis Cabrera: It seems as if regular preventative musculoskeletal care exams are commonplace for elite athletes, and is imperative for their optimal athletic performance, do you think the same techniques could be applied to the general public?
Sue Falsone: Yes! Any techniques used with athletes can be applied to the general population and are extremely effective. Many times people assume athletes only utilize crazy high level training techniques, but in actuality, my training techniques focus around basic mobility, stability, flexibility and power and strengthening training foundations. These are techniques that everyone, not only athletes, would benefit from. All manual therapy techniques that I utilize are applicable to the general public. I never base my treatments on whether a patient is an athlete or not. They are based on each patient's individual diagnosis and dysfunctions. Therefore, I may be using the exact same training or manual therapy techniques on an athlete as well as a non elite athlete, so yes, I think the same techniques/ exams could be applied to the general public and be very effective.
Lauren Jarmusz: Do you believe the traditional paradigm of PT care will transition from "treating a patient and hoping to never see him/her again for that specific injury" to a model, similar to athletic training, in which a PT would work with a patient throughout his/her life on all aspects of musculoskeletal care.
Sue Falsone: Absolutely. Why should we see people for two visits a week for four weeks then send them on their way? Once a week for two months or every other week, or even monthly, is a better way to manage long term, chronic, recurrent pain that is epidemic in our country. However, the greatest limiting factor from allowing this paradigm shift to occur is public awareness. In order for this shift in care to take place, we need to educate the public.
Lauren Jarmusz: In my experience as a student physical therapist, I have found that the general public doesn't understand that PTs are not just a "massage therapist." How can we create a more positive stigma around the role of a physical therapists to laypeople?
Sue Falsone: James Dunning makes a great point here, he has said that physical therapists may have specialization, but they do not have specialized titles. From a physician standpoint, the lay person knows, if they hurt his/her arm, he/she should go to an orthopedist. If his/her leg is numb, he/she should go to a neurologist. If a person has cancer, he/she should go to an oncologist. In all three of these scenarios, a patient would most likely be referred to see a "physical therapist", but the type of physical therapist would not be specified.
Physical therapists, like MDs, have specialties in orthopedics, sports, geriatrics, oncology, women's health, pediatrics, cardiopulmonary, and neurology, amongst others. Therefore, patients with a certain ailment should be referred to and aware of the proper type of Physical Therapy. The way the system is set up now, physical therapy is such a broad term and does not necessarily explain exactly what one health care provider does compared to another. The first follow up question to "what do you do" after someone says "I am a doctor" is "oh, what kind?" This simple follow-up question would benefit the physical therapy profession greatly.
Marquis Cabrera: You have traveled and trained around the world. What aspects of physical therapy/ athletic training/ health and wellness lifestyle techniques/treatments utilized in other countries should the U.S. adopt?
Sue Falsone: The rest of the world is able to read and interpret English based studies, however, many of us in the U.S. only speak one language and therefore it is more difficult to determine the efficacy and quality of non-english based research. I think the U.S. is missing out on a lot of innovative and effective neuromusculoskeletal techniques because of our hesitancy to trust studies not conducted in the U.S.
Lauren Jarmusz: As the first female to hold the position as head athletic trainer in any of the four major sports, was there one specific personal dogma or passion that drove your success in a male dominated industry?
Sue Falsone: I just had very strong female role models growing up. I never even considered gender being a reason I could or could not do something. My success did not come easy. It required 20 years of hard work consisting of numerous hours of volunteering and non-glamorous jobs that allowed me to work and connect with some of the industry's leading contacts. I have worked 100 hour weeks and traveled a ton. It's about knowing what you would be willing to sacrifice!
Lauren Jarmusz: What advice would you give to a student PT seeking to do something non-traditional in the physical field?
Sue Falsone: Meet as many people as you can. Be prepared to volunteer your time and enjoy the volunteer aspect. Don't focus on your barriers because they are always there. Focus on your opportunities.