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Welcome back to the Healing Pain Podcast with Dawn Magnusson

In this episode, we’re discussing the integration of population health, prevention, health promotion and wellness activities into clinical practice. With decades of research supporting the benefits of lifestyle changes on positive health outcomes, physical therapists and other health professionals are exploring and weaving integrative and lifestyle medicine into both insurance and cash-based practice settings, as well as community health and serving the private sector business. Lifestyle changes, including physical activity, nutrition and stress management all lead to improved health benefits in those with chronic disease and prevent or manage a number of non-communicable diseases, which lead to an increased quality of life. Physical therapists are well-positioned to treat non-communicable diseases through the integration of population health, prevention, health promotion, and wellness activities into clinical practice.

Joining us to discuss the topics of health promotion prevention, wellness in physical therapy practice is Professor Dawn Magnusson. She is an Assistant Professor in Physical Therapy at The University of Colorado. She received a Master’s degree in Physical Therapy and then went on to pursue a PhD in Population Health Sciences. Her research employs community-based methods within a population health framework and informs the development of innovative community-based solutions to advance health equity for underserved children. In this episode, you’ll learn all about population health, why physical therapists should care about population health, what the integration of population health and physical therapist practice looks like, how disease prevention, health promotion fit into population health and how physical therapists can become more active in population health, disease prevention, as well as health promotion. This is a big and important topic that has implications both for the entry-level of physical therapy education as well as clinical practice. Let’s get ready and let’s begin with Professor Dawn Magnusson.

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Population Health, Prevention And Health Promotion In Physical Therapist Practice With Dawn Magnusson, PT, PhD

Dawn, thanks for joining me on the show.

Thanks for having me.

I was on PubMed doing some searches on different things related to health promotion and health coaching. This popped up and I was happy to see your paper. I want to make sure that everyone can access it. It’s a great read for clinicians as well as educators. A lot of this applies to educators. This was in the PT Journal, April of 2020, and the title of the paper is Population Health, Prevention, Health Promotion, and Wellness Competencies in Physical Therapist, Professional Education: Results of a Modified Delphi Study. It’s a big study, it’s 35 pages. Congratulations. I know these things take a lot of work and effort from yourself as well as your other co-authors. Tell me first how you became involved in population health. I know you have a long history of this.

I always struggled with how to answer this question because it’s how far back I feel I need to go. It is helpful for people to understand how I was first introduced to the concept and why I became interested in population health. I worked as a pediatric physical therapist for over a decade and I loved that job. I loved working with children and families and I could never have imagined doing anything else. With life in general, I was starting to get concerned about and maybe frustrated by some of the differences with regard to the quality of care that some of the children were receiving. On top of that, I’m frustrated by my inability to better support families in providing more nurturing environments for their children. I came to this fork in the road where I could keep going through life and doing the status quo or do something about it.

I’m more of, “Let’s do something about it,” versus sit by. I didn’t know what to do but I happened to be living in Madison, Wisconsin at the time. I enrolled in a Global Health Certificate Program that talks about health equity and health disparities and things like that. I’m like, “That’s in the ballpark.” It turns out that a lot of these courses were offered in the Department of Population Health Sciences at The University of Wisconsin. I had no idea what that meant at the time, but I started looking into the program. They had a number of different programs that were available and it seemed to fit the training that I was looking for at the time in terms of one, better understanding the populations that I was serving. More importantly, developing the tools and strategies to address some of those underlying challenges and issues that families were facing. It was a perfect match for me. I ended up returning to school full-time, which was a big shock from this job that I truly loved. It was the right decision at the time to understand how I could be more impactful in this area.

All these topics are becoming and are very popular, not only in physical therapy but in many health professions. Some of it spurred by the World Health Organization. Give us an idea of when did you go back and study. How long ago was that because you probably were a little bit ahead of the curve?

I’d like to think so. It all happened somewhat happenstance, but people are like, “No, Dawn. You were a visionary.” I’m like, “I was trying to do something that felt right to me.” I appreciate people saying that. I returned to school in 2010 and I would say the term population health, population health management has been around since the mid-’80s. It certainly received more attention in the early 2000s and became a big player during that time around 2003 through 2006 or 2007. I was at the early end of it in terms of training. I consider myself to be quite fortunate in doing that. I feel sometimes like I fell into it more than I was trying to be some visionary. It’s helped me in not only my practice but my career as well, trying to impart this knowledge for other people.

The connection to pediatrics makes sense because any pediatric professional, health professional I’ve ever spoken to says, “You’re not only treating the baby, the child or the adolescent, but you’re treating their entire families.” You, out of all the different types of practitioners, start to get a sense of, “There are bigger things going on here, than just the patient in front of me that I’m treating.” I like that entry point.

I would add too, when I talk to people from different practice areas, I feel like pediatrics and home health are the two that people are like, “This makes perfect sense that we need to be thinking about these bigger factors.

I want to go through a couple of definitions. You don’t have to give us long definitions, but these terms health, health wellness, population health, health promotion are thrown around a lot and they’re in the title of the paper. First, give us a definition of what population health is.

A lot of definitions have been floated around. Like I mentioned, the term was first popularized back in the mid-’80s by Geoffrey Rose. It’s gone through somewhat of evolution and you’ll find lots of different definitions. When it comes down to it, population health, for me, I think of it as an approach to using data, whether it’s qualitative or quantitative data, to examine differences in both health outcomes and related factors that contribute to either an individual or a population’s health with the ultimate goal of eliminating those health disparities or health differences through better-informed interventions, practices, and policies. That, for me, is what population health is in a nutshell. It’s an approach to understanding our populations and serving them in a more well-informed way.

Things like population health and social determinants of health are important as we are still in the midst of COVID. We still have a lot of population health challenges with regard to healthcare in our country.

I’ve been talking with some colleagues about our situation. I think, whether for good or for bad, COVID-19 has shown a spotlight on some of the disparities within our nation and our country thinking about those social and more structural factors that contribute to our health. My hope is moving forward, we can take that information and use it and leverage that to provide better care and resources for our communities.

I know in our country, it can be difficult to collect data because we don’t have a nationalized health system. So far, the data that’s come out of Italy has told us that 99% of people who die from COVID have at least one pre-existing condition, one non-communicable disease. More than 50% of them have two or more. It’s an important topic. Let’s go into the second definition. When we go through these definitions because I think they’re important for everyone. Give some context to the rest of your paper. We mentioned population health. Let’s do prevention. What is prevention?

I like to think of prevention and health promotion. If we think of population health or population health management as an approach to understanding and addressing health issues within populations, I’d like to think of prevention and health promotion as those methods, those tools that we can use to optimize the health of our individual clients, as well as the health of our populations. Generally speaking, prevention refers to those efforts aimed at reducing the development and severity of acute and chronic conditions as well as related risk factors. We think of four levels of prevention all the way from primordial prevention, which is looking at those social and structural contributors to our health, all the way to tertiary prevention. You can imagine a triangle that tertiary prevention is the top of that triangle, which is more of those healthcare services, traditional rehabilitation services that we provide to individuals who are already sick or symptomatic. We’re trying to minimize their long-term disability and improve their quality of life. That’s prevention in a nutshell.

Health promotion?

I like to think of health promotion as the opposite side of the coin if you will. Prevention is on the one side, health promotion is on the other side. A lot of people equate health promotion to more primordial prevention. I didn’t talk about that in my definition so people can go and look that up. It talks about looking at our communities and structures within our communities and empowering and giving people the tools to improve their life working not doing something for or to the community, but working and walking alongside our community members to improve the health within that community. The other part that health promotion brings in is it highlights the importance of intersectoral collaborations. Whereas prevention tends to be focused in the healthcare sector, health promotion brings in those other sectors like education, housing, urban development, and how we can develop partnerships with those people as well to promote the health within our communities.

The last one is wellness. It’s probably the vaguest term I believe.

That’s one I don’t always have the best-canned response. At the individual level, if we think of what wellness means, it means thinking of our physical, spiritual, and mental health. That complete state of having all of those different pieces and aspects of our health working together so that we’re able to function at the top of our level and fulfill our societal roles or whatever that looks like. Wellness bringing in all of those different aspects of health into one piece.

For example, your physical, emotional, and spiritual health might all fall onto the wellness category?

Yeah. That’s how I think of it.

This is the large study that I mentioned before. Tell us what the aim of this study was. This was a modified Delphi study. Tell people first what the aim was and then second, what a Delphi study is and how that works?

If I could, I might offer a little bit of background for how the study came about, to begin with. I worked with people who are part of the APTA Council for Prevention, Health Promotion, and Wellness, the education task force of that group. We originally did a survey of an entry-level physical therapist, professional education programs to understand, what are people teaching in this space, what are their needs in the space to understand more the landscape of these topics across programs across the country. What we found is it’s like the Wild West as you can imagine in terms of both the depth and breadth of content covered. One of the things that people identified as a key barrier is we don’t even know what we’re supposed to teach in this area, in this space. We thought, “We should come up with some competencies.”

The purpose of this study was to convene experts from around the country and think about what entry-level competencies look like in population health, prevention, health promotion, and wellness. That was the impetus for the study. A modified Delphi study means we as the study team looked across all of our professional documents, literature that had been published before, and started coming up with a preliminary set of competencies or at least areas to consider. That’s the modified part. That was given to our study participants who went through multiple rounds to refine and narrow down that broad list of competencies into the final one that’s published in the paper.

That’s why it’s modified versus let’s say a regular Delphi study would be you would go directly to the experts and they would come up with the specific criteria. You gave them a little bit of a head start on what they’re looking at.

They were also within that process, given the opportunity, if they felt like anything was missing to certainly add that in. They weren’t limited to the competencies or the lists that we had created. It was within their ability to add things, especially if they felt important things were missing.

I want to ask one question because you brought up an important point of there’s a wide breadth, but not so much depth of what’s been being taught out there. I have a little bit of an idea myself, but do DPT Programs in the United States of America, let’s say required to have a health and wellness promotion class? Is it something that is the seed and spread throughout the curriculum? What is the variation of what you know out there?

My understanding is programs are required to provide some level of health and wellness content but that’s vague. It’s a couple of sentences in the CAPT criteria. We certainly have our professional position statements that talk about these things. It’s quite vague. I’m paraphrasing, but programs will provide content in health and wellness, let’s say. That doesn’t give a lot of guidance. If we look at some of the other practice areas, they are specific. If we look through those CAPT criteria, it’s specific. Students must do X, Y, and Z. Those aren’t quite as established in this area because it’s a relatively new area in physical therapist practice and something that people are still wrapping their mind around. Having said that, there are people in the physical therapy world who’ve been doing prevention, health promotion for decades. I don’t want to take anything away from those people. They were way trailblazers back in the late ’70s, probably early ’80s. As a profession, we are trying to wrap our minds around, what does this look like for entry-level education?

For example, if a DPT program director is reading this, the takeaway is that there is no requirement to have a single class on health and wellness promotion. There’s no requirement for that let say.

No, I wouldn’t say for a single class. In the previous survey that I referenced before, all programs are providing this content, but what that looks like is quite different. For me in Colorado, we have a three-credit health and wellness class. Some programs offer one credit. Some programs scatter that throughout the program. What that looks like is different from program-to-program. I’m not aware of a minimum credit requirement for this content or how that should be structured within programs.

I know CAPT doesn’t provide a credit requirement. They provide those competencies. As we touch on that, I’m jumping around a little bit because this topic excites me. Talk to me about the difference between competence and competency.

In terms of competencies, you can have competencies at any level of education, whether it’s entry-level, residency, or beyond that, expert clinician. Competency is that defined skillset, knowledge attitude that students, that learner must demonstrate enable to say, “They are competent in X, Y, and Z.” That’s how I distinguish the two.

You had this study and you go out to experts. Tell me who the experts are. That’s important for us to know. How many were there and what did they look like?

We were intentional in the way that we approached our experts. We wanted to reach out to people representing the many different practice settings where you might find physical therapists as well as educational programs. We were intentional in finding a nice broad range of people to participate in this study. It wasn’t all professionals who even have a background in health and wellness, prevention, or things like that. We’ve wanted to try to represent, get a nice cross-section of people from around the country. I’m looking back at the actual numbers.

We ended up inviting 40 members to participate in the study. Those people represented pediatrics, orthopedics, and all different practice settings. They also included people with varying years of experience. We had a number of people who were relatively new, and relatively fresh graduates. We also had some people with over 25 years of experience, whether it was teaching or in clinical practice. At the end of the day, of those 40 people, 37 completed all three rounds of the study. That’s our participants in a nutshell. Many of them had advanced degrees whether that included a Ph.D. or an Educational Doctorate, some higher level. A number of people had some additional degree behind their name but representing a pretty broad and diverse group of people.

Give us an idea of what the results are. It’s a big paper but there are a couple of key points here. There are three broad categories that you mentioned in the paper that’s useful. We can maybe dip down into some of those categories.

The three broad categories that we ended up classifying the different competencies, the biggest one that is most relevant to practicing clinicians is this clinical and community preventive services and health promotion in that space. We also had a bucket that was foundational population health knowledge and that brings in concepts like epidemiology and thinking about that bigger picture. The third bucket included competencies related to health systems and policies. Thinking about the bigger picture of what should we expect our students to demonstrate in this space? Those are three big buckets.

Those three topics are quite large. I’m like, “I feel like we need more than a three-credit course to cover this.”

I certainly wouldn’t argue with you. A strategic way to approach that is to find meaningful ways to integrate this content, these ideas throughout the program. I personally don’t know that a standalone course is a right way to go, even though that’s what our program does. There’s value in finding creative ways to integrate this information to fit into everything else we do because it’s the topic. It’s population health and everything else falls under that umbrella in my opinion. It’s something to continue working on.

Does the university teach that as problem-based learning or is it a more traditional approach?

I would say it’s a little mixed depending on the course. You see classes run the spectrum depending on the individual course goals or not even the course goals, but the learning goals for specific activities and things like that in skills.

With regard to the competency, what surprised you? These experts are commenting on things and maybe things you thought about, “I thought they would have included more of this or maybe taken this out.” What were the surprises that you found when these experts started to pine on it?

It’s maybe a little bit surprising. A lot of the competencies or descriptions that we originally included, almost all of them were perceived by the study participants as being relevant and important for physical therapist practice. Where a lot of people put on the brakes were, “This is important, but not an entry-level skill. These are things that students should learn as they progress in their careers and as they develop those skills,” but almost everything. I’m trying to think if there was anything that was like, “Nope, that’s not even physical therapist practice.” Nothing like that got completely wiped off. The reason for limiting the competencies had more to do with entry-level practice versus more advanced practice skills. Perhaps it’s not a pleasant surprise if anything. That was great.

As with anything, there were a variety of opinions. There were some people that felt strongly that some things should not be included and fell outside of our scope of practice. That was maybe 1 or 2 individuals. If we think of the process of the Delphi study, we were quite rigorous in terms of making sure we achieved a certain level of consensus in a couple of different ways. We had some people that we’re super excited about some advanced level competencies in my mind that were like, “Yes, students need to know this.” “No, maybe they don’t.” Other people that were like, “This doesn’t even fall in physical therapist practice.” There were those extreme views. I feel like we came up with a pretty good comprehensive list that takes into consideration all those different factors, but that reflects that core consensus.

It’s a comprehensive list and it’s listed beautifully in your paper, which is great for educators to access, or if they have a course or they’re seeding it throughout the program, they can look at that. Can you give us an idea of some of those extremes that you’re talking about? I’m curious to hear what the extremes were. Something that someone thought should be part of an entry-level practice, but other people thought this is something that physical therapists learn about as part of continuing education or as they advance their career.

One thing that comes to mind immediately was the idea of our role in community-based prevention and health promotion. One of the competencies and I’m not going to remember it exactly, but it was essentially conducting a community-based needs assessment and develop a community-based health promotion plan. It’s developing those things. That’s something where some people felt strongly, “Students need to know how to do that because we need to get more engaged and involved with our communities and work alongside them.” We had that camp of people and we had a couple of people on the other extreme that was like, “No, that’s not within the physical therapist scope of practice. Those aren’t things that we should be focusing on.” That’s one example where that competency ended up not being included, but you had people on the two extremes of that. That’s probably one example that comes to mind where you had differing opinions. There was some conversation and people will be able to see when they look at the paper and the process that each competency went through to either be accepted or rejected just to give people an idea.

Back to some of the ones that ended up not being accepted that maybe was a little bit of surprise to me and that was around our involvement or understanding of urban development and rural development too. Thinking about the spaces that people have access to be physically active, I feel like that’s our wheelhouse is physical activity, and if people don’t have spaces to be physically active. I was a little surprised that that one didn’t pass through understanding that urban design element. I know there are a lot of PTs around the country that are heavily invested in that space. That was one that had a little more feedback like, “I don’t know if we need to get involved in that space,” whereas the other half was like, “Yes, of course, we need to students need to.” That was another one urban design or thinking about the spaces where our clients have access to.

That’s an interesting topic because that urban development piece starts to bump up against almost the American with Disabilities Act, which years ago was a big deal. A lot of physical therapists were involved in that and still are involved in that. It also bumps up against environmental considerations, which people are passionate about nowadays, making sure that there are parks that are included when towns are built and developments are created. They’re interesting topics that people may or may not be behind.

Thank you for referencing the ADA because in my mind when that competency was originally parts of the plan, I thought, “This will probably be a no brainer. Given our history of looking at spaces where people need to access.”

On this show, we talk a lot about nutrition. I’ve been talking about nutrition for decades and people know I’m passionate about it. A lot of people that follow the show are passionate about it. I’m happy to see that nutrition communicating nutritional guidelines does show up as a competency. It was rated high as relevant by your participants. Eighty-eight percent, almost eighty-nine percent felt it was relevant. It is a big yes and the final competency. The way it reads is, “To communicate nutritional guidelines set forth by the federal government to clients as a means of promoting healthy, eating, communicating nutrition recommendations set forth by State International Agencies as a means of promoting healthy eating patterns.”

It’s awesome because nutrition is part of our scope of practice per the APTA. It hasn’t quite been rolled out the way we’d like it to be state by state. There’s passion there and debate a little bit about it as well. I’ve talked to many State Boards who say, “That’s part of health and wellness promotion.” I think it is, and this paper says it is, which is awesome. My question to you is do you feel that State Practice Acts should put more specific information with regard to nutrition or should we leave it vague and say, “Nutrition’s part of health and wellness promotion, which is part of what we learn in school?” Do we need to clarify it for people?

In some ways, we do. I’ve looked at a link that you provide from your site that breaks down each of the State Practice Acts and what they say in this regard. When nothing is said, then that’s open to interpretation as yes, we should or no, we shouldn’t. It doesn’t say we can and therefore we shouldn’t.

You can’t either.

It depends on your outlook. If it doesn’t say anything, “Let’s do it.” If it says, “We didn’t get permission,” then people are like, “Maybe we shouldn’t do it.” I do think there needs to be a little more clarification and certainly language that specifies it’s okay to do this aspect of it. I’ve spoken to many registered dieticians. We have some and they’re a great group that comes and talks with our students. They’re like, “Yes, please give patients basic nutritional information. You see them way more than we ever will. You spend so much more time with them.” I equate it with other aspects of our practice. There’s a professional scope of practice, but there’s also an individual personal scope of practice. We should all be comfortable with giving basic, like eat more fruits and vegetables language and information that’s published by the federal government. Beyond that, it depends on our own skillset that we’ve developed in that space. Ultimately, we reach a place where “This is outside of my personal and perhaps professional scope of practice. Let’s bring in an R&D or let’s bring in an expert who can help us consult in this situation.” It’s like any other area of our practice where we have to understand our boundaries and limitations and practice within that and then refer out if we need to.

Nutrition is in CAPT requirements now. That does specifically say nutrition. It’s hit CAPT. It’s hit a lot of parts of our research. Elizabeth Dean has been a big advocate talking about on many different stages and producing some good literature with regard to my question. The National Nutritional Guidelines, and there’s a little bit of controversy around this, if you speak to most nutrition professionals, they’ll tell you, “The guidelines are good, but they’re pretty baseline.” They’re the baseline of what people need to follow for baseline health. The example is the nutrition guidelines through the USDA is to eat five servings of fruits and vegetables.

It doesn’t say how many. If it’s 2 vegetables and 3 fruits or 4 fruits and 1 vegetable, it doesn’t tell you. If you go to some other organizations, they’ll tell you, “Five is not good enough. You need to hit nine to start to get the nutrients that you need.” As physical therapists, we are treating people with non-communicable diseases. Can we start to go beyond those basic nutritional guidelines and say, “For this person, maybe a Mediterranean diet is going to be better for them?” These are topics that we may not have an answer to now in the show but there are topics that both of you and I starting to discuss in various circles.

I feel like each year when I’ve taught this course, we learn so much more about the connection between the foods we ate and chronic inflammation. As we learn more and more about that, the connection between the two is becoming so clear that I agree recognizing, especially for those patients that maybe it truly is the food they’re eating that is influencing their recovery and slowing their pace of recovery. Could that be a factor and is that something we should look at? As we’re learning more about this connection between the two, it’ll be important for us to pay attention to the research and literature that comes out there because all arrows point to there’s a strong connection there.

Everything we’re talking about revolves around behavior change. A lot of it is behavior changes. Yet, I was reading somewhere in your study, you made an important point that behavior change doesn’t necessarily show up in captive requirements well.

Maybe one of those areas where it’s implied in different ways. It could be around prevention, health promotion individual behavior changes there or even working alongside a client to get them to do their home exercise program. It’s all-around their behaviors. How do we walk side by side along with our client in that journey to understand what are the factors that are allowing them to kind of make that healthy choice, the easy choice? Are there other things that are limiting that? Are there structural barriers? Are there things in their environment that are limiting that? It comes back down to the basics of understanding your client, listening to them, talking a lot less, and listening to a lot more to understand their story and how these different factors are influencing their choices and their health trajectory.

One of the reasons why people pursue a PhD is to change the profession. In addition to other studies you’ve already done, you have this wonderful 35-page report on Population Health, Prevention, Health Promotion and Wellness Competencies For Physical Therapists. Let’s go down the list. How would you like to see CAPT apply this information?

What would be helpful to educators is having more direction in terms of both the breadth and the depth of information that ought to be covered in programs. People are looking for more guidance at the end of the day. The other feedback we heard from people in that preliminary study is that our curriculum is jam-packed. If we’re going to add this, then we need to take away that. Programs are struggling with, where do we put this information? Maybe that’s where we can be a little more strategic and intentional about, it’s not another thing to add, but maybe we can weave it in ways that make sense. That gets at some of these core issues that we as a profession need to get on board with and up to our game. Maybe that would be helpful. A little more guidance for people would be helpful.

How would you like to see clinicians use this work?

It’s interesting because I’m working on putting my course online for my summer course. I’m in the weeds of integrating population health, population health management, disease prevention, health promotion in practice. Even for practicing clinicians to take a step back and think about, “How can I understand my population more?” I remember this as a clinician. I viewed each child and family as that individual basis like, “Here’s what you and I are doing. I’ll see you next week.” I never stepped back to think about, “What do these families and kiddos have in common that maybe we could start to identify some patterns and use that information in a way that one, could certainly benefit them?” Two, allow us to practice in a way that’s more efficient and effective, especially as many of our payment models are moving away from fee for service to value-based care. We need to become much more efficient and effective in the way that we do that.

That only happens if we look at our clients at the population level to see what’s happening. I know a lot of people are more tangible, concrete way that people are applying a population health management approach in their clinical practice is to use data about their clients and patients. Identify those people that are maybe at high risk for having a poor outcome and say, “We need to do things differently with them because what we’re doing isn’t working.” That’s a basic step for applying some of these principles and approaches versus those people that are low risk. You give them their home program, they go off and do it and they get better. How can we be a little smarter and more efficient with our time and resources would be a good start?

As you’ve mentioned, the payment models in values-based care for those higher at-risk populations you’re talking about. A lot of this with regards to prevention, health promotion, population health, wellness, it’s facilitating things to happen outside of the physical therapy clinic, which is a new concept for a lot of professionals.

I completely agree and I don’t know if this is a physical therapist thing or what it is, but we feel like we have to do it all and maybe other professions are like that. I certainly get that feeling like, “How am I going to do all this? I can’t address what they came in here. Their shoulder hurts. I need to address that. How do I address all these other things?” It’s like, “You don’t have to.” We’re somewhat comfortable referring to or building that network within the healthcare sector. Referring out to a surgeon or whatever people we need to there. Where I’ve seen people excel in this space, this population health, population health management space is finding those key community resources, maybe outside the health sector where they can connect with them as well.

This is an example off the top of my head. If you find a large number of your clients that are struggling to make their mortgage or their rent payments, there are a lot of communities with amazing resources that are completely underutilized. If you could start identifying some of those community resources, “Here’s a phone number for this agency that could help you in this way. Let me know if you need help calling or getting connected.” Looking beyond the health sector for some of those key community resources would be a great step too.

One of the things that keep coming to my mind is we’re used to working in that fee schedule based on seeing someone billing out a couple of codes. Where’s the opportunity for physical therapists let’s say, financial opportunity with regard to health and wellness? New grads are coming out of school and they have big loans. They want to be able to make money. How can they apply this in a way that can put money in their pocket as well as help the promotion of health and their communities?

An example of that comes almost immediately to mind is the role that physical therapists can play as a noninvasive intervention and lower cost than surgery. I’m thinking of cervical or low back pain. There have been a number of studies that have shown physical therapist services in that space, safe house systems, and oodles of money. Talk about value-based care. Physical therapist services are such a high-value service that given the price, outcomes are tremendous when they’re applied. When it comes to health systems, looking for those opportunities to demonstrate our worth and our value is going to be critical moving forward. Especially now that a lot of those decisions are being made by people maybe without the knowledge of what it is physical therapists do. We have a real opportunity and probably an obligation to demonstrate our value. Not knocking down doors and bullying our way to the table, but showing like, “When people get our services, look at how much money we save the system and look at how great the outcomes are.” That’s true value-based care. We have so much potential in that space. I hope we can better strive to achieve that potential.

Examples of that might be a physical therapist can consult with a local insurance company or a physical therapist consult with a large employer who still funds their insurance and notices that many sick days are missed each year based on lower back pain. How can we bring this down? How can we bring down sick leave? How can we bring down our workers’ compensation claims? Those might be ways where all this can be applied. When you’re saving the company money, they’re more likely to want to pay you and hire you as a consultant.

If people are interested in those examples, the APTA through their employer initiative has a number of great resources and talks about that where physical therapists are starting to demonstrate their worth and value in that space. My people have done a lot of work around employer-driven initiatives in this prevention, health promotion space. It’s another great example.

They learned a whole bunch in this episode. If they want to learn more about you and the great work you’re doing, how can they contact you?

They’re welcome to check out my faculty profile at The University of Colorado. That page contains my contact information, a little bit more background of the research that I’m involved in. They’re welcome to check that out and reach out to me anytime.

I want to thank, Dawn, for joining us for this show. Make sure to check out her paper and share this episode with your friends and family.

Important Links:

• Professor Dawn Magnusson
• Population Health, Prevention, Health Promotion, and Wellness Competencies in Physical Therapist, Professional Education: Results of a Modified Delphi Study
• @DawnMagnusson – Twitter

About Dawn Magnusson

Dawn Magnusson, PT, PhD is an Assistant Professor in the Physical Therapy Program at the University of Colorado Anschutz Medical Campus. She received a PhD in Population Health Sciences, a certificate in Global Health, and an MS in Physical Therapy from the University of Wisconsin – Madison. She completed a two-year postdoctoral fellowship in General Academic Pediatrics, with a focus on health disparities research through the Department of Pediatrics at the Johns Hopkins School of Medicine. Dr. Magnusson’s research employs community-based participatory research methods within a population health framework to a) describe the distribution of health outcomes within a population, b) understand the contribution and interconnectedness of multiple determinants of health within a population, and c) inform the development of innovative, community-based solutions that advance health equity for traditionally underserved children. Dr. Magnusson served as the lead investigator on two national studies for the APTA Council for Prevention, Health Promotion and Wellness (PHPW) that sought to a) understand the breadth and depth of PHPW content across entry-level programs and b) establish entry-level PHPW competencies. She is responsible for coordinating the delivery of population health, disease prevention, and health promotion content within the University of Colorado’s PT program. Dr. Magnusson also serves on the Developmental Screening and Referral Policy Council for the Colorado Department of Public Health and Environment.