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Tuesday, June 6, 2023

Is it time to start integrating fields (CPT, DPT, ATC, DC, DO, LMT, etc.)?

Brent Brookbush

Brent Brookbush


Panel Discussion: Is it time to start integrating fields (CPT, DPT, ATC, DC, DO, LMT, etc.)?

Why not integrate? The "in fighting" between physical therapists, personal trainers, chiropractors, and athletic trainers (and physicians too for that matter) waists an immense amount of resources. Are we really so different, or is it time to start integrating fields?

Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS

This Panel Discussion was originally posted on my facebook page - https://www.facebook.com/brent.brookbush - on 3/2/13

Barbara Kay Yay! Another panel discussion! Integration in my opinion is key to the success and future of the health field in general. As resources become more limited due to restraints on funding for specialized services in healthcare, medical professionals are going to have no choice but to work together not only in tertiary level interventions but also at the primary and secondary levels. The key to health now is prevention education and early screenings, which requires a knowledge of the holistic model of health. The medical model deals mostly with diagnosis and treatment but does not integrate everything that we know in terms of the mental, emotional, spiritual, and physical dimensions of wellness. This is where educators and personal trainers come into play - training us to become the best and most healthy versions of ourselves to increase our quality of life and help prevent onset of illness. Physical therapists need to have a good rapport and be on the same page with the physician in order to give the proper rehab for the patient's condition; and the personal trainer needs to be aware of those physical conditions when designing workouts. Tying the science to the education and training is a must if we are going to condition people effectively and efficiently.

March 2 at 10:37am

Brent Brookbush Thank you for the support Meg Trahan, Michele Maccaro, Casey Brookbush, Lucas Ryan Zarlengo, and Anne Giese Foust… but who is going to jump in with the first comment. Let's Get Ready to Rumble!!! Alright I'm just kidding, but "Let's Get Ready for Intelligent Discourse!" Just doesn't sound as good. Come on panel, let's make this the biggest and most important discussion to date.

March 2 at 10:38am

Barbara Kay Of course you know I would be first.

March 2 at 10:38am

Ryan Crandall Movement is the common denominator that is key to all of those fields. This I agree 100% with.

March 2 at 10:45am

Stacey Cooke Penney Fantastic, ongoing topic of discussion! I always enjoying connecting with the various professionals that see the benefit of an integrated approach- we can all compliment each others services and strengths! And on the flip side, it's always frustrating to see professionals adamantly opposed and looking down on the other fields.

March 2 at 10:48am

Barbara Kay That's exactly what it is Stacey - people in the field look down on each other based on education level and what they "think" they know about the other professions. Maybe all fields need to up the bar in terms of education, certifications, etc. to be sure we get quality professionals at every level.

March 2 at 10:52am

Edwin Ambitious Rodriguez Barbara: You hit it right on the nail.

I'm starting from scratch in my personal training career & working towards my way to the top & integrating w/ other professionals in the medical field. I'm just learning about kettlebells & found out that most Russians used kettlebells for injury prevention & it reduced the medical costs dramatically. I didn't know kettlebells exercise was that effective on the kinetic chain.

I still have a lot to learn but I like my journey so far.

March 2 at 11:09am

Brent Brookbush Hey Stacey Cooke Penney, Ryan Crandall, and Barbara Kay… This is not just about looking down at one another… if I may play devils advocate this is also about "Scope"… for two reasons. One, not everyone is qualified to do the same work… (For example, trainers need to stop trying to manually release, massage and mobilize, and physicians need to stop prescribing workout routines… both are dangerous.).. Second, we have to create a financial model that allows all professionals in the medical community to make a good living… How do we all get a nice size slice of a limited financial pie?

March 2 at 11:15am

Ryan Crandall I agree Brent. I did the 40 week Gary Gray mentorship called GIFT years back. In it, you have some amazing and smart PT's, ATC, DO's, and trainers who all bring something to the table. I agree we should all have our various scope based on education. It's a good question on how…right now I need to get an A on this test coming up in a couple hours

March 2 at 11:18am

Jesse Smash Howland This is a very good point and I'd like to see more of a unified front on these issues. After all aren't we all fighting for the same cause to help people become strong, fast and resilient?

March 2 at 11:19am

Barbara Kay Hmmm…to make sure you get your slice of the pie, you need to do your baking. Raising the bar of professionals in each area of the field will attract more quality professionals, thereby contributing to quality assurance in care and best use of resources in the process.

March 2 at 11:24am

Barbara Kay More respect and better care at every level will increase the value of those professionals - ergo, increased pay.

March 2 at 11:26am

Rick Daigle Agreed 100%. This is what I try to preach to all of my attendees when I lead a CEU class! We need to all work together to further improve ourselves! There is so much I and we all can learn from other professionals! Take it even a step further and professionals in their own profession need to wrk better with others, as I see so much bickering across the board. Again, there is a ton I can learn from so many other PTs but there are so many out there that either do not want to help or take a "it's my way or the highway" approach.

March 2 at 12:51pm via mobile

Melinda Reiner Agree with Barbara, the are many professionals in each area with a "chip on their shoulder." Collaboration is the only way to go. The problem is that these folks don't honor what is necessary, the patient/client's needs are paramount and focus should never be on the bottom dollar/assembly line atmosphere. I could go on and on with what I've seen. It's all about intent.

March 2 at 2:10pm

Brent Brookbush Great points all,

March 2 at 3:43pm

Brent Brookbush A couple of points of my own,

Barbara Kay , raising the bar of each professional individually may or may not solve the problem… for example, if personal trainers are required to have degrees will the expect an increase in scope and will that scope encroach on other professions, physical therapists have been fighting this fight with the advancement of the Doctorate in Physical Therapy and direct access… there are many physicians who do not agree with this move as it implies the ability to differentially diagnose and reduces the number of visits to a physician who may or may not have made the same diagnosis.

Rick Daigle, I know you are an "integrationist" as am I and our mutual friends Perry Nickelston and David Weinstock (The HMS Fam')… but what will this mean further down the line? Could we be looking at a merge between chiropractors, ATC's and DPT's? Maybe, a doctorate in Intergrated Orthopedic Manual Medicine?

Melinda Reiner, although I would love to agree with your altruism, I often repeat an epiphany I had several years back when starting my company… "Any program that is not profitable is not sustainable" That does not mean we have to reduce care, but we have to be innovative in our solutions to ensure that we attract quality professionals with compensation that justifies the sacrifices made to enter and work in the profession. Overlapping scopes is a real concern and with the cost of education sky-rocketing and the compensation for professionals decreasing (relative to the cost of living) we need to look for solutions that ensure everyone is able to continue with care.

Just some thoughts, looking forward to hearing your thoughts everyone… and most importantly… thank you for making this another quality educational experience for not only the participants in this discussion, but those who read it.

March 2 at 3:52pm

Kinesiology Cscs I work as the Fitness Coordinator at the only Medical Fitness facility in NY and the most comprehensive in the U.S. so I'm filled with opinions on this. I've been staff at Duke Univ. Medical Center (slightly integrative) and UCLA Medical Center (very little integration), and where I'm at now is definitely a step up. Having said that I still see so many hurdles that I don't know can be overcome -- failures within curriculums; failures at regulation; major political issues; major egos; time constraints that lead to lack of true interaction between providers; lack of interest in wanting to truly integrate among providers, even within an Integrative Health facility -- I could go on. It's very frustrating because integration is definitely the way to go, but the rut each component of the healthcare industry is stuck in is an overwhelming rut and I currently stand on the side of pessimism regarding the ability of the industry being fixed and our idealistic views coming to fruition.

March 2 at 5:33pm

Karl Sterling Great conversation - thanks for posting, Brent. Quick note - different topic (but it's all related) I'm a nutrition major at Syracuse University, finishing my degree this year. When I went for my annual physical last fall, my doctor asked "How's school going? What kinds of things do you learning as a nutrition major?" When I answered, in detail - he looked at me, appearing kind of confused and said "That sounds interesting. I don't know much about nutrition. We only took a semester or two of nutrition in med school." He couldn't remember, for sure how many semesters. After talking with my son, who is a medical student at Hershey Penn state - he informed me that a large percentage of physicians know very little about good nutrition. Anyways - I find this interesting and disturbing. Anyone have thoughts they wish to share about this?

March 2 at 6:44pm

Karam Al-hamdani Although you are absolutely right on wanting to join forces the problem arises when an individual starts working beyond his or her scope of practice. I think joining forces is a good idea but that there should be boundaries that each industry should respect. From there I believe that creating a good network is the best option so that when you are faced with particular situations where you cannot fix the problem "even if you know how" you know who to refer to.

March 2 at 6:44pm

Melinda Reiner Karl, the answer is yes. There is no to little training in nutrition or dealing with insurance issues. Both need to be included in med school curriculum.

March 2 at 7:49pm

Brent Brookbush Great points Kinesiology Cscs, I really appreciate your personal account of a valiant attempt at integration within your own facility… and Karl Sterling, I think you will remember Myth #1 in my book … Unfortunately, many physicians over step there bounds in nutrition - having little to no background - not really sure why, physicians have such an immense scope as it is and they have so many other issues to deal with. I agree with you Karam Al-hamdani on the networking… uber-important, just wish more people where actively working on a networking system… and thank you for the personal account on your education Melinda Reiner… Once, again another great panel discussion. Thank you Kats!!!

March 3 at 10:39pm

Jaco Victorious Blom I am so glad to hear that it is not only in South Africa that there exists a "in fighting" between physical therapists, personal trainers, chiropractors, and athletic trainers. I am a registered Biokineticist, also know in other countries as Exercise Physiologist and my scope of practice is very wide and consist mostly of rehabilitation in orthopedic injuries and clinical problems. The problem I have with the system we work with is that for example our physio's do not refer there patients, but instead starts the second and third phase of rehabilitaion themselves, which is not there job. The problem is that it is all about keeping the patient and thus trying to "keep" the money coming in. The professions that studied in a certain area of medical science must keep to what they have studied and not try to keep the patients by do other professions jobs.

March 4 at 11:29pm

Jenny Frodsham Medina It's starting to happen in medicine by pure default. I'm a NASM CPT and we

It's starting to happen in medicine by pure default. I'm a NASM CPT and health/wellness educator. My mom has been a nurse practitioner for years and has seen such change. Most medical professionals DO NOT get any real nutritional training. Now, they will be prescribing exercise, as well as reaching out to fitness/wellness/nutritional consultants to create a healthy lifestyle plan for families and individuals. The challenge will be agreement on and creation of a preventative model. Old school is basic macronutrition, vitamin supplements and a heavy emphasis on animal products for protein and calcium. Science is now very clear that a whole food, plant based diet is the gold standard. I know, easier said then done. However, people can make little shifts (I use that word instead of change) and movement (use instead of exercise at times) to create an irreversible catalyst. Please feel free to contact me for resources at :jmjrmedina@gmail.com . Challenge for all: watch Forks Over Knives, DVD if you haven't already. All my best, Jenny Medina

March 7 at 5:12pm

Brent Brookbush Hey Jaco Victorious Blom,

That is pretty crazy… luckily there is no medical professional who can take the place of a physical therapist in our system. Orthopedic physicians, physiatrists, and osteopaths all should refer out. Insurance would simply not pay for the number of sessions needed for PT with a physician.

I do believe some are trying Jenny Frodsham Medina to integrate health professions, but the rest of your post does point to another issue. Bias… A plant based, vegetarian diet has not been proven conclusively better than a diet rich in fruits, vegetables, grain and lean meat sources. I personally could not live a vegetarian lifestyle if for no other reason than my size and activity level would make it frustrating to get the volume of calories I need… not to mention, complete proteins, vitamin B12, folic acid, fat, etc…

A balanced approach is always necessary… more fruits and vegetables is almost always a good thing… all vegetarian is actually as extreme a thinking process as the Atkins Diet (speaking purely from a health perspective).

If you are reading this and have ethical issues with the consumption of animal products that is a totally separate topic, please do not take offense to the statements above.

March 7 at 7:35pm

Jenny Frodsham Medina I definitely highly encourage you to read The China Study and watch the DVD I mentioned. it is absolutely conclusive in terms of a dirt rich in fruits, vegetables, nuts, seeds, legumes. whole grains will reduce the risk of…See More

March 7 at 9:27pm

Kinesiology Cscs anyone can provide evidence to back up a belief/view. providing a ton of evidence to support a view isn't equivalent to "absolutely conclusive." dr. jeff volek, a renowned nutrition researcher and associate professor at the university of connecticut …See More

March 7 at 8:52pm

Brent Brookbush Thanks for the great point Kinesiology Cscs… Very well said. In my book (here we go… no I'm entering my bias)… I give the basics of each nutrient, and my conclusion is that the body is actually fairly resilient and can work well within a varie…See More

March 7 at 9:13pm

Kinesiology Cscs totally agree

March 8 at 7:40am

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