For today’s PT Profile, we welcome Steve Goldrick. Steve graduated magna cum laude in 2008 and was also a Presidential Scholar with a Bachelor of Science degree in Exercise Science Pre-Physical Therapy from Western Washington University. He worked as a personal trainer throughout college as well as a PT aide and became a Certified Strength and Conditioning Specialist (CSCS) from the National Strength and Conditioning Association (NSCA) in 2008. He then went on to graduate top of his class in the Doctor of Physical Therapy program at Eastern Washington University in 2011. During his graduate studies, he worked as a research associate in the ergonomics/biomechanics laboratory where he was published in the Orthopedic Practice PT Journal (Ortho Section) for his work involving ergonomic exposure assessment methods in the grocery industry.
He has attended numerous continuing education conference and courses throughout his young PT career, including many NAIOMT courses. He recently sat for the Orthopedic Clinical Specialist (OCS) examination from the American Board of Physical Therapy Specialists for 2015. His clinical specialties include orthopedic manual therapy, vestibular therapy, occupational physical therapy (work conditioning and physical capacity testing), and stage 3 cardiac rehabilitation. He plans to pursue further education with finishing his Certified Orthopedic Manual Therapist (COMT) training and then completing a fellowship in manual physical therapy. He is active in the blogging community and has been writing an orthopedic blog “OMT Talk” for the last year. His current clinical interests are in pain science education and the work of David Butler, Lorimer Mosely, and Adrian Louw
Where do you practice, Steve?
I am a partner and staff physical therapist at Kitsap Physical Therapy and Sports Clinics in Silverdale, WA. Kitsap Physical therapy is a PT owned group practice with 16 owners among 7 locations in the greater Puget Sound area. We specialize in “Getting people back to work, sports, and life at any age” through a unique blend of evidenced informed orthopedic therapy as well as many physical therapy subspecialties including Women’s Health, Temperomandibular Disorder Rehabilitation, Lymphedema management, etc.
Why did you choose PT as a career?
I chose to be a PT because I felt that it was a perfect blend of what I was interested in (science, anatomy/physiology, biomechanics) and the fact that I was helping people. I feel that the field has grown to be more autonomous as our educational training has increased which has allowed us to stride forward toward being the first line of orthopedic management in our medical model. We have a terrific place in healthcare as we look for cost effective alternatives because PTs have been shown to be quite effective and cheaper in the long term compared to usual medical management (surgery, injection, etc)
Is there a specific area of PT you’re particularly drawn to/enjoy doing?
It may seem commonplace to say it, but I am drawn to using my hands and all that is manual therapy assessment and treatment. I guess it’s the biomechanist in me that really enjoys that aspect of orthopedic care. However, I agree with what we are seeing in today’s research that our manual therapy technique is only as effective as the exercise that follows it to maintain the neuromusculoskeletal benefit. I guess this is starting to shed light on the fact that we may actually be making neuromuscular changes when we do manual therapy rather than the pure mechanical effect we once thought. This is an exciting topic of interest as manual therapy research advances.
Tell us about a patient-related challenge you’ve faced and how you worked through it.
I have recently have had quite a struggle as I have embarked on the journey to teach people more about pain (as we know, pain is the main thing that brings most people in to see a physical therapist) and the neuroscience research that has been coming out over the last decade. As some of the pioneers in neuroscience research say.. “the key is to teach people that the pain is their head (produced by the brain) without telling them that its all in their head.” The first few times I tried to tell stories and teach pain science using analogies I completely botched it. I am sure that the patient left my care feeling more confused about what is causing their pain than when they came in. The key is to “create your own style” and use stories/analogies that fit with the patient’s history. This is a challenge for all of us as physical therapists, but to keep up on the current literature that is coming out, we need to embark on this journey together and fight the common notion that “pain is bad and equals tissue injury” but rather teach the complexity of pain science in a fundamental way to empower people and reduce fear avoidance so that we can catapult our patients in the direction of self management.
Do you teach or participate in PT continuing education and/or learning new manual therapy techniques? Why?
Absolutely, I take a lot of continuing education! It may seem scandalous to say, but you can’t claim to be an evidenced based or an evidence informed clinician without being actively involved in bettering yourself and your skill set. What we learned in school is simply not enough and often outdated by the time we are a few years into practice. I thoroughly enjoy learning various manual therapy approaches as I feel it makes me an eclectic therapist. My practice is based very much on the eclectic model; taking the best from various systems or schools of thought and putting it together to accurately manage the patient at hand. I take learning seriously because not only does it make me a better clinician, but it improves the care for my patients on the receiving end of my education. I believe that we should all encourage one another and our colleagues in our academic pursuits so that as a profession we can rightly become the profession of choice for musculoskeletal management.
How important do you think the role of mentorship plays in the PT field?
I feel that mentorship is key to developing good habits in the novice clinician. As we know, all students now come out of school with the Doctor of Physical Therapy (DPT) degree, a noble academic credential no doubt. They are entry level clinicians with a wealth of knowledge in the various practice settings as recorded in the Guide to PT practice. With these highly skilled new grads, mentorship can help them to hone their skills in the practice setting of their choice and develop the critically important clinical reasoning process that is paramount to the patient management model. When I graduated, I was not in a place to enroll in a residency or fellowship, although I see this as a very valuable endeavor. I did seek employment with a group practice where the clinicians were very eclectic and we would have in-services whenever anyone took a new class so that the rest of the group learned the “pearls” of the course. We have since developed to the point where we have “Master Clinicians” within our staffing whose role is to help the new grads with mentorship. For those graduating therapists who aren’t ready or like me not in a place to enroll in a full time residency/fellowship program, I would encourage them to look at the places of employment very carefully and evaluate what the mentorship would be like. Residency and Fellowship can also be done in a distant learning fashion through various continuing education groups so this is another option for the “working new grad.”
What are some of the changes you’d like to see made in PT in the next decade?
I would like to see the aspects of the Vision 20/20 statement by the APTA come to fruition. As you read through the Vision statement, indeed we are already doing many of the things listed in the statement. However, aspects like direct access and “Practitioner of choice” could evolve over the next 5 years. In Washington State where I practice, certain insurance policy carriers will allow us to utilize the direct access practices, however many of the major insurance groups are still caught up in the “gatekeeper mentality” in that a medical doctor, nurse practitioner, or chiropractor must send a referral with a signature. To be transparent, I find this quite frustrating that a direct consumer competitor (chiropractor) has the upper hand of being part of the gatekeeper in this system when physical therapists and their current educational and clinical training are absolutely sufficient to be a direct access provider. This is where I believe the burden falls on us as a profession to continue to educate the public and governing bodies of healthcare and insurance contracting. We are THE profession to manage neuromusculoskeletal disorders and presented in the research is the data that so convincingly shows that our place in health care is safe, cost effective, and leads to better outcomes than current interventions used in the medical marketplace.
As an orthopedic clinician, I would like to see PTs be able to order basic imaging studies (when clinically needed of course which is an entirely different conversation all together). I would also like to see us become the primary source of preventative wellness, with annual functional screening evaluations to catch musculoskeletal problems before they start. Examples of this would include annual falls prevention screenings for the aging population and teaming with pediatricians to perform functional screens as part of the pre-participation physicals for young athletes. Our colleagues in density medicine are forward thinking in have check in every 6 months to assess our teeth and catch problems before they become significant dental conditions. Is it rouge to say that we ought to be doing the same? I would argue that insurances would be saving themselves significant dollars by using PTs in this way.
What steps do you think PTs can be doing now to get closer to those changes?
Be an APTA member and support what the APTA is doing nationally for our profession. Be active in your local chapter, and politically with APTA’s initiatives by contacting your local state representatives over issues such as the therapy cap which has been a topic of much discussion recently. Most importantly, talk to your patient. While you are doing soft tissue, joint mobs, etc. use the time to educate your patient about why PT is such a great profession and so important to the healthcare system at large. Awareness will stimulate change and the awareness falls on our shoulders by voicing who we are and what we can do.
What is it that makes you a PT worth seeing?
I am a PT worth seeing because I am committed to the career long pursuit of bettering myself for my patient’s benefit. I don’t claim to be a guru, matter of fact quite the opposite. I just claim to be a guy who loves his job and profession and wants to help people understand what is going on with themselves and find ways of managing their own condition. I also view myself as a desirable PT to see because I have diversified my practice with sub-specializing in areas other than general orthopedics which I think speaks to my ability to treat various conditions in the outpatient setting. Lastly, I think I am a PT worth seeing because I care about the long term relationship with my patients; I not only want them to do well when they are actively within my care, but I want to be a part of their life and develop a partnership where I can routinely help them maintain a healthy lifestyle.
What advice would you give to new physical therapists and students about to embark on their careers?
My advice to the graduating or new PT entering our profession would be to seek out a job where you will grow the most as a clinician. Don’t necessarily seek out the position where you will get paid the most as this can come later in your career. Your primary goal as a young clinician should be to grow clinically: to treat patients, make mistakes, and learn from them; to soak up as much peer guidance and constructive feedback as you can and to better your skills as much as possible. Also, keep up on what’s going on in the profession and try to support our political body to improve our position in the changing healthcare system. Don’t stop reading and learning.. there is so much to read and so many readily available cheap resources to take advantage of.
Anything else you’d like to add?
For those that are into following clinically relevant blogs, check out my blog at omttalk.wordpress.com. I try to post patient cases that help to demonstrate the useful application of evidence with patient management. I also try to post a “Quiz Friday” question every Friday in the form of what would be tested on orthopedic/manual therapy exams for those that are studying for upcoming professional examinations.