The last time I tried to get into my primary care for a sore throat (negative Covid test) I was offered an appointment in 10 days. 10 days! One of two things was going to happen after 10 days: my sore throat would resolve on it's own or it would evolve into way more than just the mild cough I was experiencing. The only reasonable option was to go to urgent care where I received treatment by a healthcare provider that I am unfamiliar with. And it cost more than 4x than a primary care visit. This is one of many examples of the challenges in accessing healthcare in a large city like Denver. In rural areas there are additional challenges, complexities, and complications that can greatly interfere with accessing necessary healthcare.
Healthcare Challenges
A central challenge in rural healthcare is a lack of providers. This leads to long wait times for appointments which can be compounded by poor interdisciplinary communication between providers. The US insurance-driven healthcare system generally functions with a "gatekeeper" system, where a primary care physician, PA or NP serves as the first-contact provider for all health concerns, and then refers to external specialists on an as-needed basis. This model has created healthcare "silos", where each clinical specialist works exclusively within their specialty. If the system broke free of this pattern and recognized that other types of providers have the expertise to serve as first-contact roles for many patients, this would greatly reduce the wait time for visits, promote comprehensive care, and encourage interdisciplinary collaboration. This model would ultimately provide higher quality healthcare, especially in rural settings.
The Solution: Primary Care Physical Therapy
A 2019 research study out of Sweden supports physical therapists (PTs) as a first contact provider. This study concluded that patients who saw a physical therapist as the initial point of contact for musculoskeletal disorders had improved reports of pain, disability, and health-related quality of life at follow-up at 2 weeks all the way to a year later (1). Physical therapists are experts in musculoskeletal disorders, as suggested in this study, but PTs can also play a key role in educating and managing non-communicable diseases such as diabetes, high blood pressure, osteoporosis and osteoarthritis.
PTs are in a prime position to assume the first-contact role in healthcare. The required education for a Doctor of Physical Therapy (DPT) includes a four year degree and a clinical doctorate degree along with passing a national board exam and participating in continuing education to maintain licensure. The US military and select hospital systems around the country have utilized PTs in team-based primary care and other first-contact roles since the 1970s, providing a blue-print for PTs to not only improve healthcare access, but also reduce mortality and disability related to non-communicable diseases.
The American Physical Therapy Association has formally encouraged physical therapists to assume roles as first-contact providers in order to reduce the burden on the current primary care “silo” structure. APTA’s formal statement on primary care physical therapists:
“Physical therapists make unique contributions as individuals or members of primary care teams and are entry-point providers into the healthcare system. Physical therapists provide a broad range of services to optimize movement, including screening, examination, evaluation, diagnosis, prognosis, intervention, coordination of care, prevention, wellness and fitness, and, when indicated, referral to other providers. “
Interested in becoming a primary care therapist?
Our primary care therapist course equips rehab professionals with the skills necessary to perform comprehensive medical screening & systems review, differential diagnosis, triage & referral. This course prepares therapists to effectively consider & manage the complete patient with long term wellness strategies, rather than isolated functional complaints. It also equips therapists with interdisciplinary communication skills, so that they feel confident in reaching out to other healthcare professionals whenever necessary.
Our lead instructor, Dr. Katie O’Bright (click for bio page), brings her extensive knowledge and experience of team-based care settings in academic health systems, private practice, and the military where she served as an activity duty Army physical therapist.
Course Specifics:
Foundations for the Primary Care Therapist is an interactive 18-hr course (2-hr online pre-course, 15 hr in-person, 1 hour post course), where we do a deep dive into the essentials of complete patient care. Our goal is to enhance the fundamental systems review competencies in PTs across the nation, so that each patient has all aspects of health considered in their diagnosis & care plan.
Examples of Case Discussions:
- hip pain that is actually BPH
- neck pain secondary to from accessory respiratory muscle overuse in COPD
- subtle s/s of cardiac episodes in a young healthy runner
- shoulder pain coming from a liver abscess...
- subtle s/s of anemia in a patient presenting with arm weakness
We teach a clinical decision making framework that can be used simply and efficiently in any outpatient practice setting, to ensure all medical history and systems are considered. We also emphasize exactly what to do when they present, who to call, what to say, and what to recommend.
Upcoming Live Primary Care Classes:
Phillipsburg, Kansas: November 4-5, 2022
Sign up here
Salt Lake City, Utah: January 28-29, 2023
Sign up here
References
Health effects of direct triaging to physiotherapists in primary care for patients with musculoskeletal disorders: a pragmatic randomized controlled trial. Lena Bornhöft |Maria EH Larsson| Lena Nordeman| Robert Eggertsen| Jörgen Thorn. Ther Adv Musculoskelet Dis. 2019; 11: 1759720X19827504.
Author
Dr. Jessica Klain PT, DPT, OCS, COMT, CSCS, CNPT is a physical therapist and business owner in Denver, CO.
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