As the Affordable Health Care Act kicks into gear, millions more Americans find themselves with health insurance, and health care providers are faced with the difficult task of accommodating an unprecedented influx of new patients. In the midst of this struggle to meet the needs of our nation’s ill and infirm, Nurse Practitioners may prove to be the single greatest asset in managing this monumental change.

Although Nurse Practitioners have operated in the United States for over 40 years, many people don’t know about them or what kind of services they offer. For this reason, Tay Kopanos, vice president of state government affairs for the American Association of Nurse Practitioners calls them “the best-kept secret in health care.”

Nurse Practitioners hold master’s degrees and perform many of the duties commonly associated with primary care or family practice physicians. The road to becoming a nurse practitioner begins in the field of nursing, where most candidates first obtain a bachelor of science in nursing. Experienced nurses who wish to move to the next step must then achieve a master’s of science in nursing, and finally pass a board certification test before officially becoming a nurse practitioner.

Though nurse practitioners are not a complete substitute for physicians—and laws in nearly every state require they practice under the supervision of an MD—there are areas in which a nurse practitioner may be better suited for care. Studies have shown high satisfaction rates among patients treated by nurse practitioners, perhaps in part because of the bedside manner they develop during their time as nurses. “Local nurse practitioner said their training as nurses follows a different philosophy from a doctor’s medical training, focusing more on the total patient than just the disease,” says Diane D’Amico, a staff writer for The Press of Atlantic City. Similarly Jettie Deden-Castillo, an obstetrics/gynecology nurse practitioner and contributor to the San Diego Union-Tribune, relates: “An NP can function much like a primary-care physician, but with the heart of a nurse.”

The need for highly trained physicians will not diminish with further implementation of nurse practitioners.  If anything, their workloads should be lightened by the additional coverage provided by nurse practitioners, as many serious health concerns can be avoided if patients receive necessary preventive care and education. “In 1979, the vision was for nurse practitioners to manage the care of routine, healthy patients and free up physicians to take more complicated cases,” Deden-Castillo remarks. This teamed approach may be the best method we have for facing the country’s growing healthcare needs.

SOURCES:

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A social worker has developed a non-traditional method of treating service members suffering from post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) who have not responded to traditional treatment methods.  What is unique about the Warrior Canine Connection (WCC), developed by Rick Yount, MS, LSW?  As the name implies, the program treats military members by pairing them with canine companions, which they train to eventually become service dogs for mobility-impaired veterans.

Rick Yount created the first soldier-dog training program in 2008 after working in the child welfare system where he noticed the therapeutic value of involving his golden retriever, Gabe with the children. The program was so effective that the military invited Yount to design a service dog training program for its National Intrepid Center of Excellence (NICoE). The NICoE aims to treat service members with psychological health conditions who have not responded to traditional therapies.

The patients of the WCC are given the mission of training a 12-week old future service dog, and in doing so are forced to confront many of the issues experienced by those suffering from PTSD and TBI. Introducing the puppy to new environments, keeping it calm in arousing situations, and developing a close bond requires one to confront issues of self-isolation, anxiety, and emotional numbness.

Rather than honing in on clinical symptoms and treating patient deficiencies, the WCC approach instead seeks to empower soldiers by giving them a task that utilizes their strengths and serves a greater purpose. In this way, the WCC’s approach is in line with the warrior ethos of the army: “I will always place the mission first. I will never accept defeat. I will never quit. I will never leave a fallen comrade.”

Driven by the mission to aide their wounded comrades and holding to ethos of never accepting defeat, many soldiers have already benefited from this unique new treatment and so far the WCC has been a rousing success.

RESOURCES:

1. “Warrior Canine Connection — Puppy Training Program Tackles PTSD and TBI” by Lynne Soine, DSW, MSW, LMSW in Social Work Today, Vol. 13 No. 4 P. 16
   Accessed: http://www.socialworktoday.com/archive/070813p16.shtml

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When people think of speech language pathology, they typically envision a sterile office environment where patients recite drill-like speech patterns. However, the increasing prevalence of a technique known as hippotherapy ought to change some conceptions of what speech language pathology entails.

Hippotherapy, or equine-assisted therapy, is a physical, occupational, and speech-language therapy treatment strategy that utilizes the movement of a horse.  While riding on a horse may not appear to have anything to do with speech therapy, the spectrum of benefits provided by hippotherapy is wide-ranging.

According to the American Hippotherapy Association, the multidimensional movement provided by a horse is variable, rhythmic, and repetitive, which produces a calming effect on riders.  This in turn facilitates neurophysiologic systems that support all of our functional daily living skills.¹  A trained therapist or handler can adjust the horse’s gait, enabling them to control the degree of sensory input to the patient.

There is a growing trend in speech and language intervention toward developing naturalistic approaches to add to or replace the traditional, more drill-like methods traditionally utilized in speech-language therapy. Hippotherapy may be a viable option, as it offers a unique alternative for clients who languish in more conventional settings.²

Rachel Gerhart is one such proponent of hippotherapy for speech-language treatment. Her company, Pony Talk Speech Therapy, has operated in Reading, PA since 2010. Gerhart specializes in working with children age 10 and under, and uses horseback games to draw out their communication skills. Gerhart affirms that “being on the horse is a distraction, but a good one….A lot of them really don’t think they’re doing therapy.”³

Her clients notice the difference in their children’s progress as well. Joseph Geloso was four years old when he began hippotherapy with Gerhart, and since then his mother has noted significant improvement. “He was a little hesitant,” Nicole Geloso recalls, “but once he got on [the horse’s] back, he was a different kid.” During his 30 minute sessions Joseph, who is diagnosed with Down syndrome, moves from near-gibberish to intelligible speech to complete the games Gerhart creates.

Speech-language pathology is a diverse and expansive field of treatment, with much to offer those suffering from vocal impediments. The successful implementation of hippotherapy is just another sign of the field’s innovative expansion.

SOURCES:

1. http://www.americanhippotherapyassociation.org/hippotherapy/hippotherapy-as-a-treatment-strategy/
2. http://www.speechpathology.com/articles/therapeutic-riding-and-hippotherapy-what-1177
3. http://readingeagle.com/article.aspx?id=516374

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Despite the less-than-certain job prospects facing today’s college graduates, the new Dean of University of Cincinnati’s College of Pharmacy is confident his students will find jobs almost immediately out the door.  When asked in a recent interview how many upcoming College of Pharmacy graduates can expect to land jobs, Neil MacKinnon quickly responded: “Easy question, 100 percent.”*

MacKinnon’s response might sound overly optimistic, but there are several reasons that back up what he says.

Most notably, the implementation of the Affordable Care Act in January will extend healthcare coverage to millions of Americans, including roughly 164,000 uninsured residents in Southwest Ohio alone. “That’s a lot of new prescriptions,” quipped MacKinnon. “January is going to be crunch time. We’re going to be desperate in this country for family physicians, physician assistants, nurse practitioners and pharmacists.”

The employment of pharmacists is expected to increase by 25% between now and 2020, according to studies performed by the Bureau of Labor Statistics.  This is considerably faster than the average projected growth for all occupations, which is estimated at 14%. Contributing to this growth is not only an increase in healthcare coverage, but also the continuing growth of the pharmaceutical industry and the various personnel needed to prescribe and counsel patients on new drugs.

Prospective pharmacists should be enticed by high wages and a good work-life balance. The median annual salary for a pharmacist in Cincinnati is $116,000, and some entry-level pharmacists make just as much.  According to the Bureau, most pharmacists work a standard 40 hour workweek, with the occasional night and weekend shift.  Approximately 21% work part-time.  Perhaps this is because, according to MacKinnon, “pharmacy is the kind of field where somebody could take career breaks or work part-time to raise children and later return to a full-time job.”

SOURCES:

1. http://www.bizjournals.com/cincinnati/blog/2013/10/obamacare-to-create-pharmacy-jobs-new.html?page=all
2. http://www.bls.gov/ooh/Healthcare/Pharmacists.htm#tab-3

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As comic books and graphic novels become increasingly popular source material for major motion pictures, they are also providing inspiration in a more unlikely realm: psychology.  Chicago Psychologist Dr. Patrick O’Connor, PsyD, who specializes in treating teens and young adults, has pioneered an effort to use comic books for therapy.

Dr. O’Connor first got the idea to use comic books as therapeutic tools when working in foster care. Dr. O’Connor recalls, “one day I had a question about whether there were any Batman and Robin comics that dealt with similar father/son issues as my clients, given that Dick Grayson [Robin, Batman’s sidekick] is a ward of Bruce Wayne.”¹ His subsequent investigation into the question led Dr. O’Connor to the conclusion that comic books have the potential to be a great tool for connecting with patients.

Counselors and therapists have utilized the arts to connect with and help patients for years, and there are several qualities that make comic books an ideal vehicle for reaching teens and adolescents. Unlike books comprised solely of text, comic books have the added dimension of visual expression, making them more accessible to younger readers. And while a novel may appear daunting to those to aren’t avid readers, most single issue comic books take only 15 minutes to read.  “In the end, reading is reading, and if you have a child who hates to read, what better person than Batman or Spider-Man to get them interested?” Dr. O’Connor reflects.¹

Another reason comic books work so well with troubled adolescents is that many characters in the stories deal with similar issues. Classic superheroes such as Batman and Spider-Man were inspired to fight crime after experiencing its traumatic effects firsthand. Many comics today deal with serious themes, such as gang violence and substance abuse. During an Ask Me Anything thread on the popular website Reddit, Dr. O’Connor related one such instance in which the content of a comic book got through to a reader: “I had a 17 year old gang member with a history of violence and substance abuse pause while reading an issue of Irredeemable, point to this panel, and say, ‘This is how I feel about the world. This describes it perfectly.’ That opened up a huge door for us.”²

His success with patients led Dr. O’Connor to found Comicspedia, an online database containing hundreds of individual comic book summaries. What’s more, the entries on Comicspedia are categorized by the theme, allowing visitors to search for stories that address their topic of interest.

While Dr. O’Connor imagines he isn’t the first to utilize comic books for therapy, he hopes that by doing so he can open up doors for others to do the same. With Comicspedia as a freely available resource, “folks can cut down the number of steps between wondering how they can use comics to help others and actually doing it in practice.”¹

Sources:

1. http://www.comicbooked.com/patrick-oconnor-gets-comic-booked/
2.  http://comicsalliance.com/psychologist-superhero-comics-psychology/

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Demand for Physical Therapists remains high across the US, despite calls in Congress for drastic cuts to Medicare.  Graduates from accredited Physical Therapy degree programs have their pick of locations whether applying for their first job, or changing positions.

Physical therapy employment opportunities are remarkably secure and abundant in the United States due to a variety of factors, including a shortage of physical therapists, an aging pool of professionals, and healthcare reform. This trend in job security for physical therapists has been on the rise since at least the early 2000s, but has dramatically increased in the past two years. According to Forbes, “In 2010, only 0.4 percent — one in 250 — of PTs seeking work were jobless,” (“Demand for Therapy Jobs Critically High in 2012,” Forbes).

Factors bolstering demand include funding from the Individuals with Disabilities Education Act of 2004, providing free access to children in need of physical therapy, and the aging of baby boomers.

Healthcare reform, pressures to update record keeping methods, a shortage in Physical Therapists, and cuts in government funding are playing significant roles in the influence of market trends in the Physical Therapy profession as a whole and will continue to do so throughout 2012, according to the American Physical Therapy Association. Automatic cuts in Medicare payments to physicians and physical therapists have been delayed until after November, due to the hot button nature of issues surrounding Medicare in this significant election year.

While the APTA is attempting to work against certain government influences, it is rushing to adapt to others, specifically healthcare reform. On Tuesday, February 7, the APTA announced it will be holding an audio conference in late March to discuss and evaluate the significant changes implicit with the reform.

The conference will allow clinicians, managers, owners, and patients to gain a unique perspective and deeper understanding of new policies, such as, “reforming payments, healthcare delivery, and the workforce” (“Registration Open for Health Care Reform Audio Conference,” Physical Therapy in Motion). APTA vice president Justin Moore will conduct the conference and address additional, “contemporary issues surrounding the upcoming Supreme Court decision on the constitutionality of the law, the pressures on states to implement key provisions, and efforts in Congress to repeal, revise, and redirect funding related to the Affordable Care Act.”

Another trend the Physical Therapy profession is hurrying to adapt to is the need for digitalized information, particularly with regards to health records. Concerning Electronic Health Records (EHRs), the APTA has released a Guide to Understanding and Adopting Electronic Health Records, which “aims to help physical therapists (PTs) and physical therapist assistants (PTAs) assess and implement EHRs,” (“APTA Launches Guide to Electronic Health Records,” Physical Therapy in Motion).

The guide not only helps users to successfully adopt the new system, it allows them to understand the importance of the transition and how it will ultimately affect the Physical Therapy profession as a whole.

Sources

1. “Call to Action: Congressional Action Needed on Caps and Cuts” http://www.apta.org/PTinMotion/NewsNow/2012/2/6/CapSGR/?blogid=10737418615&category=APTA%20Working%20For%20You
2. Registration Open for Health Care Reform Audio Conference”http://www.apta.org/PTinMotion/NewsNow/2012/2/7/HCRAudioConference/
3. “APTA Launches Guide to Electronic Health Records”http://www.apta.org/PTinMotion/NewsNow/2012/2/7/EHRGuide/
4. “Demand for Therapy Jobs Critically High in 2012” http://www.forbes.com/sites/moneywisewomen/2012/01/27/demand-for-therapy-jobs-critically-high-in-2012/

The post Demand for Physical Therapists Remains High Despite Threatened Medicare Cuts first appeared on Sterling Medical.

Three factors are changing the demand for physical therapists and occupational therapists:  changes in state/federal funding of health care, the modification of requirements in state acts for physician referrals of patients to receive therapy, and the reimbursement limitations of private insurers. Areas of physical therapy that have appeared to have the greatest likelihood of increase are services for youth, older adults, and wellness programs.

Legislation has continued to affect the Physical Therapy profession. The Balanced Budget Act of 1997 (BBA) is known for changing the way in which skilled nursing facilities are reimbursed by Medicare from a “retrospective to a prospective payment system” (2). The BBA put a ceiling on annual total payment for physical and occupational therapy services and put therapy payments in the “same schedule as physician payments” (3).

Another piece of legislation to directly affect the field of occupational and physical therapy is the Individuals with Disabilities Education Act (IDEA). This act affects physical and occupational therapy by influencing provider interest while also putting into question the financial feasibility of providing such services. However, the effects of the IDEA on school system therapy have not been extensively explored.

Potential growth areas of physical and occupational therapy employment are:

•  Older Adults:  There has been a steady increase in the proportion of older adults to current population. This increase shows a positive correlation to increased need for physical therapy providers. While correlation does not necessarily prove causation, it is known that roughly 45% of older adults are limited in activities due to chronic conditions (4). This number shows that the baby generation will have an increasing need for physical therapists to help them cope with these “chronic conditions”.

• Children: Recently, there have been calls for therapy services in schools. Occupational therapy is known to be important for the management of behavioral issues in the schools. Today’s parents are more knowledgeable than ever of the benefits of occupational and physical therapy for their children’s conditions or problems.

•  Wellness Services/Programs: One reason for the increase of wellness programs and services is due to the aging population mentioned above, and their use of these programs. Neither physical nor occupational therapists seem very poised to take advantage of this opportunity. There is a lack of entrepreneurship in the field; few therapists want to move past “traditional” practice.

When the fields of physical and occupational therapy are looked at from afar, a shortage of workers is seen. In simple economic terms, supply is decreasing and demand is increasing.

The increasing demand for physical therapists and occupational therapist in the areas of wellness programs, the therapy needs of children, and the therapy needs of older adults, will continue to rise.

Sources

1. Hack, L. M., & Konrad T. R. (1995). Determination of supply and requirements in physical therapy: Some considerations and examples. Physical Therapy, 75, 43‐55.
2. Kahn, C.N. and Kuttner, H. (1999). Budget bills and Medicare policy: the politics of the BBA. Health Affairs, 1999 Jan‐Feb;18(1):37‐47.
3. Olshin,J, Ciolek, D, & Hwang, W. (2002). Study and report on outpatient therapy utilization: Physical therapy, occupational therapy, and speech‐language   pathology services billed to Medicare Part B in all settings in 1998, 1999, and  2000. Accessed March 30, 2007, at http://www.cms.hhs.gov/TherapyServices/SAR/itemdetail.asp?filterType=none&filterByDID=‐99&sortByDID=1&sortOrder=ascending&itemID=CMS057266
4. Wilmoth, J. M., Longino, C.F. (2006). Demographic trends that will shape U. S. policy in the twentyfirst century. Research on aging, 28(3), 269‐288.
5. http://www.ahs.uic.edu

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The rise in Physician Assistant positions is a consistent trend. The levels of PA education have increased from less than 21% of PA’s with four or more years of college in 1980, to more than 65% in 2007. Percentage of minority and age of the PA workforce have increased over time.

Prominent causes of the changes in the PA workforce include educational factors and federal/state legislation and regulation. Less than 17% of PA’s were of minority groups in 1980, this figure rose to 23% in 2007. Although nearly 70% of PA’s were younger than 35 years old in 1980, this percentage fell to 38% in 2007.

The number of states which allow PA’s to prescribe drugs has also increased. In 1992 there were a surprising 15 states which gave PA’s zero authority to prescribe medication (1). Comparatively, in 2005 only 2 states did not grant PA’s the right to prescribe drugs. In 1992 the number of states where PA’s possess controlled substance prescriptive authority totaled a measly 24 (1). In 2005, 44 states gave PA’s the right to controlled substance prescriptive authority.

Some states realize the importance of PA’s more than others. In 2004, it was stated that Indiana had only 0.63 Physician Assistants in Clinical Practice per 10,000 Residents (2). Maine stood at a higher 3.33 Physician Assistants in Clinical Practice per 10,000 Residents (2).

The average number of Physician Assistants in Clinical Practice per 10,000 Residents in the United States stood at 1.69, totaling roughly 53,667 PA’s in Clinical Practice (2). These statistics mark a staggering increase in the number of PA’s in the United States. In 1990, the number of PA’s in the US totaled roughly 24,000 (3). In only 15 short years the number of PA’s in the United States has virtually doubled.

The identified trends in Physician Assistant opportunities are as follows:

“Educational level, percentage of minority, and age of the PA workforce have increased over time. Major causes of the changes in the PA workforce include educational factors and federal legislation or state regulation.” (4).

(1) Staff research of state regulations and statutes and American Academy of Physician

Assistants’ Physician Assistant State Laws and Regulations, 1992.

(2)  Kraditor and U.S. Census Bureau

*Note: The latest state population figures from the U.S. Census Bureau are for 2004.

(3) Hum Resource Health. 2009; 7: 86.

Published online 2009 November 26. doi: 10.1186/1478-4491-7-86

(4) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788515/

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