Clinical Changes

So I had my last two clinical experiences all set up, it was gravy... yesterday I get an e-mail from my Academic Coordinator of Clinical Education (ACCE) telling me she has to speak to me about one of these placements. As I feared she informed me that it was canceled, the reason being under-staffing and an inability to provide a quality clinical instructor for me. I appreciate their honesty but now I have to scramble a little.

There are two clinics within the NYC area that are available, however they require an immense amount of travel time and do not have great reputations for providing quality clinical experiences. I can also go to Philadelphia, PA to Magee Rehabilitation Hospital but I would need to find a place to live which is not the end of the world, and also find a means of transportation... so that is a strong possibility right now. Since I found out yesterday I have been calling around trying to find out if anyone I know has some kind of connection to Philly that would be willing to house me for 11 weeks (middle of Feb.-beginning May 2008).

Another option, which the ACCE is not very fond of, is finding a rehab hospital (it is required that I have a "rehab setting" experience) that we do not have a contract with. There seems to be a lot of logistics involved, but I am willing to try for the sake of having a better learning experience.

So if anyone out there knows of a place in Philly where I could stay or of a rehab hospital that I could affiliate with please shoot me a comment or e-mail.

Thanks in advance.

I am Guilty

...of not voting in my boroughs primary elections. What's worse is I did not take advantage of the opportunity to help PT. I am writing this to remind myself to do this in the upcoming elections and to hopefully inspire other PT/PTA students, professionals and most importantly PATIENTS to follow suit.
In voting for candidates my main concern is their stance in regards to PT related issues. Now I am sure many politicians are not exactly experts on healthcare issues but when they are running for an office this could be a great time to make them aware and vote accordingly.
So in the future, I (and I hope you) will be writing a letter or e-mail or going to public appearances to inquire about the candiates stance on healthcare and specifically what they can do for PT and our patients.
I want you... to go out and vote... and visit ww.apta.org/advocacy to find out more.
Dealing with politics can be streamlined and APTA has done a great job so far. Unfortunately we still have an uphill climb to make... it gets easier when we all unite (see unions and majority voters).
To conclude I am going to try to remember this great quote: "Democracy is not a government of the people, it is a government of the people who participate"... I'm pretty sure I butchered that but I hope you get the idea.

Falling through the Cracks - VT and the Restructuring of College Mental Health Services

The following is more related to health care delivery than directly to PT...

I recently read an interesting article about the tragedy at Virginia Tech (VT) that occurred earlier this year and the state of college mental health services. The author begins by presenting the accounts of the young man who gunned down 27 students and 5 faculty members. She presents a number of situations that show his disturbed nature in his interactions with his peers and with a professor. He had a few incidents that led him to be admitted to a psychiatric hospital but it remains unclear if there was any follow up after this. What appears clear is "there was no clear way to screen [Cho] for reentry to VT" after his release from the psychiatric hospital.

This extreme case highlights what the author found to be recurring themes through a number of interviews with campus mental health experts from a number of universities: a lack of communication within the campus mental health system and a lack of understanding of privacy laws. "Experts differ about whether and when HIPAA applies" and the The Family Educational Rights and Privacy Act seems to often be misinterpreted to be more restricting than is intended. Hopefully, this unfortunate incident can serve as a catalyst to improve what is presented as a very broken system and help save lives in the future.

The article is a perspective piece that serves to point out a problem that needs to be fixed. Some suggestions are presented to avoid allowing students to "slip through the cracks" but it there are few current systems shown to be very effective. One such effective suicide prevention program was designed for the U.S. Air Force. Some of its success can be attributed to being championed by top generals which helps to overcome the possible stigma associated with mental health.

No matter which system is implemented at universities around the country it is clear communication needs to be more defined. One person should be responsible for each patient in the system, more staff is necessary to handle the magnitude of issues, and the privacy laws have to be made clearer. These gaps in the campus mental health system seem to reflect what is described by many as a broken medical system in the U.S. Personally, I believe there is no excuse for such a poor system and based on the research presented in this one article the politics need to be thrown out of the window to help create a system that works because it seems to be right at our fingertips.

Shuchman, M. (2007). Falling through the cracks - Virgina tech and the restructuring of college mental health services. The New England Journal of Medicine, 357 (2), 105-108.

There are now a few less uninsured people in America

Check out this New York Times Article... kudos to San Francisco...what a treat

San Francisco to Offer Care for Uninsured Adults

This is part of the cost breakdown from the article:
"Those from families with incomes below the federal poverty line pay nothing. Those who earn more pay quarterly fees that range from $60 to $675, which is the rate for those with incomes above 500 percent of the poverty level ($51,050 for a single; $103,250 for a family of four). That is where the subsidy ends. The co-payments range from $10 to $20 for a clinic visit and from $200 to $350 for an inpatient stay."

Legislative Action Needed

This is from an e-mail I received from the APTA today... help out... even if you are not a PT and can understand where we are coming from please contact your legislator... it makes a difference (if you do not know how to contact your legislator please send me a message and I will try to help you out)

DON’T LET PHYSICAL THERAPY BE CAPPED AND CUT –

CONTACT CONGRESS NOW

Physical therapists, physical therapist assistants, and the patients we treat must tell their Members of Congress to act now on the Medicare therapy cap and proposed fee schedule cuts! If Congress doesn’t take action, beneficiaries will lose the exceptions process that protects them from the Medicare therapy cap and PTs will face a nearly 10% cut in payments starting January 1, 2008.

Currently, leaders of House and Senate health committees are discussing options to resolve the impasse on legislation to reauthorize the State Children’s Health Insurance Program (SCHIP). The House passed bill includes important Medicare provisions and expands children’s health coverage while the Senate version does not have any Medicare provisions. The President has also indicated that he will veto either bill if it arrives on his desk. Passage of health care legislation this year is clearly uncertain.

It is imperative to communicate now with your Members of Congress to cosponsor HR 748/S 450 to repeal the Medicare therapy cap and to pass legislation to prevent the 9.9% cuts in the 2008 Medicare physician fee schedule. Please contact your Members of Congress and their staff about the importance of physical therapy to your Medicare patients and the harmful results if a “hard” therapy cap is reinstituted and payments are cut in 2008.

What You Can Do

It is important that you send a strong message to your Members of Congress to request that they become cosponsors to repeal the therapy cap once and for all. Please contact your Members of Congress and ask them to cosponsor HR 748/S 450 and support legislation to prevent the 9.9% cuts in the 2008 physician fee schedule. You can contact your Members of Congress by calling 202/224-3121 or by utilizing APTA’s Legislative Action Center to Ask Congress to Repeal the Therapy Cap & Prevent Fee Schedule Cuts. You can write a letter or e-mail to your Members of Congress regarding this important issue.

In your call or letter to your Members of Congress, include specific examples of your patients that will be affected if the therapy cap is imposed again. Also, have your patients contact their legislators. Provide them with a letter they can sign and you can mail or have them access APTA’s Patient Action Center on the therapy cap . If you have any questions please contact APTA at 1/800-999-2782, ext. 8533.

First week of classes

The semester is a little different than I thought... but in a good way... except there is more reading than usual which I need to get back to... but I also want to share with you...

One article we had to read is Blau, 2002 (PT Journal) <--not proper referencing format, but I am tired so :P

This article involved interviewing 5 PT's (all female) who worked at a hospital for 4 years where there was a large amount of systemic change... five main themes emerged (four of them negative): loss of control, stress, discontent, disheartenment, and yet a "silver lining" in their work lives. There was increased patients (up to 18 a day), increased documentation, and a lack of support staff were the main factors leading to a negative outcome, while the love for the profession and their colleagues seemed to be the "silver lining." There was a lot of mention of burn-out but the experiences at this one clinic (and those mentioned in the lit review) should not reflect the state of PT clinics.

Off to read the other few articles for tomorrow... I am freakin' tired

Mobile Update

So after I finished clinic, I had almost three weeks off and I spent most of that time coaching high school football and watching movies...among other things. But not too much PT dedicated time. All that is about to flip... except the football coaching.
My last 5 classes of PT school start on Monday so I will be focusing the majority of my time on that. In defense of my extracurricular activities they tend to relate back to my PT education in some capacity. For instance as a football coach I get to see a lot of interesting injuried and get to use some of the skills I have been taught as a PT or even as a former EMT... and man do I just love the game of football, I have as much passion for football as I do for PT...
I should start a football coach blog... that may have too much profanity in it though...

SMART

This is a great idea I signed up for today and I think many other students should take part in as soon as they get a chance.

Seeking Students to Mentor Fellow Students

APTA's Members Mentoring Members program has a new student-to-student mentoring component, SMART (Student Mentoring: Achieving & Reaching Together). Peer mentoring is a noncompetitive alternative to traditional mentoring that provides greater understanding of day-to-day problems, experiences, stresses of protégés. We are hoping that components will encourage their student members to sign up to be a SMART mentor! Interested students can find out more about the SMART program online. Both SMART mentors and protégés must be APTA members.

And I want to thank Lloyd for the kind comments in the "people" post.

Course

Title: Low Back Pain Examination: A Classification Approach Using Current Evidence

Sponsored by the NY Student Special Interest Group

Presenter: Michael Masaracchio PT, DPT, MS, OCS
Assistant Professor/Coordinator of Anatomy Lab
Long Island University, Division of Physical Therapy

Place: Long Island University, Division of Physical Therapy
1 University Plaza, Brooklyn NY, 11201 Room 230

When: Thursday, September 20, 2007

Time: 5:30-7:30

Description: Low back pain (LBP) continues to be a prevalent and costly problem in our society. Clinicians use a variety of examination techniques and approaches to evaluate individuals with LBP. Recently, an updated classification system has been presented to try to identify subgroups of patients likely to benefit from certain interventions. The purpose of this course is to understand the current classification system that exists for LBP and try to group patients into an appropriate category using scientific evidence.

Contact studentpt@gmail.com for more info or directions (or for directions go to: http://www.brooklyn.liu.edu/location/directions.html ).