EPISODE 448

A Unique Look at the Evolving Role of Physical Therapists - Dr. James Gordon, Chair of the Division of Biokinesiology and Physical Therapy at the University of Southern California

01-25-2024

It’s not often that you have the chance to benefit from the sweeping perspective of someone who has been in the same profession for 50 years, but that is the fortunate circumstance we find ourselves in on this episode of Raise the Line. Our guest, Dr. Jim Gordon, describes the remarkable evolution of physical therapists from being limited to hospital-based, post-op rehabilitation to becoming community-based providers of choice in a wide and growing list of specialties from orthopedics to oncology. “We have established ourselves as essential actors in the healthcare system. We have the education and research behind us, but most important, I think we have credibility among other healthcare professionals and with patients.” As the leader of one of the top ranked physical therapy programs in the US at the University of Southern California, Gordon is in a position to shape the future of the field as well. As he tells host Hillary Acer, he sees a greater role for physical therapists in prevention and primary care, and also expects changes in the application of new technologies in neurorehabilitation, his area of specialty. “What we’re trying to do is not look at technologies as a solution in and of themselves and instead develop a patient-centered approach which focuses on how people are able to use these technologies to make their lives better.” Don’t miss this great opportunity for a unique look at the current and future state of a vital part of the healthcare system from a leading figure in the field.

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Transcript

Hillary Acer: Hi, I'm Hillary Acer, welcoming you to Raise the Line with Osmosis from Elsevier. We're going to shine light today on a healthcare profession that studies consistently show is a lower cost choice for providing high quality patient care in a wide and growing list of fields from orthopedics to oncology. I'm talking about physical therapy, and as its impact on healthcare has changed over the years, so have the profession's educational requirements.

 

We're going to take a look at the evolution of physical therapy practice and education today with Dr. James Gordon, Associate Dean and Chair of the Division of Biokinesiology and Physical Therapy at University of Southern California, one of the top PT departments in the U.S. He is widely recognized as a leading figure in the field, having spent many decades in clinical practice, research and teaching, including at Columbia University and New York Medical College before coming to USC in 2000. 

 

Dr. Gordon's current research focuses on neurorehabilitation and motor control, and he is considered one of the foremost thinkers in motor learning and its application to people with neurological conditions. 

 

Thanks so much for being with us today, Dr. Gordon.

 

Dr. James Gordon: Yeah, thank you, Hillary. I'm thrilled to be here and to join what is really an amazing list of people that you've had as guests on this podcast. So, I'm really honored to be asked to be interviewed on this and excited about the possibility of talking about physical therapy and the evolution of the profession. So yeah, thanks. 

 

Hillary: Well, we're happy to have you here, Dr. Gordon. I think you're actually one of the first physical therapists that we've had a chance to talk to, so we're excited to shine more light on this field. And also, we have a number of learners in the physical therapy space, as well as practitioners, so we're looking forward to hearing your unique perspective. 

 

Dr. Gordon: Great.

 

Hillary: All right. I'd like to start with learning more about you and what first got you interested in healthcare and particularly physical therapy. 

 

Dr. Gordon: Yeah, that could be a very long answer. Let me try to do that as a short answer. I took a somewhat circuitous route into physical therapy. I actually dropped out of college in my sophomore year, this was in the 1960s, and I did what I now consider a form of national service, which is that I was very active in the anti-war and social justice movements of the 1960s. But by the early 1970s, I was actually then looking for something that would be more sustainable and I started looking at healthcare. My parents were both in healthcare. My father was a physician, and my mother was a nurse. So, I gravitated to that. 

 

I think what attracted me to physical therapy was two things, really. First, the emphasis on science...that it was a profession that was grounded in science, the basic sciences, anatomy, physiology, neuroscience, biomechanics, but also that it was fundamentally about establishing a one-to-one relationship with patients. And those two things, that's a very powerful combination, actually, when you think about it, to be very engaged on a one-to-one with patients, but also have to be able to deliver real science in that interaction. I don't think I understood that at the time, don't get me wrong. It was much more intuitive, but I think looking back, that's what attracted me. 

 

So, I ended up going to SUNY Downstate in the State University in New York, Downstate Medical Center in Brooklyn, where I grew up, and I graduated with a bachelor's degree in 1974. 

 

Hillary: Wow. You've come a long way since then. A couple of notes, actually. So my dad grew up in Brooklyn, too, near Prospect Park. I've gone back to visit there quite a bit. But also, I've spent a number of visits in physical therapy offices, and that's actually something that drew me to that field after college. I was very interested in physical therapy. I didn't end up pursuing it, but what I loved was that physical therapists stay with you throughout the entire duration of your treatment. You're at a point, maybe post operation or post injury, and you're pretty vulnerable. You're going through significant changes sometimes with your identity. If you're an athlete and you can't perform your athletic activities, or if you've had a more severe medical condition or something like that, you're really looking for not just the treatment and the medicine that physical therapy provides, but you're also looking for that relationship with a provider who can help you get through what could be a really tough time. So, I love that you pointed that out, the one-on-one time with patients and the close connection that you get to draw with them.

 

Dr. Gordon: Yeah. I mean, honestly, I think that's what continues to attract great people to the profession. There's a study that was done about fifteen years ago at the University of Chicago on what they call job satisfaction and they came out with this ranking of the professions that had the highest job satisfaction. Physical therapy was number two. So then you should ask yourself then, well, what was number one? And number one was clergy. Actually, physical therapy was tied for number two with firefighter. So I think that tells you something about physical therapy as a profession that we get to come home every day and know that we've made a difference in people's lives and a difference in a very personal way where we've accompanied people on those journeys that they take through these challenging times.

 

So yeah, I still feel that's what makes physical therapy the best profession there is, to be honest, but also biased.

 

Hillary: I think it's really interesting you point that out and one of the trends that we hear often across healthcare is this moral injury and increasing rates of burnout. Some of the things that I've been recently reading are tied to the relationships that you can build with your patients and the meaning that you can get from your day-to-day work. It sounds like that could potentially be playing a role here as well in keeping physical therapists really connected to their mission and their purpose. 

 

Dr. Gordon: Absolutely. Excellent point.

 

Hillary: So you've been in this field for fifty years, almost fifty years, I should say. What are some of the most significant changes that you've seen in the profession over that period of time?

 

Dr. Gordon: Yeah. I'm proud to say that next year, actually in six months, I will celebrate my fiftieth anniversary as a physical therapist, which is kind of amazing. You think that's a long time, but looking at it from my perspective, it's actually kind of a blink of an eye in many respects. But yes, the profession is so completely different, in just so many different ways. 

 

I think most obviously the settings in which we practice have changed enormously. When I graduated, most physical therapists practiced in hospitals and rehab centers, and only a minority were in outpatient, and very, very small number had private practices. Now that's completely flipped and most physical therapists practice in outpatient, and most of those people are in independent private practices. So what that means is that physical therapists now practice in the community, and that's a big change that has really changed, you know, who we are and what we do. 

 

Of course, our education has changed. We've gone from a bachelor's degree, which I got, then to a master's degree and now all physical therapy programs, you know, all graduates have a Doctor of Physical Therapy degree. We're Doctor of Physical Therapy now. So that's been a huge change. We now have specialties. Physical therapists can be board certified in ten different specialties. We have residency programs. We have fellowship programs.

 

The research aspect of physical therapy...when I graduated, I think I could count the number of physical therapists with PhDs on one or two hands. Now, there are a lot of people who are. It's really probably thousands of physical therapists. The major physical therapy programs have flourishing research enterprises. So, physical therapy now has its own science, which it didn't have fifty years ago. Those are the obvious changes, but I think the most important changes are what we do and what we're able to do. 

 

Probably the best example of that is the development of orthopedic physical therapy. You know, when I graduated, physical therapists really did not treat what I would call non-surgical musculoskeletal disorders. We were primarily in hospitals treating patients post-surgically. But an interesting thing happened around that time, which is that orthopedic surgeons really moved big time into surgery and sort of gave up being interested in the treatment of non-surgical disorders, so physical therapists began to move into that area of practice and began to develop approaches for teaching and for treating patients with what we think of as the aches and pains of daily life or the injuries that we suffer. When we overstretch on the tennis court, or we spend a weekend painting our daughter's bedroom or something like that -- and now we have a sore shoulder or, or a pulled hamstring -- orthopedic surgeons no longer were interested in that, and physical therapists really moved into that and really developed ways of treating patients so that now physical therapists are practitioners of choice for those kinds of disorders. That has really happened because physical therapists saw an opportunity and moved into that and developed treatment procedures for that. So, a lot has happened in fifty years. 

 

Hillary: It sure sounds like it. Wow. I actually didn't know many of those changes. I am aware of some of the educational shifts from bachelor's to doctorate programs, but it’s really interesting to point out the change in orthopedic PT. So, thanks for enlightening me on that. 

 

On a broader note, how has the evolution of the profession positioned physical therapy for the current state of the U.S. healthcare system?

 

Dr. Gordon: Yeah, that's a good question. I think the first important thing there is the use of the word evolution. Evolution is a good word, not just because the change in the profession has been gradual, but also because it, in many respects, is similar to biological evolution. 

 

We have this massive, complex healthcare system but it's really made up of many smaller ecosystems that exist in just hundreds of different ways in the community and institutions and schools with many different people participating in healthcare. Within these ecosystems, people adapt and create new ways of solving healthcare and that just keeps going on and on. That's a continuous process, and I think we kind of have this illusion that here we are in 2023, and we've reached some sort of mature state. That this is kind of the end of history illusion, which is, okay, now, history has brought us to this point in time and the profession, so physical therapy is now in its mature state. It's really kind of reached maturity.

 

Well, that's, of course, absurd and silly. I mean, with from the perspective of fifty years, I can tell you, that's not the case. Physical therapy is still evolving and we are still engaged in this complicated evolutionary process. What's critical now is that we have established ourselves as essential actors in a healthcare system. You know, we have the education, the research, but most important, I think we have credibility among other healthcare professionals and in consumers and patients.

 

So, I think we are in a good position to adapt to the changes that are happening, and really being able to solve problems moving forward. 

 

Hillary: All of that makes sense. I'm curious, as we look forward, are there any trends that you see maybe around the corner or changes in the healthcare system that could adjust how physical therapy is seen in healthcare?

 

Dr. Gordon: You know, one obvious change that's happening is that we're moving more and more to focusing on prevention and primary care and I think that physical therapists are very, very ready to be involved. We're already involved in both of those areas and so we definitely can be more involved with those We could come back to that if you'd like. 

 

Hillary: Maybe a follow-up more related to your research, actually. I know you've done quite a bit of research on the neurological conditions and neurorehabilitation and things like that. I'd love to know if there's any recent advances in that space that you're particularly excited about, or even areas of your research that you're digging into more. 

 

Dr. Gordon: The area of neurorehabilitation has come a long way. I think that we are sort of trying to find a balance. There's a lot of technology that is very promising in neurorehabilitation...a whole range of different technologies from robotic approaches and other kinds of approaches, but there's also the focus on how people learn new ways of moving. 

 

So, what we're trying to do, and I think what's exciting, is to not look at technologies as a solution in and of themselves, but to try to marry or unify an approach that focuses on technology and on a kind of a patient centered approach, which says how do people use these technologies, and how are they able to use these technologies to make their lives better?

 

I think in the past, we've looked at some of these new technologies -- whether they're robotic approaches or electrical stimulation approaches or brain stimulators or brain computer interface -- we've seen these as kind of solutions in and of themselves, and I think the next stage is to bring them together with the people who are actually working with patients.

So, I think it's an exciting time in neurorehabilitation.

 

Hillary: Definitely sounds like it, and that's really fascinating. I will be following that field a little bit more closely to see what's around the corner in terms of that integration between technology and more patient-centered and behavioral approaches.

 

I want to shift gears just a little bit and talk about USC's physical therapy program. Can you give us an overview of the program and maybe some of its particular strengths? 

 

Dr. Gordon: I think our vision at USC in physical therapy is what I would like to think of as the power of the three-legged stool, which is that we think that what makes us strong is to have strength not just in our educational program and research program and clinical practice, but in all three. We have a very strong educational program, we have top-notch researchers who are pushing the envelope, and we have a large clinical practice.

 

The most challenging aspect of physical therapy education is that we are educating our graduates to practice in the future, and you know, none of us have practiced in the future, so how do we prepare people to practice in the future? We think the answer to that is by being fully engaged in the present, that is to say, having the ability to engage in our own practice, confronting the challenges of practice, trying to push the envelope in our own practice, and in our own research labs, and as well in the way in which we educate patients, so that we are part of the process of creating the future, that gives us the best chance of being able to prepare our students for the future.


Hillary: I love that kind of mindfulness approach. I love that kind of putting, you know, your attention and effort on what's in front of you right now. And, of course, that will have big influence on what comes around the corner. So, it sounds like you're kind of building a muscle in your students to think critically and to really be a part of that change, which is great.

 

Dr. Gordon: Well put. 

 

Hillary: Yeah, thank you. Can you talk a little bit about some of the biggest changes in how PTs are educated? We talked about, you know, some of the programmatic changes and bachelor's versus doctorate degree programs. Are there other things that have shifted in the PT education space that you'd like to tell our learners about?

 

Dr. Gordon: Yeah, I think there's been a big change in the last decade or so, maybe a bit longer, in how we educate students and I think there's been a recognition that we can't just, you know, put the students in front of the fire hose and let them drink. We have to be mindful about how we educate our students and be very intentional about the approaches we use. 

 

So, the education has really been a focus. We are more student-centered in our approaches. We've moved away from lecture-based approaches to more approaches that flip the classroom and do things like that and small group learning. Also we recognize that students learn at different paces and so we’re using different methodologies. A greatly increased focus on equity, diversity, inclusion, trying to bring in more diverse classes, having more inclusive approaches to education, more and better use of technologies. 

 

One thing we've done at USC is to develop a hybrid pathway. We now have our traditional residential pathway who are here five days a week in classes, but we also now have a hybrid pathway, and they do much of their learning online and we have a full online curriculum. But in addition, then they come for what we call immersion. They come usually for about a week to ten days at a time, twice a semester, to learn the skills that they need and that really has improved our ability to provide the education to people who otherwise could not come and be residential students. So, that's another change and we're seeing that as a growing pathway or mechanism in physical therapy education.

 

Hillary: That's great to hear. It sounds like you and your faculty are working really hard to meet students where they are and to kind of deliver these educational opportunities in more creative ways. I'm familiar with a couple of other programs such as the Yale Physician Associate Program that does a blended program like this. So, I think this probably is something we can see more of in the future is a hybrid model of learning. You mentioned that you're already doing that even within your residential program where you're flipping the classroom and you're doing more problem based learning or case based learning, personalized learning. So that's great. 

 

That's, of course, where Osmosis was started...medical students realizing that there were a lot of better ways to learn and there were a lot of evidence-based techniques that weren't necessarily able to be integrated into things like traditional lectures that now we can do better with technology. So it's great to see this evolution to go back to that world and continue.

 

As far as Osmosis goes, we focus on teaching and educating, and we love to fill in knowledge gaps. Is there a particular topic you think that Osmosis should make a video or course about that's something of interest to you? 

 

Dr. Gordon: I'm not sure this would be of any interest to Osmosis, but here's what we need. First and foremost, I think one of the big gaps in health professional education is what's called IPE that's interprofessional education. And this is a real issue in how do we educate our students about what other health professions do? So, even here at USC, where we have a medical school and we have occupational therapy and we have pharmacy and we have, you know, others, it's challenging to get people together because every curricula is all very complicated. So, I think IPE is something that a company like yours might start to think about. How to provide that the kind of education about how different professions, for example, address a similar problem. 

 

Another area that I think would be of interest to us would be primary care. Here's my take on primary care: physicians don't want to do primary care. I think we need to realize that. We can do everything... we can say we need to create incentives. No. They don't want to do it because medical school is educating them for these very exciting specialty areas, they're not interested.

 

Primary care is something that physical therapists, nurse practitioners, physician assistants, pharmacists, counselors, dentists -- all of these people do primary care in different ways. But maybe - and this is kind of like fits with the IPE -- maybe there are common elements to primary care that could be of interest to people in all of those fields. That would make a real contribution, because I think we need to figure out how to do the primary care thing. You asked me before, what do we need? We need to solve the primary care problem. That's the big problem in healthcare. The big problem in healthcare is not how to do hip replacements or how to how to do a heart transplant. The big problem is how to help people solve the health problems in their daily lives, and primary care is what we need. 

 

Hillary: I think it's a great point, and I love that you pointed out the interprofessional education aspect. I actually started a program at Osmosis with our team called the Osmosis Health Leadership Initiative, which originally started with medical students. As we started to build out a nursing platform with educational videos specific to nurses, we brought in nurses, so we had medical nursing students. Then over time, we actually started to see dental students and pharmacy students using our educational materials and physical therapists and veterinary students. So, this program has slowly expanded.

 

At first, we had our medical education fellowship and our nursing student fellowship all siloed, and we actually realized that we could bring them together and help our students start learning from one another. It's been so enlightening, actually, because something we figured out is this is how they're, of course, interacting in practice. You know, they're working across these diverse care teams and they need to have an understanding of what each specialty does and they can actually learn quite a bit from the other specialties. So, it's been a really awesome journey for us over the last year and a half to really start to bring these health professional students together -- and not just across health professions, but even now internationally -- and see what best practices we can gather. Again, how can you teach these students early on to really leverage the skill sets of these other professions? So I think there's a lot more we can do in that space and definitely something I'm passionate about.

 

Dr. Gordon: So, you're way ahead of me, is what you’re saying. 

 

Hillary: Well, we only have about two hundred students in the program. We are recruiting for more and in fact, if students are interested, they can go to our careers page and apply to be part of the program. But we are always looking for student leaders who can help to make this change on their campus and that's one of the hopes, is that while we only have two hundred students in the program, that they actually go back to their universities and their campuses and they can help to kind of spread these ideas and help their colleagues work more collaboratively. So, that's one thing. 

 

The other early dream that I'll just mention -- if you'll stay with me for a bit -- when I joined Osmosis, I really was pre-med actually, but I had worked in a physical therapy office. I started teaching yoga, was very interested in nutrition and I had this, you know, kind of hope that someday there would be a platform, maybe, where a doctor could actually learn more about physical therapy and they could go watch videos or do assessments, and they could take on maybe a physical therapy sub-certification or something. 

 

So, I had this dream that wherever specialty you were in, you could potentially just learn more about other specialties and other professions and integrate that more seamlessly. Of course, there are rules and guidelines we need to follow, but, you know...who knows? Maybe that's another promise of Osmosis down the road. 

 

Dr. Gordon: I'm all for it, by the way. I think the more we learn from each other the better. By the way, our faculty teach the musculoskeletal diagnosis section of their diagnosis course in the medical school, so, I mean, they can learn from us and we can learn from them. I'm all for that. I think that's a great vision.

 

Hillary: Yeah, I love that. Well, we have a lot of students and early health career professionals in our audience. Is there any advice that you'd like to share with them about meeting the challenges of healthcare today? 

 

Dr. Gordon: You know, Hillary, that's probably the most challenging question that you've given me so far. The first thing I would say is that I am in awe of young people today. I think they're so capable. I think they are dealing with challenges that are just hard to imagine. And yet, there are so many of them that are really doing great things. 

 

My advice is to a student coming into the health professions is to think of yourself as a leader. I think all of the changes that I described in physical therapy that I've seen over fifty years, those changes didn't just happen. This isn't just an automatic process. Those changes happened because individuals saw the need for change. They saw opportunities, they took those opportunities, they grabbed the brass ring, and they were leaders, even though maybe they didn't even think of themselves that way. So, where we are today is the result of leadership that was demonstrated by individuals. Real people. And those people had vision and most of all, they had the drive to help people. So, I guess that's my advice.

 

Hillary: Well, I think to our audience, if you're looking for a sign or if you need a little bit of motivation to, you know, take initiative or lead that project or make change, here it is.

 

I think, Dr. Gordon, that's a great way to close out and very inspirational for our audience just to get that reassurance that even one person can make a difference. We're obviously here to support you if we can. The team at Osmosis is always excited to help disrupt and make positive change. So, I really appreciate that.

 

Dr. Gordon, thanks so much for being with us today. It was a pleasure speaking with you. It was a pleasure highlighting physical therapy. I hope we can continue the conversation and continue to learn more about this field that has become so central to our healthcare system. 

 

Dr. Gordon: Yeah, thank you, Hillary. This has been fun and interesting and stimulating for me. I'm excited to hear more programming about this topic. So, I look forward to that. 

 

Hillary: We'll definitely keep you in the loop. So, thanks again for being with us today. I'm Hillary Acer. Remember to do your part to raise the line and strengthen our healthcare system. We're all in this together.