In episode 208 we’re joined by Dr. Bill Boissonnault, VP of Professional Affairs for the American Physical Therapy Association and author of Primary Care for the Physical Therapist; Examination and Triage. He shares his role within the APTA, his professional journey, considerations in functioning as a primary care provider and more. This week on MCF!
Dr. Boissonnault is in Alexandria, Virginia working for APTA in the past 2 1/2 years and is currently the Executive Vice President of Professional Affairs, which focuses on education, practice and research.
When Dr. Boissonnault graduated 40 years ago from physical therapy school when there was no direct access. His first position was with a home health company, which he feels ended up being the best setting to start practice. The setting challenged him to be creative, since one does not have access to a lot of equipment. It also got him to focus on imparting education to patient and family members and understand the importance of education in management. Over time he was drawn towards the musculoskeletal area and realizing that he had limited skills, enrolled into a Master’s program at University of St. Augustine.
Stanley Paris, PT, Ph.D who founded the University of St. Augustine, was one of his mentor. He was a role model for Bill for advocacy of physical therapy profession and those we serve.
After graduation, he taught in Northwest University, Chicago and also connected with a private practice that focused on musculoskeletal injuries. Later he joined a private practice in Minneapolis-St. Paul where he was exposed to primary care/family medicine practice. He spent time with the primary care doctors in their practice and worked on collaborative patient care.
This interest, lead Dr. Boissonnault to go back to school at St. Augustine with Dr. Paris, with focus on primary care.
He spent time with physical therapists who worked in the primary care model, namely those in military and those working for Kaiser. He also took coursework in a PA program which forced him to take off his PT hat and changed his perspectives. He was then trained by two physicians, Dr. Kupiner and Dr. Bass into medical screening.
During the time spent with primary care physicians, Dr. Boissonnault noticed that they had extremely busy schedules and usually had 10-15 minutes to spend with a patient. He received quick handover of musculoskeletal patients from the physicians to educate and determine need for PT.
He realized that his skill sets as a physical therapist and those of physicians were complementary. Physicians could focus their time and expertise on medically sick patients who were out of the realm of PT practice. Some patients needed to be referred to sub-specialities. The idea of “triage” was realized in the setting.
Perspective on PT as a primary provider
Dr. Boissonnault feels that as of now physical therapists do not have a specialization (residences or fellowship programs) for primary care setting. His current work with APTA is exploring the feasibility of primary care being a way of practice. Along with foundational knowledge, he feels that PT’s need experience to work in tandem with other primary care providers including physicians and dietitians for a successful triage model.
He doesn’t believe that there is opposition for PT’s but a lack of understanding among other providers for the role of PT in primary care.
Cost-effectiveness of direct access
Julie Fritz and G. Brennan’s research about timing of PT interventions and the adverse impact on outcomes when patients have seen a physician or had MRI’s prior to seeing a PT. He feels that timing and avoidance of excessive testing prior to PT interventions can have positive outcomes not just in cost but overall rehab.
Dr. Boissonnault along with Mike Ross, PT conducted a review of published case reports that described physical therapist/patient episodes of care that resulted in the referral of the patient to a physician and a subsequent diagnosis of medical disease. They concluded that physical therapists with effective multifactorial screening strategies contribute to the diagnostic process, ensuring that patients see the appropriate practitioner in a timely fashion.
Message for collaboration
Dr. Boissonnault feels it's important to collaborate and have a two-way street between physicians and physical therapists. He believes that we need to take the time to build relationships and make physicians understand that as PT’s we can be a referral source for them.
Advice to a young clinician
All patients need to be assessed in the same way, irrespective of their referral source (PCP or specialist) or the elapsed since their visit to the doctor for their complaints. Make sure you have tools in place to get an informed and detailed health/medical/surgical history. When a patient is referred through a physician it is important to educate the patient that the PT and the doctor are in concurrence.
Advice regarding advocacy for PT’s as primary care providers
Bill believes it's important to get involved in policy and legislative efforts. Be more aware of internal policies of the workplace about direct access when applying for jobs.
JOSPT 2012 study: https://www.jospt.org/doi/full/10.2519/jospt.2012.3890
Fritz and Brennan 2015 study: https://onlinelibrary.wiley.com/doi/full/10.1111/1475-6773.12301