Transcription:
Teaming up with Physical Therapy: What Sports Medicine Physicians Should Know

Melanie:  Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole, and I invite you to listen as we examine teaming up with physical therapy, what sports medicine physicians really need to know.

Joining me is Dr. Lucas Buchler. He's an Assistant Professor of Orthopedic Surgery at Northwestern Medicine. Dr. Buchler, it's a pleasure to have you join us again today. And from a layperson's perspective and even some in the field itself, it would seem that sports medicine and physical therapy are two competing entities. However, you'd like to make the case that the two fields can actually work together. Can you speak to us about why it's beneficial for a patient when physical therapy and sports medicine work together in a more synergistic manner?

Dr Lucas Buchler: Sure. Yeah. Thank you for having me back today. It's wonderful to be on again. I think, for me, at least in my mindset, there's really no difference in sports medicine and physical therapy. Certainly, I'm a sports medicine surgeon, I do orthopedic surgery. And the physical therapists have a different skillset. But I think that it's really a more collaborative effort in taking care of patients. And I really think it's nearly impossible to have a good sports medicine practice without great collaboration with physical therapists.

And I think depending on practice environment and practice setting, you'll see a variety of setups with that. Some places physical therapy is integrated directly into the office where on the same floor or same building patients see the orthopedic surgeon and they see the sports medicine doctors or they see physical therapists all kind of in the same venue.

But I think that, you know, for example, most of our patients in sports medicine, we treat non-surgically. I talk to a lot of the patients and actually our residents and medical students about that a lot that most of sports medicine is actually non-surgical. It's the medicine side of things. And most of that treatment is done with rehab with good physical therapists. And so I think it's vital to any good sports medicine practice to have good partnership with either physical therapists in the same practice setting or locally with other groups around town.

Melanie: I couldn't agree with you more. And Dr. Buchler, as an exercise physiologist, over the years, I have seen many of the physical medicine specialties coming together. I mean chiropractors and massage therapists and physical therapists and sports medicine physicians and orthopods and exercise physiologists, athletic trainers, you know, I mean, there's so many of us with many different aspects, but similarly inclined. We're looking for the rehab. We're looking to get returned to play. We're looking to keep people active, right? Do you see this collaboration happening more and more in the future? And how does that really improve the quality of care and treatment selection?

Dr Lucas Buchler: I think you're completely right. and I think some of the best examples we see of that are the sports medicine teams that take care of our athletes, whether it's professional athletes or college athletes, and in many settings, even recreational athletes or high school athletes. But for our pro sports teams, the physical medicine or sports medicine teams that you talked about, incorporate folks from all of those different avenues. So we have physical therapists, chiropractors, massage therapists, exercise physiologist, et cetera, all working is a group in collaboration to provide the best care we can for our athletes.

And I think our goal in practice at least is to try as best we can to adopt that model for taking care of all of our patients. And it's just not functional for all of our patients to be seeing all of those providers like a professional athlete might. And what I tell our patients is that that has nothing to do with not deserving that kind of treatment, but professional athletes are paid to take care of themselves, physically for a full-time job. And most of our patients that we see in the office don't have that kind of time. They have a job that they have to tend to or families that they have to tend to. And so we're trying to get them that multidisciplinary collaborative care without taking up all that time. And I think that's where the integration and working together with physical therapy is so huge.

I think the other big change, it's still relatively recently, is the direct access laws that have been passed in many states. So Illinois is now a direct access state where patients can present directly to physical therapist without having a prescription or an order from a physician. And that's a change. It used to be that if patients wanted to get treatment from the physical therapist, they had to first have an order from a physician. And so those new laws have changed the way that patients flow through the medical system a bit more. So many of the patients I take care of are first seen by a physical therapist, whether it's part of our group here at Northwestern or locally around town with one of the more private physical therapy groups.

They're seen and evaluated by a therapist. They start the treatment. And then at some point, they may refer them for care over to our team if the patient isn't progressing appropriate, if they would like another set of eyes on the patient, if they feel they need more evaluation or sometimes if they're failing the non-surgical treatment and they think that the patient may need a surgical approach. So I think that that collaboration is even more important.

Melanie: Well, I certainly agree with you and. You're speaking to other providers. Are there any challenges you might like to mention? Have you, in your own personal experience, had any disagreements on protocol or treatment course? And while you're telling us about that, tell us a little bit about the referral process. What does that look like? When does PT care stop and sports medicine care start or vice versa? How does all of this work together?

Dr Lucas Buchler: So I would say, no, I really haven't had any difficulty, and that may just be my experience. But, for me, it's been pretty seamless. We've worked very well with our partners in physical therapy and others. And I think that the reason for that is we kind of demand an open line of communication. And I say that as it's something we have to push, we really don't.

Most of the physical therapists that we partner with know that if patients are having trouble, not following the normal post-operative protocol or even a non-surgical protocol, or if they feel like they're coming offline for some reason. They reach out to us, they contact us directly, whether it's me or my physician's assistant or our nurse. And so we have that open line of communication, and I think that's vital to taking care of patients in the right way.

And we haven't had any issues with disagreement. I think one thing I have noticed is that sometimes our physical therapy partners feel like they may be burdening us by sending a patient. They a lot of times to say, "You know, I know you're very busy" and for us, it's quite the opposite. We're happy to see those folks. We're happy to take care of them and help.

And many times, like I said, I am a surgeon, I enjoy doing orthopedic surgery. That's my primary role in the whole team environment here. But we're happy to see patients whether they need surgery or not. So that referral process has been very easy.

it set up kind of one of two ways. We have our information that we provide to the physical therapy partners to try to make sure that that's out there and available as much as possible so that patients can just call in and schedule with us. And then on the backend, we work very hard to make sure we maintain availability within our schedule so that those patients can be seen.

And then for the physical therapists, we've established relationship with and have our contact information, you know, if they ever have a patient who's having trouble getting in or can't get an appointment in a timely manner, we have them reach out to us directly and we'll schedule that patient directly to make sure that they're getting the care that they need.

Melanie: How have your patients liked this collaboration and this referral process? Tell us a little bit about what they've said to you.

Dr Lucas Buchler: I think they've been very happy. I think one thing we noticed is that the physical therapists tend to see the patients more frequently. So oftentimes once, twice, sometimes three or four times a week, they're seeing these patients and so they interact a lot. They tend to develop really strong relationships. The patients will have a lot of-- I don't know if loyalty is the right word-- but you know, most of our patients come in and they're very, very happy with their physical therapist. And so we see them at more spaced out interval.

So we rely on the physical therapists a lot to kind of be the eyes and ears. And so if they see something that they're worried about, again, whether it's a patient we've operated on or not, that they reach out and contact us. And I think the patients like having that reassurance. They like having that regular check-in with somebody who's part of the team.

And again, for us downtown, sometimes or a lot of times actually that the therapist we're working with are not directly affiliated with our practice. They're with a different private group or somewhere else. And so, that collaboration and that conversation is not something as easy as being right down the hallway. And so we've been thrilled with how great the therapists have been in keeping us in the loop, keeping us up to date on what's going on. So whether it be sending us emails, giving us calls and providing reports back for the patients, but our patients have been very, very happy with things.

Melanie: Are there any misconceptions regarding this referral process you'd like to dispel or correct?

Dr Lucas Buchler: I think the biggest thing is, like I mentioned earlier, is that we've often heard from therapists that they don't want to bother us or don't want to burden us with whether it be communications, phone calls, sending a patient over, a patient who's having trouble and they want to get a second opinion or set of eyes on them. I think there's really no burden us. I feel like that's our role and it's our job and that's what we like to do. And so, we're always more than happy to see folks. And again, sometimes those folks are folks that need surgery and that's great. And a lot of times they're not, and that's okay too. What matters to us is that the folks are getting better, getting back to the activities they want to do and making progress so we can keep them active and keep them moving.

Melanie: Well, certainly that is the goal. And as we wrap up, Dr. Buchler, you're such a great guest, is there any other information you'd like other providers to know about how physical therapy and sports medicine really work together for the best patient outcomes?

Dr Lucas Buchler: I think it's a little bit of reiterating what I discussed earlier. I think for me, as I started practice, I started right around the time of the direct access laws for physical therapy changing. And I've noticed that it's a big change in referral patterns. It used to be that most patients would present either to their orthopedic surgeon or their primary care physician and then they would be referred to physical therapy. And if they didn't improve, then they may be referred back to their primary care physician or to the orthopedic surgeon.

We've seen a lot more of our patients, especially our young patients who don't have necessarily established relationships within the medical world. And so the 22-year-old who's healthy and has never had any medical problems and starts to have some shoulder pain, they may go directly to physical therapy because they don't have an established primary care physician, or they don't have an orthopedic surgeon they worked with in the past. And so we've seen that pattern change a little bit.

I think it's great actually, is I think most of the time those patients do need the care from the physical therapist. And so it streamlines things for them a bit. There's nothing harder for us or for the patient when they feel like they've wasted their time and coming to see us. And so it's nice that most of the patients are getting in and getting started with their treatment with the physical therapist.

If the physical therapist is concerned about whatever their presentation may be and they'd like us to see them earlier, they'd let us know and we see them. And if they feel like they can treat them adequately, they'll treat them and they'll send them over if they're not improving. But I certainly think it has changed the landscape a bit. And again, I think it's better for the patients. And so as we go forward, we will see more and more patients who present directly to physical therapist for their primary entry into the medical system in that first evaluation.

And so I think it's just important to always maintain those relationships. And that open line of communication so that if there's any concerns that a patient is not responding appropriately, not recovering post-surgically and in an appropriate manner, that that open communication is there to keep the physician and the orthopedic surgeon in the loop.

Melanie: One-hundred percent great information about this unique collaboration that really benefits the patients all around. Dr. Buchler, thank you so much for joining us. And to refer your patient or for more information, you can visit our website at breakthroughsforphysicians.nm.org.

And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please also remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. And for the latest updates and breakthroughs, follow us on your social channels. I'm Melanie Cole.