PEPonline
Professionalization of Exercise Physiologyonline

An international electronic
journal for exercise physiologists
ISSN 1099-5862

Vol 5 No 12 December 2002

 



Developing a Private Practice
Aliisa Seppala, MA, EPC, ESC, ATC/L
Healthy Lifestyles Department
Good Samaritan Health Systems
Kearney, NE 68848
 

I HAVE BEEN blessed with the position I currently hold.  Presently, I am one of six specialists who make up a Healthy Lifestyles Department within a major hospital in Kearney, Nebraska.  Each specialist represents a different profession among those involved in health and wellness.  With the support of our director, we are all encouraged to develop programming that is interesting to us.  As an exercise physiologist, the obvious choice for me was to do exercise and fitness consulting.

However, my department is not located within a fitness center.  So, I wondered how I would develop a clientele.  I knew that I wanted to evaluate and prescribe exercise for individuals with specific medical conditions.  But, strangely, at the time I failed to see the huge resource right in front of my face (i.e., the Health Promotion Department).  It is located directly in the center of a large multi-specialty clinic full of potential clients.  The key to my success was marketing the value of my professional services to the physicians in the community. 

This raises the question though, “How do you get to the physicians?”  As we know, medical doctors are extremely busy.  Often times, they do not have time to investigate new services for their clients.  It occurred to me that the best way to share information with physicians is through their nurses.  Since most doctors are unaware of what exercise physiologists are capable of doing for their patients, it is our responsibility to market what we do.  Generally, physicians are in favor of services that will benefit their patients as long as they are safe.  If you get the support of their nurses, they can then bring up the subject of exercise consultation with the physicians. 

In my experience, the best way to interact with nurses is by sharing what I know and what I can do for their patients.  Where appropriate, I offer my point of view about the role of exercise and rehabilitation and how both may impact their patients’ illnesses.  I usually pick a subject like osteoporosis or diabetes and talk about how exercise can reduce the risk for either or improve the health and fitness status of the patient with either disease.  I also point out that the prescribe exercise program is safe for either medical condition.  This allows me to educate health care providers on the benefits of exercise, promote the profession of exercise physiology, and open up a resource for referrals. 

Another key to success comes from being able to help health care professionals understand how the services of an exercise physiologist differ from the more recognized care provided by other health care practitioners (such as physical therapists), and how patients will benefit from the exercise physiology body of knowledge.  In fact, just recently, I had a conversation with a physician who specialized in surgeries of the spine.   He asked me to explain why he should refer his patients to me.  It was crucial that I was able to help him understand that exercise physiologists have extensive training in the science of exercise.  I also emphasized that our programs of study included physiological assessment, cardiac rehabilitation (which included pathophysiology of heart disease), functional anatomy, and applied physiology.  It was important for the physician to realize that exercise physiologists spend a lot of time developing exercise program to promote muscular strength, flexibility as well as the intensity of exercise to produce important cardiovascular results. 

By the end of our conversation, the physician was able to see the benefits of  referring patients to an exercise physiologist.  Another idea that came out of this conversation was to develop an exercise consultation referral pad.  The doctor brought up the fact that I needed something to make it easy for him to refer his patients to me (see the Exercise Consultation Referral).  I wanted a process that would make it easy for physicians to refer patients to me.  The Exercise Consultation Referral has worked very well.  It also acts as a physician release for exercise.  And, the need for my services has became more apparent as I observed related processes within our own department.  For example, our dietitian had been receiving a lot of outpatient dietary consults for diabetic patients that would clearly benefit from an exercise consultation.  But, this aspect of their care had not being addressed. 

What I discovered was that the diabetic patients were generally told, “You need to start an exercise program” without any further guidance or direction.  The problem of course is there is much more to prescribing exercise for a diabetic patient than “get some exercise”.   Diabetic patients benefit from controlling their blood sugar levels, and exercise is a great way to do just that.  In some cases, exercise is as powerful an influence as medicine.  There are also many things that diabetics have to be aware of when exercising.  My thought was that educating a diabetic patient solely on nutrition was really only getting half the job done.  Everyone who is diabetic should see both a dietician for nutrition counseling and an exercise physiologist for exercise counseling and prescription. 

In addition to a direct communication within my own department, I sent an evaluation of the client along with plans for exercise to participating physicians.  These letters include the results of the submaximal graded exercise test (including heart rate and blood pressure responses and the predicted maximal oxygen consumption), along with body composition, flexibility, strength and posture test results.  I also inform the physicians of any physiological indicators that might be red flags.  For example, recently, a client presented a resting blood pressure of 118/96 mm Hg.  The elevated diastolic blood pressure is potentially a concern.  During the exercise test, the client’s systolic blood pressure responded normally while the diastolic blood pressure decreased to 76 mm Hg.  After recovery, the client’s diastolic blood pressure increased to 90 mm Hg.  The physician appreciated receiving the exercise test data. 

The other side of the picture is the issue of insurance reimbursement.  Except in rare circumstances, we not in position to receive insurance reimbursement because we are not a licensed profession.  To further compound the problem, most people are not willing to pay for exercise consultations out of pocket.  If we can find a way to resolve this issue, then every exercise physiologist will be overwhelmed with business.  When one considers all the different diseases and conditions that exercise is used to help correct or rehabilitate, not to mention the possibility of preventing certain diseases, there really should be no end to the number of patients we can help. 

I am reminded of a quote from Per-Olaf Astrand, one of the founding fathers of exercise physiology, “Given what we know about the health benefits of physical activity, it should be mandatory to get a doctor’s permission NOT to exercise.”  Steve Blair, Chief Scientific Editor of the Surgeon General’s Report on Physical Activity and Health, also stated, “Physical inactivity is as harmful to your health as high blood pressure, high cholesterol, and smoking.”

At the present time, the following requirements are necessary for exercise physiologists to become licensed:

• Professional organization dedicated to the advancement of exercise physiologists.
• National Board Certification to increase credibility of exercise physiologists. 
• Accreditation of undergraduate exercise physiology programs to set the stage for licensure of exercise physiologists.
Fortunately, the great thing is that the American Society of Exercise Physiologists has fulfilled all of these requirements.  When we do obtain licensure status, it will be that much easier to get referrals from physicians.  We will not only be in a better position to help more people, but we will have better wages too.  Health care is expensive.  We have the scientific body of knowledge to help decrease the overall costs through disease prevention. 



 
 

 Aliisa Seppala, MA, EPC, ESC, ATC/L 
10 E. 31st Street Kearney, NE  69947
Ph: 308-865-2640   Fax: 308-865-2967
Exercise Consultation Referral 
Exercise Physiologist





Patient Name: _________________ Date: _________ Phone Number: ____________

Diagnosis / Problems to be treated: 

___________________________________________________________________

_____ No restriction on physical activity 
_____ Limited activity (exclude items listed below)
_____ Turttle pool (84 - 94 degrees)
_____ Aerobic activity/equipment (treadmill, bike, etc) _________________________
_____ Machine and free weight equipment 

• Restricted to __________lbs.
• Restricted movements_______________________________________
_____ Other guidance regarding physical activity or environmental conditions     _________

           ________________________________________________________________

Patient to be seen: ________# times a week for ________ weeks  _______ PRN ______

Treatment Goals (check all that apply):

___Strengthening 
___Cholesterol management 
___Weight loss
___Increase aerobic capacity 
___Decrease blood pressure 
___Increase bone mass
___Increase flexibility 
___Improve diabetic control 
___Other


Comments: 

_____________________________________________________________________

_____________________________________________________________________ 

Physician Signature  __________________      Date ___________

Provider ID Number: ___________________________________



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