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: ___________________________________
Copyright
©1997-2007
American Society of Exercise Physiologists All Rights
Reserved.