Dr. Spoonemore walks us through what it is like working in the United States Public Health Service and how he got there from physical therapy school. He is a board certified orthopedic clinical specialist, fellow of the American Academy of Orthopedic Manual Physical Therapists and completing a terminal degree through Bellin College.
Alright, well, we're here today on spilling the DPT with Dr. Stevens spoon more junior who's a physical therapists and he's currently serving on active duty as a commander in the United States Public Health Service.
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Dr. Steven Spoonemore is a board certified orthopedic clinical specialist also a Fellow of the American Academy of orthopaedic manual physical therapists.
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And completing his terminal degree through Belen College, which is a DSC. He's currently stationed in Anchorage, Alaska, where he works with Alaskan Native populations in both primary care PT and outpatient rehab settings.
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The mission of the US public health services to protect promote in advance the health and safety of our nation.
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In addition to clinical roles. He serves on an advisory or sub advisory committees that provide input to the US Surgeon General deploys in response to public health emergencies, such as hurricanes humanitarian missions and the current
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Pandemic aside from that he and his wife visit Carrie.
stevenspoonemore
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Carrie, yes.
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We're married 15 years ago and they have four children as a family. They enjoy hiking fishing camping family movie pizza nights soaking up the midnight sun in Alaska.
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And are learning to enjoy all of the winter activities in the winter wonderland and Alaska.
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And I believe there's a few things there. You probably left off. I don't know if you're a black belt or what that was.
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But I know you also have some other things on there that you'll get a chance to share. But we wanted to thank you for coming on and really talk about quite a bit of what you're currently doing. Not necessarily.
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In detail, but what your position entails and kind of how your career trajectory has been decided and advanced and just have fun talking about those things. So, if you don't mind, Stephen. Would you share kind of what initially
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got you interested
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In your current position.
stevenspoonemore
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Sure thing. Let me just first and upfront because I am a government official
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Put the disclaimer out there that you're anything we talked about today. These are my own comments and opinions and don't represent any official position of the
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United States Department of Health and Human Services, the US. Public Health Service, the Indian Health Service or South Central foundation. I'm certainly grateful for.
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All their support and help they've been throughout my career, but these are my own opinions and thoughts as we talked today.
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But my journey and of the Public Health Service goes back to 2008 when I was at a an annual apta conference and
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My wife and I are walking through the exhibition hall, we saw in the corner a little flag up in the corner that said student loan repayment. And I said, Hey, let's go check that out. What's this about and that led us to the individual who's doing recruiting became a mentor of mine.
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Captain Joseph students who was there, on behalf of the Indian Health Service doing some recruiting for the IHS for the US public health service.
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And talking about their student loan repayment program which we obviously decided was a good idea. And that kind of got my feet wet in the door.
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So I was able to start my career I commissioned in 2009 and went to ship rock, New Mexico, where I worked for number of years there as an outpatient clinician.
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And as I mentioned in the captain students who is also a Fellow of the American Academy of orthopaedic manual physical therapists became a mentor and really helped me grow clinically
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Proven my skill set and I saw the abilities that he had and wanted to
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Obtain that that level of expertise myself and that really led me in the pathway into fellowship training and ultimately completing that in 2016 with evidence and motion.
Ryan McConnell
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Yeah, that's, I would say that that's kind of where all of our journey, just as a fellow and training starts as you see somebody, and I know for me, mine was during residency. I watched a recording and
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Unfortunately, you know, I wasn't in the clinic with the person, but there was actually a Daniel medics and I was
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Like his, his questions or next level and I need to get I need to get there somehow. Because there's a big gap, but you also mentioned there's a, you know, initial I guess interest in in
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In the
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Military route, just in general like art.
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Whether it's Army, Navy it. They all have some sort of loan repayment that you can get on and obviously with the current student loan debt problems that have probably expanded since even you graduated doubt that would get just about anybody interested
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And do you mind sharing what the service commitment or, you know, what sort of obligation, you had in signing that
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Sure, so
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To to seek a Commission with the US public health service, I believe, is a two year commitment initially
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And then the you know you're an officer commissioned as such, you take the we take the same as any other officer in
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The Army, Navy, Air Force Marine Corps. The other uniformed services and have the same obligations responsibilities we enjoy many of the same benefits that they do. But then the loan repayment piece itself has its own
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Set of governance, if you will. So the Indian Health Service, there is the primary means within the US public health service or and let me clarify that the Indian Health Service and the US. Public Health Service are two different entities.
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So I don't want to mislead anyone to think there are routes as a civilian to work within the Indian Health Service.
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Us. Public Health Service officers may serve within the Indian Health Service. They also serve within 20 other different federal agencies.
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My career pathway has been within the Indian Health Service. So I'm most familiar with that role does. That's where I've spent the last 11 years
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Within the Indian Health Service itself, there are opportunities to seek student loan repayment, the Indian Health Service has its own loan repayment program that physical therapists are eligible for
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It is a very nice program, honestly. So for a two year commitment you receive $40,000 in student loan repayment.
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With the opportunity to re up, if you will, to extend that contract and additional year for an additional $20,000
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And that can go on indefinitely until your loan balances company is paid in full. So you could you could pay off $150,000 plus of student loan debt if you continue to work within and approved, I just position.
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That's incredible. I mean, I think there's a lot of us that that would probably raise eyebrows for
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Any other details you feel like are worthy of telling our listeners.
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Yeah, so I mean I came into working within the Indian Health Service and and
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Received a commission as an officer in the US. Public Health Service and the character, the door for me was the loan repayment program.
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But once I got in, I realized, so many other avenues and opportunities that I really didn't even know about existed and that's what's kept me
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It's been a very fulfilling 11 years that have been in uniform thus far and have full intentions of continuing that and Tom eligible to retire. So some other opportunities that have come along, are
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Working directly in committees that respond as I mentioned in the intro through what's called the Therapist, Professional advisory committee.
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We actually can provide some input to the office of the US Surgeon General and and in some ways have some influence on policies that are decided at the national level for our health care system.
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Which is pretty exciting. You know, to think about opportunities to have a bigger role than just the direct patient care role that we have
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Yeah. So walk me through that I know obviously that, that sounds a really exciting and fulfilling did when you were first commission. Can you kind of walk us through what even if it was just in percentage of administrative versus direct patient care.
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You know, just round about like what as as you first entered service and to where you are now kind of how that's evolved and what you see your career shaping out to be
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So started off as a as a staff therapist. So it was really a clinical role that I would say was 80% plus time in treating patients. And then there were other administrative duties that were along the side. I was fortunate to have
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A solid supervisor and a good tutelage not only as a as a clinician, but also as an officer in which they helped
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Facilitate time and opportunity for me to be involved in things that would allow me to continue to grow in both realms, both as a clinician and as an officer. And so that has expanded a little bit. My time is still primarily clinical I'm a clinician first
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I do have some other responsibilities. Now I've moved up from being just members of different task force and and committees to now being in charge.
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Of the education subcommittee, for example, that we have within our Therapist, Professional advisory committee where I coordinate journal club meetings that we have on a quarterly basis and other educational opportunities. Keep us abreast of the emerging trends within
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Within the field, not only a physical therapy, but also the other therapists, we have our occupational therapists, speech language pathologist and audiologist so coordinating different elements and and opportunities for training for for those different professions.
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Yeah, it sounds like he you are able to do quite a bit. And I know this could be just ignorance on my part, but
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Obviously, there's a lot of research and things that we see at CSM just as far as army goes and the ability to have some role in imaging or not necessarily pharmaceuticals, but making suggestions about over the counter things and
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What's that look like on your end,
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And within the the positions within the Public Health Service. There are two main areas where you'll, you'll be provided clinical care. One is within the Indian Health Service, the other was in the Bureau of Prisons
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And both are a little unique they serve unique populations and the responsibilities, the extended events practice privileges that you would have
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Very somewhat on the duty station where you're at. It's not uncommon for PhD is therapists to have access to imaging privileges, they can order Plainfield X rays in particular, perhaps ultrasounds.
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But it's a little bit variable. It's not as streamlined as it is within the Department of Defense, where there are some set standards that in order to
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To perform those skills. It's more universal across the service. Ours is much more individualized to the service unit where you're at.
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Okay, so. Would that require you know I'm again showing my ignorance here but additional formal education in those areas or is it kind of like a almost like a tech where you have on job training if if the position demands it.
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Yeah, good question, and I can't speak to all the positions but my experience has been that it was more on the job training and being able to demonstrate clinical competence.
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I would take the approval of the medical committee at the hospital. We're typically credentialed as members of the medical team.
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And so similar to advancing, you know, another medical provider attaining privileges to work in a certain capacity, it goes through that review process up to the chief medical officer and the CEO.
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Yeah, so that's that's really interesting. Now I wanted. While we're on the topic of primary care and and just clinical life for you in general.
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For a lot of listeners out there. The idea or concept of primary care physical therapist or triage obviously there's some different things that people could look to for just an idea like
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The VA, you know, potentially, or Kaiser Permanente and you know there's some of these models out there. But if you don't mind, shedding just a little bit of light on what that exactly means or what you've seen across, you know, the country, even in civilian life primary care physical therapy.
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Yeah, sure.
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And I've done some reading really about the Kaiser Permanente model, looking at the VA model and some of the others, but I haven't had any direct
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Interaction in those realms, but from what I understand the model that we use at South Central foundation here in Anchorage where I'm currently at is similar to that.
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The, the model we bring in is one of a consultant role. So the, the clinics are organized into pods each pod has a primary care provider with an RN case manager with a
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certified medical assistant and another individual called they referred to as a case management support to help manage scheduling things
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And they operate as a team as a unit. There are other individuals that come into that team. There'll be an integrated pharmacist.
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We have mental health professionals that integrate into the team that are there on the same day as needed basis to meet the needs of the primary care team, physical therapists are now becoming part of that integrated model.
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So there's really only one of us who's on
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On the primary care floor at a time. And so I'm covering a number of different primary care clinics and really just kind of there in a holding pattern waiting for
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A console to come through and then at that point. I'm interacting with the patient. Many times it's an acute injury that's occurred.
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And we're providing the initial education some initial treatment and then helping to make decision making downstream.
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Some of that is aiding in the differential diagnosis determining whether or not imaging would be appropriate if referral to a specialist or to a therapy clinic etc would be appropriate or not, in many cases, it's really just
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Education to the patient, helping to set the stage for recovery and then allowing them, you know, kind of giving them permission to get better almost
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As where I see it a lot of times, because unfortunately our, our healthcare system is so in flux, with the negative messages about pain and negative messages about
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The downsides of feeling discomfort that people come into the clinic worried and they're quite concerned about the symptoms, they're feeling
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And being able to just shift their mindset and understand that the healing process will occur. The things will get better can have a powerful impact.
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So that's a large part of what I end up doing in the primary care realm, but we also it gives me a chance to interact on the other side of it. The other patient group of patients that I see are those that
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The ones that topic typically would not cross the door into the therapy clinic.
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Or the folks at the primary care provider has been trying to do something active for a long time, the chronic persistent
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Pain patient that is the no show frequently in the PT clinic and so I'll have an opportunity there in primary care to meet this person.
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To talk with them to help build some bridges and some connections and then shift that trajectory. If and when they're ready into more active management strategies and put them on a pathway towards better health and recovery.
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Yeah. And to be clear, Stephen, you're talking in. I'm just going to add some elements of clarification. So when you're looking at you mentioned injuries.
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So it's been established that this is likely a musculoskeletal involvement and that's where you take role you're not in there, deciding if somebody has a you know a kidney stone versus, you know, low back pain, or is that part of your role.
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It could be. And it's I found it's it varies depending on the primary care team I'm working with, and the level of confidence that that team has one in myself and my skills and to within
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The team's ability to differentiate some of those disorders. So I do occasionally have a master come in and they're, you know, things are fuzzy
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To be honest, I think as as an outpatient physical therapist, we often see things after the initial push and they're more clear.
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When someone's first coming into the primary care setting. There's a lot more differential diagnosis to be done.
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And certainly the systemic pathology and those other visceral conditions is always forefront and my mind and ensuring that it's not something that looks like just low back pain that's masquerading as something else.
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Right and and i know you and I've talked a lot about this and feel free. If there's ever information that is is proprietary or that that you can't reveal. But do you use
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Certain things to help you in your day to day. Some of the triage for Ms. K, or even red flags that were taught in fellowship or residency, or sometimes even entry level programs like
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For instance, AWS pro why F or RF even start back tool. Are there different tools that help you in your day to day
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Yeah, those are things we're working on.
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We haven't formally adopted implementation of those tools yet informally, I have the
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The questions to the start back or they're relatively simple straightforward nine questions. So I have those elements in my mind.
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And as I'm meeting and talking with the person I'm listening for those elements to come out. I may ask them directly ask them, those questions so that I can make some informed decision making, based on the love likelihood of recovery or not recovery.
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So we don't have any formal tools that we've necessarily adopted. It's actually one of the projects that we're currently working on
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Is is developing a system to do that, but certainly having an awareness of those knowing the content of those predictive factors absolutely aids in my decision making.
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Yeah, I'd say that's kind of where it doesn't matter where you are in the country. I'd say they're, they're still relatively, some of those are pretty new tools just when we talk about
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AWS pro and getting integrated into workflow widespread be pretty pretty a advanced, I'd say for some some organizations to have already streamline that
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I know once in a while, or actually a little bit ago you and I talked a little bit about some important things to consider. Just as far as physical therapists out there potentially working in a primary care setting such as
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Communication with support staff or relationship with the, you know, overseeing physician or nurse practitioner. Would you mind speaking to some of that and some of those keys you shared with me a few months ago.
Unknown Speaker
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Oh, absolutely.
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Communication really is key. And I'd say that that makes or breaks, we know as as clinicians that makes or breaks the therapeutic alliance and the ability for people to really move forward.
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Is whether or not they have that confidence in themselves that confidence in their healthcare team, but within the team itself, the ability to build relationships with the primary care teams that I work with.
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Certainly, Those with which I have a stronger relationship. I get more calls and contacts and I'm asked to to weigh in on things in a different way versus the primary care teams that I haven't had the opportunity to build those those kinds of relationships with yet.
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calls are less frequent from them and so effective ways to build that communication. You know, I've what I found is if I can
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And a model that we we continually practice and advocate here South Central foundation is always closing the loop.
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So if I am asked to go in and see someone I touch in as best I can. We usually have a very brief face to face visit between the
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Primary care team and myself as a handoff. Hey, this is so and so this is why they're here. This is what we're, you know, their concerns are. This is what I'm concerned about or this is what I'm thinking.
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I'd like to hear your input. And then after I work with the patient, I come back and I'll report back and just close the loop on the dialogue, saying, well, this is what I found. Yes and no.
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Maybe I'm considering something else that I would also put into the mix. And then that AIDS and that mutual decision making.
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And not only between the the providers ourselves but also including the patient into the loop so that we're, we're all on the same page. At the end of the day.
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I found the app when I have opportunity to to do a co visit. So the primary care providers, there were both there.
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The analyzing examining and then treating the patient together in unison that that builds strong therapeutic alliance between all three members.
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That are there and really has been very well received by the providers that I get to work with. They feel much more empowered with
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Our skill set and what we bring to the table as physical therapist and have a better understanding of this sort of nebulous black box that is physical therapy that they hear about, but
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Many of our primary care providers that I found don't have a lot of depth of experience of what what it looks like. Within a physical therapy setting.
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Yeah, I'd say that that's that's something that's probably echoed around at least this country as far as
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Some, some knowledge gaps on what each professional does and kind of where the right places to step in, or step back and that goes to more than just the physician and physical therapist relationship. It could be pharmacy or anything else.
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Next question that I wanted to ask you about was
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Just as far as your opinion on where you think, physical therapy, whether it's civilian or or any other
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Industry or life, where do you think that primary care sits in the future of physical therapists and kind of our practice act and everything moving forward.
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You know i i hope that we continue to have an ever growing presence.
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In that realm. I'm a full supporter and firmly believe that we should have direct access to patients should have the choice to see a physical therapist as their primary means for care, particularly if we're dealing with musculoskeletal conditions.
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Yet, you know, we know that in 2012, for example, dead was published by john child's that it's only 7% of those within their military health setting that they looked at
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Receive care from for low back pain by a PT and then subsequent studies looked at it again and and really the numbers. Haven't shifted a whole lot. The reality is, people
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seek care from the primary from their primary care physician. And so I think we really need to
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move upstream to have a greater opportunity to work collaboratively with our primary care providers and give give patients the best choice for care.
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Whichever route. They choose whether they choose to see a chiropractor physical therapist an acupuncturist.
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The to go to the primary care provider or to stay home and manage things on their own. I believe we need to empower people to receive the best education, they can receive and that comes through mutual collaboration that comes to educating our as our healthcare system as a whole.
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So that's, that's one element. I think that we can really bring to the table moving upstream in the primary cares, we, we have the opportunity to ensure that the the education that's out there is sound it's evidence based and represents the best care that's there.
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In but bigger than that. I mean, bigger than that. I think we have also got to get beyond
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Treating conditions and helping to improve quality of life. I mean so much of what we can bring to the table and some of the initiatives, we're looking at currently where I'm at, is how do we
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Look at things more holistically, providing functional assessments and preventative inputs that keep people healthy. So rather than sick care, can we really start providing health care again.
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And keep people healthy rather than waiting for them to become sick and injured damage. Before we start to intervene.
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So I would love to see physical therapists more involved in primary care in that preventative realm.
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That there is that that one year physical that comes in that part of that physical is a movement exam, such as the PTA is advocated for
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So that we're looking ahead at what we can do to keep people physically active and strong because we know of the long term health benefits of that brings
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Yeah, and I can say, just from, you know, an academic standpoint and also working kind of through the spectrum of physical therapy outpatient and continuing education.
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That is, it's definitely a challenge mean finding things for Inner professional education or collaborative teaching
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opportunities within the, the university con text for entry level programs or even in educating undergrad, it's hard to take steps forward without really like a firm.
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United you know vision for what healthcare should look like. And it is so kind of fragmented and there's a lot of angsty and in
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Unrest just from not just a provider standpoint, but also patient standpoint that I feel like it is almost that critical mass, where things
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Do need to change and we have huge opportunity, like you mentioned from instead of tertiary care kind of looking at primary prevention wellness and and that sort of you know those sort of opportunities where we have a huge amount of skill set and ability to serve people
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Do you see that, or do you feel like personally that
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Any one what entities could help solidify that message or what what do you envision being kind of the first few steps in progress towards those goals.
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Well, that's a big question.
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Yeah.
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You're welcome. Yeah, I think.
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You know, I really want to be positive and optimistic because I believe that as physical therapist and the level of our education.
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For students coming out of school. I feel continues to elevate it continues to be stronger and stronger and our, our new generations of therapists coming out, have this more global holistic view.
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That they're looking at at the whole person and looking at wellness. They're looking at how do we maintain longevity.
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And some I'm enthusiastic I'm confident with what we see there
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At the same time, we have this internal struggle that seems to continue to be there that we're, we're, we're entrenched in camps still and our identity as a profession.
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Is still nebulous. Yeah. And until we can really be united and have that strong front pushing forward as to who we are, it's going to be difficult for us to really have a strong voice within the greater health care entity and the decision making that comes forward.
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So I think the first step, I think, is continuing to
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To define and refine who we are as a profession and recognize that there are many different pathways that a patient can follow that a person can follow towards wellness and rather than
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Kind of nitpicking and trying to identify as is my group superior to the other group but recognize that both have value and and being able to move forward with the more mutual respect for each other within our different camps within the physical therapy profession.
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Will be my first, my first objective and then, you know, from there, and I think we need to then be able to reach out across the board and build those relationships with other professions.
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And bring the message in a united front so that it's not just, well, this is what the physical therapist says, and this is what the orthopedic surgeon says, but
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This is what the evidence says this is what we found to be solid and there's benefits to the surgery route and there's benefits to a traditional route and then then allow the patient to begin to make the decision.
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So, so getting that collaborative care so that everyone is on the same page. I think I guess would be my
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Yeah, and I think you're right. There's so much upside to that. And that's probably what everybody wants. And definitely, definitely, we're capable professionals to do that so
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I agree with you, and I appreciate your words of encouragement really there for the whole profession, and I think that
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Obviously, you and I are not alone in that vision.
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Just looking at the time here. I wanted to give you an opportunity to answer a couple of the favorite questions of the show and wrap things up. But what Steven are you currently doing to develop professionally or personally
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Yeah. So, as was mentioned, I'm working a Doctor of Science and effect Ryan and I are working together on a research project with that.
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And that's consuming a lot of my time right now is it's a pretty pretty onerous but growing a lot in learning more about how to conduct research, the ins and outs and being a better consumer
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Of the research in the literature as well as refining my abilities to teach and hopefully become a better mentor and instructor. I have hopes to move in more into the academic world. Once I retire from the US. Public Health Service.
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And so those really my professional development that I'm currently involved in
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On a personal note and. And just to clarify, I am a a white with yellow belt in taekwondo it's a new venture. For me, that we my family and I started studying Taekwondo the summer. So it's exciting. I'm learning.
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A new realm and developing some new skills, I'm learning. Just how stiff my hips have become in the last few years. So it's great for my own my own health and well being. But it's fun. I'm really enjoying being able to learn that and gain a lot from it.
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That's, that's awesome. Yeah, so sorry that I'm never have done any martial arts or anything like that. So,
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There's, there's a my disclosure on that.
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And then what would you say that you're currently most passionate about Stephen
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You know I'm most passionate about this primary care model that I've, I've really enjoyed being there working directly alongside the primary care teams that I'm with it's very rewarding.
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personally and professionally, you know, being able to
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To see firsthand.
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Changing someone's trajectory, the person that comes in the clinic that you know the first intake is, wow, this, this person could go one way or they could go the other. This could be a persistent
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Pain that smear emerging or hopefully we can help this person on on the pathway going the other direction and be part of that is really, really rewarding.
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So that, that's really, I would say more my my passion lies the most is building that capacity and
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And hopefully developing a program where we can train other therapists within the US public health service within the Indian Health Service to move into this realm, then
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slowly developing
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A model, a program that I would like to propose for implementation, the future on just how to train people therapist to have the best success working in the primary care environment.Ryan McConnell34:58
That sounds like something that everybody needs to stay tuned for. And then last question there for you. Stephen would be
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What would you say in the last maybe, who knows. It could be six months to a year, the biggest lesson you've learned or taken away from the year, what would that be for you.
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The value of
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Face to face human interaction.
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You know, in the last seven months as the covert 19 pandemic has been going forth. It's really manifested to me personally, the value of those face to face interactions that
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Because of the social distancing in isolation has been not as prevalent and so sometimes you don't miss things you don't recognize how much you missed something or you value until
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It's absent from you. And I think that transcends with across patient care to professional communication.
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To family life to things in general, take advantage of the opportunities to meet with the people in your life and let them know how much you value them and have that mutual respect for each other.
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Yeah, I'd say that everybody again could echo that span challenge for sure. And lastly, Stephen, just as far as if any of the listeners had any further questions about your career or wanted to reach out, what would be the best way to contact you.
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Yeah. Email is probably the best way, which is Stephen dot spoon more there's an E in the middle SP O n e m o r e at South Central foundation.com and that'll be, I'm sure, Ryan, you can put that contact in the minutes of the meaning there.
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Yeah yeah yeah yeah
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Definitely do that so people can reach out and
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Definitely great resources and there'll be a couple things in the show notes for you and
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Just want to take this opportunity again to to thank you, Steven for jumping on here and really sharing some of those things that you're passionate about and obviously there's a ton of information that our listeners could take from this and
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And benefit from. So just wanted to thank you
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Hey, I appreciate. It's been fun. Thanks, right. Yep.
