Leaving a legacy.

Although each year we say goodbye to colleagues and lifelong friends, we were especially saddened by the recent loss of 3 highly respected and loved colleagues: Dr Jules Rothstein, Dr Scot Irwin, and Florence Kendall. Many of us have spent time remembering and reflecting about what their friendship meant to us, the impact they had on our profession, and the loss that occurred as a result of their deaths. Jules, Scot, and Florence were each exceptional leaders within our profession. They inspired us. They made the profession better. To us, they were legends, and they left us a special legacy. Simply put, each of them made a meaningful difference.

Throughout my career in physical therapy, I have had the opportunity to meet many great individuals in our Association and the profession who are making a difference. I would like to focus my address tonight on those individuals and on each of you. It's all about having an impact--an impact on our profession and on the patients we serve. It's about our role in identifying and shaping new leaders ... and those leaders mentoring new leaders. It's all about legacies--and creating the legacy that each of us will leave.

Albert Einstein once said, "Great spirits have always found violent opposition from mediocre minds. The latter cannot understand it when a man does not thoughtlessly submit to hereditary prejudices but honestly and courageously uses his intelligence." Let this address be my acknowledgment of your great spirit ... your willingness to courageously pursue a vision that shatters the status quo of the mediocre mind--a vision that seeks an effective and logical approach for providing access, choice, and high-quality physical therapist services. The same greatness that was embodied by our colleagues. Jules, Scot, and Florence, is also embodied by you.

If you "Google" the word "leadership," the resulting search will provide about 50 million sites. At one site, you will find my favorite definition of leadership by John C Maxwell. He says that leadership is defined simply as "influencing." Each and every day, we have the opportunity and ability to influence. More accurately, each and every day we do influence. The ability we have, however, is to choose how we influence--what our message will be. In the simplest of ways, we affect numerous people by how we dress, conduct our business, and express attitudes and by the quality of our outcomes. We have influence on a multitude of people-patients, families, administrators, students, government officials and "bureaucrats," policy makers, schoolteachers, coaches, local health club workers, ministers, neighbors, and, perhaps most importantly, our children. You cannot choose not to influence. You can only choose how you will influence. The sum of choices we make about all of these opportunities to influence and to lead is the legacy of our career, or the legacy of our life. Each of us will find our own unique and individual way to leave our mark. We all have the opportunity to make the world a better place and to leave a legacy that will positively influence generations to come.

Let's look at an example. Recently, I was asked by a part-time transition DPT student/clinician to present an in-service on APTA's vision to approximately 25 physical therapist staff at the clinic where she works. The clinic is owned by physicians of a prestigious and highly respected orthopedic practice. When I asked the question "How many physical therapists present are board-certified clinical specialists?," no one raised his or her hand. When I asked "How many of those present have doctoral degrees?," there was only one. The majority of those present had never heard of "Hooked on Evidence," and only a few of those who were aware of Hooked said they had used it. Later I learned that only a few of the staff were members of APTA, which was very disappointing to me. I know first-hand about the consistent efforts of APTA to improve reimbursement for outpatient physical therapy services and the tangible financial impact that we've had on outpatient practices in the last several years. The strength of the Medicare fee schedule and the Medicare cap exceptions process are benefits enjoyed by these nonmember practitioners--benefits supported by you, the dues-paying members of our Association.

Regardless of my disappointment, I was grateful that the transition DPT student/clinician had invited me to speak. Her invitation gave me the opportunity to talk about the elements of Vision 2020 and to provide information on which the staff could reflect. It was an opportunity to talk about the importance of patient choice and the benefits of Vision 2020 for our patients. Most importantly, I realized that the transition DPT student/clinician was playing a critical role by serving as a clinical leader and striving to inspire others within the practice to become "PTs of Vision 2020." To raise the level of practice within this clinic, the transition DPT student/clinician did not need to have the title of "supervisor," "director," or "senior therapist." All that was needed was the ability to lead by example and show others what can be accomplished clinically and professionally by raising one's own skill level and competence. Daily she was incorporating evidence in her practice decisions and was demonstrating how research in practice can improve outcomes with patients. This clinical leader was demonstrating that the DPT degree and board certification are more than just credentials; they are a way of practice. When the other therapists at her clinic begin to see what clinical results she achieves, they will have to choose: become a PT of Vision 2020 or be left behind. This example highlights the dramatic influence one individual can have and the beginning of her professional legacy.

One of my favorite quotes about "influence" comes from Bette Reese: "If you think you're too small to be effective, you have never been in bed with a mosquito." (1) Perhaps the itch left by a mosquito is not the legacy we aim for in practice, but the message is still very compelling. In our example, the transition DPT student/clinician has recognized her power of influence.

Over these last few months, I've taken some time to reflect on the privilege you have afforded me the past 6 years as your president (Figure). I've thought about what has been accomplished and what is still left to do, but mostly I've thought about how my presidency has been shaped by all of you and the pivotal role that you have had in moving us all toward Vision 2020.

[FIGURE OMITTED]

As members:

* You came to consensus about our vision and its 6 elements: Autonomous Practice, Doctor of Physical Therapy, Direct Access, Evidence-based Practice, Professionalism, and Practitioner of Choice.

* You enrolled in transition DFF and residency programs. We have 64 transition DPT programs and more than 2,700 transition DPT graduates. Out of 210 entry-level (professional) programs, we now have 158 that have converted to the DPT. By 2008, we predict that 80% will be at the DPT level. In total, we have more than 12,000 physical therapists and students who have been enrolled in DPT and transition DPT programs. In the past 6 years, the number of board-certified clinical specialists has doubled to more than 6,000 and the number of residency programs has continued to grow.

* You marched on Washington and state capitals advocating for direct access. We now have 42 states that have direct access, and our presence and member involvement on Capitol Hill have never been stronger. Members of our Association have contributed so generously to the PT-PAC that it is now a million-dollar PAC and ranked second among non-physician health care PACs in the country. We have made steady progress with our Medicare direct access legislation, enabling patients on Medicare to seek our services without the requirement of a physician's referral. We have an "exceptions process" in place to address the Medicare cap so that our patients will be able to continue to receive outpatient services after they have reached the cap maximum. And the Centers for Medicare and Medicaid Services (CMS) has determined that only physical therapists can bill for physical therapy services.

* You have incorporated evidence in your practice and have reviewed the literature for "Hooked on Evidence." Since its debut in 2002, "Hooked on Evidence" now contains nearly 3,000 extractions of articles and has received 25,000 unique visitors to its Web site. I'm excited to announce that next month, APTA members will have a new member benefit, "Open Door" will give members online access to full-text articles from more than 1,000 journals. And in the exhibit hall, you can witness the launch of APTA CONNECT, our electronic patient record system that will build APTA's national outcomes database.

* You have reached out to the media and to the public. Physical therapy is now routinely mentioned in a number of major publications, including a segment earlier this year on National Public Radio (NPR) that featured physical therapist evidence-based practice for back pain. PARADE Magazine listed physical therapy as among the nation's "Top Jobs." Last year alone, APTA reached 450 million people through newspaper articles and television shows and on general media as well as health-based Web sites. Speaking about the media, APTA has unveiled its new advertising campaign called "America's Physical Therapists: Moving You to Better Health" that is available for members to use. It features print and radio ads as well as 2 television spots.

* Finally, you have adopted the core values. Physical therapist membership in APTA is at an all-time high. You have taken the privilege and opportunities of membership seriously. On a daily basis, you e-mailed me and other members of the Board of Directors to share your opinions about the direction of our course, to let us know if we had failed to recognize your needs, or if you thought we had totally lost our minds. You shaped our collective vision and actions. Truly the accomplishments of these past 6 years are yours.

Your legacy also has been influenced by the many mentors who have come before us. Just think where you would be today without the mentoring of an individual who has played a key role in your life. Who was the person who led you to appreciate the importance, the privilege, of membership in APTA? Whose influence helped you make a key decision that has influenced your entire career? Most of us would not be where we are today as clinicians, academicians, researchers, advocates for the profession, or as individuals if it were not for our colleagues who were able to see in us something others did not. Mentoring can be as simple as inviting a colleague to lunch and discussing the value of specialization, taking 5 minutes a day to help a novice clinician problem-solve about complex patients, or developing an ongoing meaningful relationship with a colleague that could last for years. It could be signing up for APTA's Members Mentoring Members program. It could even be a former APTA President, Bob Bartlett, cornering a relatively new therapist at a poolside party in Winston-Salem, NC, in 1979, encouraging him to run for a chapter office. And then continuing to mentor him throughout his career until he was elected APTA President 21 years later.

I believe that every attendee sitting in this room tonight is, in one way or another, a leader in this profession. You, as an individual, can make an even more significant impact on the profession you love, your community, or the world. As physical therapists and physical therapist assistants, we offer unique perspectives based on our education and experience. When you think about a school PTA meeting, who is more qualified to offer advice regarding the effects of exercise in reducing childhood obesity than a physical therapist? Who is more qualified to address the health care needs of our citizens in the state assemblies and in Congress than a physical therapist? Who is more qualified to help developing countries address childhood disabilities or traumatic war injuries than us? Physical therapists have the education, knowledge, and the expertise. We have the caring and compassion to answer these challenges and the collaborative skills to work closely with other health care and community service providers to optimize outcomes.

But what really sets us apart from other providers is our passion--our passion to make a difference. I've witnessed this passion over my entire career but most dramatically in these past 6 years. It's time for us, both individually and collectively, to channel our passion and make our mark on society, to choose our individual and collective legacies. It's time to demonstrate that we are autonomous practitioners and leaders within health care who can, and will, make a meaningful difference. They say that timing is everything and that the qualities of certain leaders fit a situation at a specific time. The timing is right for our profession. The timing is right for you to seize the moment.

The Association has just elected a new president, a president full of passion and great new ideas, who will help us reach our individual and collective potential. My challenge to you is to continue doing your part in supporting and shaping our new president's leadership. Be a participant in the leadership process. Continue to make a meaningful difference. Leave your legacy.

Reference

(1) Betty Reese quotes. Available at http://en.thinkexist.com/quotes/ betty_reese.

Ben F Massey, Jr, PT, MA

BF Massey, Jr, is Executive Director, North Carolina Board of Physical Therapy Examiners, 18 West Colony Place, Ste 140, Durham, NC 27705-5582 (USA). Address all correspondence to Mr Massey at: [e-mail].

The 2006 APTA Presidential Address was presented at the Opening Ceremonies of PT 2006: The Annual Conference and Exposition of the American Physical Therapy Association; June 21, 2006; Orlando, Fla.