"I wanted to reach out and share with you some good news as you have all been so instrumental in helping me achieve this. I was recently offered both of the Sports Residency positions that I applied and interviewed for at Mass General Hospital/Northeastern University and at the University of Delaware. After some deliberation, I accepted the position at the University of Delaware which I will begin immediately after my 4th clinical affiliation ends. I wanted to send out a thank you to the entire faculty as I know I would not have been able to accomplish this goal without your help. Specifically all of the learning and mentoring I received both inside and outside of the classroom really made this dream a reality for me."
Thomas R. Mandala
Doctor of Physical Therapy Candidate, Class of 2018
The College of Staten Island
Alumni Focus: Jonathan Fass - DPT Class of 2009
What have you been doing since graduation?
Right after I graduated, I was accepted as the Orthopedic Physical Therapy Resident at the University of Delaware. I had just completed 10 out of the 13 ½ months of the residency when I was offered the position of Private Physiotherapist and Sports Manager for His Royal Highness Prince Alwaleed bin Talal, billionaire investor, philanthropist and humanitarian and nephew of the King of Saudi Arabia. I spent five years living in Riyadh, Saudi Arabia, traveling the world with His Royal Highness, visiting 67 cities in 44 countries. I met HRH Prince Charles (twice!), tech billionaire Bill Gates, former US president Jimmy Carter, Former UK Prime Minister Tony Blair, the King of Bhutan, the King of Bahrain, and so many princes, princesses and politicians that I lost count.
I
also presented at the APTA Combined Sections Meeting, and I’ll be a featured
speaker at next year’s San Diego Pain Summit as well. I guest lectured at
Rutgers University and Drexel University, performed professional peer-review
for physical therapy research, recorded about 100 episodes of the popular
“FitCast” podcast on iTunes, wrote for a number of magazines including Men's
Health, Men's Fitness and Advance for Physical Therapy, and I contributed to
the popular book series "The New Rules of Lifting" by Lou Schuler and
Alwyn Cosgrove. So I guess that you could say that I’ve been busy!
I
now work as an outpatient physical therapist at Excel Physical Therapy in
Jenkintown, PA, just a short commute from my home in Southern NJ.
Why did you choose CSI for your Physical Therapy Education? What
class/s impacted your career the most?
My family has strong ties with CUNY: my uncle is a professor
at Baruch and my cousin earned his undergraduate degree in business from
Baruch, too. My aunt worked as an administrator at Brooklyn College for many
years before her retirement, as well. Most influentially, I worked as a PT aide
for a former graduate of CSI’s program before I applied to PT school, and it
was such a great experience that I absolutely knew that I wanted to go to the
same school that he did. For me, it felt like a “homecoming” to be a student at
CUNY, and in fact I didn’t even apply to any other grad programs. CUNY was
where I wanted to be. CSI’s small class sizes and cost-basis value made it the
right choice for me.
I knew that I wanted to be an orthopedic physical therapist
when I applied to school, having worked as a personal trainer for many years
before taking on PT, so it was natural that classes like our kinesiology
courses, anatomy, and orthopedics were very influential. Now that I’m a
practicing therapist, I am surprised just how often I recall our courses in
patient care and neuroscience as well. Outpatient therapy is more than just
knowing how joints move or which muscles perform which actions, of course:
delivering customer service and making the environment safe and enjoyable for
patients is paramount. Our neuroscience courses have helped me to delve deeper
into how any why my patients develop and experience pain (just about always the
primary complaint that brings them under my care) and our patient care courses
helped me to develop my personal style and approach to developing a
collaborative, respectful partnership with my patients.
What changes do you
see coming in the field of Physical Therapy?
There’s a struggle within the outpatient Physical Therapy
world as co-pays continue to increase for our patients: some businesses have
fallen into “factory medicine” approaches, where a therapist will be expected
to see upwards of 20-25 patients/day, while the other side remains committed to
putting the patient and the therapist first, which means fewer patients per day
and pushing efficiency and quality over quantity. I am fortunate to work for a
company that focuses on efficiency over volume, but it’s become increasingly
difficult to find clinics that are able – or willing – to work this way.
The Physical Therapy profession in general has always
struggled to make its case to the consumer, that not all physical therapy is
equal and not all choices in a crowded healthcare field are equal, too, but we
must do better if we want expertly delivered physical therapy to survive.
“Vision 2020” might sound like a good idea on paper, but not if it has no
connection to the real world of increasing patient costs and our average
visits/day. If we are to pursue residencies, to become specialists in orthopedics,
sports, neuro, etc, then we have to do a better job of proving the value of
such things with evidence and incentives. If we are to be the profession of
choice to our communities for rehabilitation services and recovery, then we
need to do a better job of selling the public on our value. Make no mistake,
healthcare is a business, and if we want to avoid the factory system that so
many other health professions have found themselves trapped in, we need to do a
better job of proving the value of expert, low-volume care.
In addition, clinically, there is a growing recognition of
the value of understanding and incorporating Pain Neuroscience Education into
PT schools and outpatient practice, although it is still a young “movement.”
Modern neuroscience-focused theories for the development of pain (as opposed to
biomechanical or biomedical theories) and a more complete understanding of chronic
pain (such as the Biopsychosocial model of pain) has been a part of research
since Wall & Melzack first proposed the Gate Control Theory in 1965, and
later Melzack’s groundbreaking Neuromatrix theory in 1996. While the appeal to
Physical Therapy for a more robust explanation of pain and its many forms would
seem to be obvious, so far this area of research has been looked over by most
US-trained physical therapists (like so many areas of orthopedic therapy, once
again the Australians and New Zealand Physios are leading the way while the
rest of the world is left behind).
This is an area that I feel will become increasingly more valuable and necessary as chronic pain conditions continue to become more and more prevalent in society. The costs to our country alone are staggering, being estimated by some sources as being well over half of a trillion dollars each year in care, lost work hours, and lost wages. There are already signs that this change is already taking place, with a growing interest in PT-specific pain research and clinical measures of Biopsychosocial “yellow flags” such as the FAB-Q pre-screening tool. Understanding Pain and how to treat it is a wide-open field that desperately needs better solutions. I believe that PT can fill that gap, and if we’re wise, we will.
This is an area that I feel will become increasingly more valuable and necessary as chronic pain conditions continue to become more and more prevalent in society. The costs to our country alone are staggering, being estimated by some sources as being well over half of a trillion dollars each year in care, lost work hours, and lost wages. There are already signs that this change is already taking place, with a growing interest in PT-specific pain research and clinical measures of Biopsychosocial “yellow flags” such as the FAB-Q pre-screening tool. Understanding Pain and how to treat it is a wide-open field that desperately needs better solutions. I believe that PT can fill that gap, and if we’re wise, we will.
What are your current goals?
Now that I’m back in the States and back to life as a
clinician, I’ve been focused on picking up where I “left off” when I moved to
Riyadh to work for the Prince. This year I’ll be studying for my OCS exam, and
then I’ll be looking into Fellowship training to become a Fellow in the Academy
of Orthopedic Manual Physical Therapists. From there, I’d like to earn my PhD
and become more involved with teaching and researching. I love having students
in the clinic as a CI, and being able to teach classes in orthopedics and
painscience is something that I’m terribly interested in.
What advice do you
have for current Physical Therapy students?
Pay attention to statistics and research! If you’re anything
like I was as a student, your stats and research classes were interesting,
sure, but they never seemed like anything that you might actually use as a
practicing clinician. How wrong I was! It’s vital to be literate in research,
to be able to discern quality papers from lower-value information.
Evidence-informed or Evidence-based practice should be the cornerstone of
everything performed clinically, and without it physical therapy would be no
more “legitimate” than homeopathy or the copper bracelets that are sold on tv.
There are so many papers published each week, it may seem like there is
justification for anything, but if you understand how to read research
properly, how to determine good research methods from bad, appropriate
statistics from improperly performed ones, and you develop a healthy skepticism
for the outlandish, you’ll know what’s worth your time, and what’s not even
worth the paper that it was printed on. Research can tell us which tests to use
in order to form a clinical opinion and diagnosis and which ones not to, it helps
us to wisely choose which classes to use our continuing education money on and
which classes to avoid, and it keeps us honest with ourselves and with our
patients in terms of what we know and what we don’t. Expert therapists aren’t
the ones that know the most; experts are the ones that know what’s most worth
knowing.