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Opening a Closed Door: How to Gain Access to the Medical Suite

Your passion is to help people maintain or regain optimal health and fitness. Under current law and standards, you are only permitted to work with clients who are already-fit and healthy or have been released for independent exercise and have passed your health screening questionnaire. But those are not the people you yearn to work with. The clients you seek must have authorization or approval from a medical provider before you can proceed.

How often have you met with a potential new client, asked them to get clearance from their doctor, and then never seen them again? Or, a client develops a new pain or problem and you refer them for consultation and that ends the relationship. Another frequent scenario: Your client has followed through with your request only to be referred by their primary care provider for a cardiac treadmill test, but your concern about their low back pain or shoulder dysfunction was not addressed. Success as a medical fitness specialist is dependent upon working relationships with medical professionals. In order to establish those relationships, the aspiring medical fitness trainer needs a better understanding of the medical system. What follows are a few insights into the medical system that medical fitness specialists need to understand.

Recognize how busy the medical practitioner might be

“Estimates suggest that a primary care physician would spend 21.7 hours per day to provide all recommended acute, chronic, and preventive care for a panel of 2,500 patients.”1[i]. Today, the average primary care provider is responsible for roughly 2,300 patients, so not quite 21.7 hours of work/day, but more than any individual can possibly provide.

In order to cope with the workload, doctors must rely on their support staff to help whenever possible. Do not be alarmed or offended if your inquiries are met by a nurse or medical assistant. Most providers simply do not have the time to meet with you for an introduction or discussion. On the flip side, most doctors would love to have effective, safe, and reliable resources for their patients who need to lose weight, get fit, manage diabetes, recover from surgery or cancer treatment, etc. They need you.

Understand the current reimbursement rules

In most cases, providers cannot bill for services unless the patient is in the room with them. Therefore, time spent talking on the telephone, responding to emails, or filling out forms is usually unreimbursed time. This means that your client will probably need to actually make an appointment to be assessed and cleared for exercising with you. To streamline the process, send a letter with your client introducing yourself and what you do. Include a form stating your concerns and your proposed training plan. Design the form to be easy to read, with a simple agree or disagree that can be checked or circled and space for the provider’s signature. You might also want to leave room for comments and questions. If you have received a response from a provider, you should consider sending intermittent progress reports updating the provider about your mutual client/patient.

Be familiar with HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 to protect an individual’s medical confidentiality, particularly when changing jobs which at that time meant changing health insurance providers. Unfortunately, the law is complicated and places multiple restrictions on who members of a medical team can talk to about a patient’s medical condition.

As an unlicensed party, the fitness professional is not privy to “protected health information” (PHI) without direct written consent from the patient (your client). Due to these restrictions, the medical providers cannot fill out or respond to your request for information or clearance without your client’s “written” consent. If the client takes the form and returns it to you, this action implies they have agreed to share the information. If you send the form directly to the provider, that permission has not been granted unless the client has signed a HIPAA release form allowing the doctor to share personal health information with you personally.

The aforementioned are a few reasons why you may have perceived a wall or barrier between you and medical providers. One solution is to ask your client if you might accompany him or her to the appointment to obtain medical clearance or guidance. That way the medical provider would have a specified time and be reimbursed for addressing your concerns. You would be communicating directly with the medical provider and not support staff, and it would be easiest for the client/patient. It is also a way to introduce yourself to the medical provider and initiate a working relationship. Although you will probably not be compensated, it may be well worth your time in the long run.

Once you have made it into the office with your client, now what?

Know your details

Because there are so many different avenues to becoming certified as a personal trainer, there can be large differences in the knowledge base and competence of one trainer compared to another. The aspiring medical fitness professional must have a thorough understanding of the pathophysiology of the conditions they will be working with in order to communicate effectively with medical providers. In addition, you need skill and experience in the programs you design and utilize with your clients. Be able to back up your training plans with published research.

Recognize that a medical fitness professional has a fund of knowledge that the medical provider does not have

Exercise science is not covered in medical school curricula. Medical school is about illness and disease, not health and fitness. Generally speaking, the average MD knows very little about exercise science. Most do not know about the effects of eccentric versus concentric loading, how to train for endurance versus strength, what to do to improve stability, balance, and core strength. Fitness professionals are not inferior to medical professionals; you have a different knowledge base. Recognize and believe that you have something to offer. You may not know all of the anatomy and biochemistry that the doctor does, but you have a basic understanding of your client’s condition and you know the potential benefits of your interventions. Share this information with the medical providers.

Stay within your scope of practice

Because personal trainers and medical fitness specialists are not licensed by any governmental or legal agency, and because laws vary from state to state, there is no clear definition of the skills and competencies of a medical fitness specialist. Working outside of your scope of practice can lead to civil and even criminal penalties[ii]. Therefore, for the time being, if you want to work with clients struggling to manage chronic illnesses, recover fully from injuries or surgeries, etc., you need to work under the wing of medical professionals who have prescriptive authority – those professionals in the medical field licensed to diagnose problems and prescribe treatment.

Dr. Robert Butler MD, founder of the National Institute on Aging once said: “If exercise could be packaged in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” There are pockets here and there in the US where medical providers and fitness professionals work together. In many cases, there is a visionary medical provider at the helm of an interdisciplinary team. In other cases, fitness professionals have worked hard to become part of a medical delivery model. The more medical fitness specialists that can take the leap and align themselves with medical providers, the more people will be helped.


This article was featured in MedFit Professional Magazine. 

Dr. Mary Hoagland-Scher,MD is a board-certified family physician who practiced medicine for 30 years. When she entered medical school, her goal was to help people stay healthy. As the focus of western medicine shifted away from health to disease management with a strong emphasis on pharmaceutical and or surgical intervention, she became uneasy with her role and decided to discard her prescription pad and learn new tools. Now as a NASM Certified Personal Trainer she is working to shrink the gap between fitness and medicine.

References

  • [i] Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation Justin Altschuler, MD, David Margolius, MD, Thomas Bodenheimer, MD and Kevin Grumbach, MD Ann Fam Med September/October 2012 vol. 10 no. 5 39
  • [ii] For an excellent discussion of this issue, see: Abbott, Anthony Ed.D, FACSM, FNSCA. Scope of Practice, ASCM Health and Fitness Journal ,Sept/Oct 2018, Vol 22 Issue 5 pp 51-55
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Redefining Healthcare: A Battle Cry for Medical Fitness Professionals

For years, fitness and medical professionals have advocated the need for bridging the gap that exists between preventative care and chronic pain and disease. Medicine today does the heavy lifting of disease management, acute trauma, and injury. We are an advanced nation in regard to communicable disease, traumatic and emergency medicine. However, the system is imploding with high costs of care coupled with an epidemic of unresolved chronic disease and pain within traditional insurance-covered care. Inside the healthcare system, the financial and political power lands at the top of the chain – pharmaceutical producers, government, insurance companies, the food industry, hospitals, and surgeons – yet we are failing at producing successful and sustainable care.

A new measure for quality of care

At a recent nationally recognized orthopedic conference I was part of a roundtable of practice executives reviewing key elements on running a profitable practice. Each group was discussing how many patients their top producing physicians were able to see per day. One group was cheering that their top physician is able to see 80 patients a day. Another said 70, and another 60 as if that was a badge of honor. I spoke up and said, “Let’s assume that doctor only uses the bathroom once, walks to the next room between each patient, washes their hands after each patient, and somehow spends no time in his medical charts. At best he or she has three to four minutes to spend with each patient. I would not want that care for you, a family member, or anyone I would refer. We should be ashamed of seeing this as quality care.”

As a result, over the last decade, we have seen a rising trend of medical providers experiencing burnout, dissatisfaction, and moral conflict. Many have decided to go against the grain of the standard care in medicine and open functional, lifestyle, regenerative, and direct primary care clinical models that have been formed in an effort to provide restorative, root cause, and preventative medicine that can reverse the rise of chronic disease. It’s a model where medical providers have the proper time to listen, evaluate, diagnose, empathize, connect, provide options, coach, and empower patients towards optimal health.

The third leading cause of death right now in the United States is medical negligence, according to the Journal of the American Medical Association. This is an alarming fact because many medical errors are entirely preventable. Functional medicine physician and pioneer, Joseph Mercola recently stated at the healthcare event, Mindshare, “Those in control are building the largest tribe and protecting advertisers. It’s a threat, PR firms are doing all they can to discredit those that want to heal the world.” We have the science and evidence to not let a diagnosis be the reason for a life of decline. However, we are all fighting Goliath on steroids. Those in the position of profits-over-people are doing their best to keep education, research, innovation, and successful outcomes from progressing to be an option for all. Alternative healthcare providers attempting to educate the public are seeing censorship through Google and social media on topics such as vaccinations, lifestyle medicine, plant medicine, and functional medicine. In response, many health leaders are looking to create an alternative search engine specifically designed for uncensored health-related information.

Think differently and independently

To begin to redefine healthcare, it requires us to think differently and independently about how to slow the rise of chronic disease. Here are four frameworks from which to begin to explore new solutions in healthcare:

  1. See to believe
    Keep an open mind and realize that most exercise and nutrition plans have their place for the right person. Visit alternative offices and practitioners to see the outcomes they are having with patients. See if the service or treatment has a history of successful outcomes that can be consistently repeated.
  2. Look at evidence
    Practitioners often state that the research shows there is no evidence. Ask them about the last paper or research article they have read on the subject matter. For instance, there are several new research studies showing the effectiveness of regenerative treatments such as platelet-rich plasma (PRP) and stem cells that have new data to support effectiveness compared to other standard of care treatments.
  3. Experience it
    The only thing better than seeing it, is having had it work for you. If it worked for others, it may work for (you) others.
  4. Know the research and the outcomes
    Just because the FDA approves a drug, or that surgery is your only option, you have no guarantee it’s going to heal you or help you without affecting another part of your system or worse.

Requirements for redefining healthcare

If the entire medical system turned around today and added preventative and less invasive options like nutrition, fitness, health coaching and energy medicine, we would not be prepared to fill the immediate demand. Consumers seeking optimal health are now aware and seeking expert health professionals who can listen, empower, hold them accountable, and help deliver successful outcomes.

Private clinics offering cash procedures and preventative care need to charge more to be able to spend more time with patients. This would allow providers to dig deeper with root cause lab analysis and would offer a greater probability to help lead patients toward successful outcomes. Healthcare in general will perform significantly better when providers are paid based on successful outcomes as opposed to time and service fulfillment. True healthcare is in demand for personal trainers, health coaches, and those with exercise physiology and kinesiology backgrounds to help deliver provider-recommended, outcome-based treatment programs. Most medical providers do not have the training, education or time to provide the nutrition, exercise or individualized care for patients that health and fitness professionals are trained to provide. Therefore, this article is a battle cry to the next-level fitness professional.

Not one doctor, trainer, diet or even single field of study has the answer to deliver the best health to the world. This all-encompassing effort can include surgeons, researchers, regenerative medicine specialists, functional medicine providers, behavioral therapists, chiropractors, acupuncturists, nutritionists, personal trainers, massage therapists, physical therapists, energy healers, naturopaths and coaches; not one alone has had all the answers. It will take a combination of the right internal, physical, emotional, nutritional and spiritual support to take a person on the journey towards optimal health.

The only way for primary care and transformative clinical models to succeed are with patient behavior change. Clinics need certified personal trainers and health coaches who have expertise in the more specific needs to help patients follow through on the recommended treatment plans. The medical fitness professionals of the future can fill the gap by becoming fluent in any of the following niches:

  • General biometric lab analysis (serum, gut, nutrient, saliva, heavy metals, etc.)
  • Genetics and epigenetics
  • Bio-hacking technology and equipment such as near and far inferred light, PEMF, vibration therapy, cryotherapy, hyperbaric chambers, and many more
  • Energy work
  • Functional movement evaluation and corrective exercising programming
  • Artificial Intelligence
  • Bracing, foam rolling, taping
  • Safe and progressive exercise for all conditions
  • Health coaching centered around: purpose, hydration, nreathing, oxygen, nature, mindfulness, stress management, communication, preparation, sleep, nutrition, and movement.
  • Food sensitivities
  • Mental health
  • Disease management
  • Hormones
  • Detoxification
  • Group health education
  • In-home fitness products
  • Tele-health
  • Medical compliance
  • Corporate wellness

The demand is rising and will explode in the coming decade. Private practices are on the rise. Self-insured companies are seeking savings from healthcare costs. The equipped health and fitness professional will have no shortage of opportunity. If you have a solid knowledge base in any of these areas, there is significant opportunity to work for, partner, refer to, or carve out your own fitness and health business of the future.

To change the entire healthcare system over the next few years, we need everyone to collaborate to create universal consensus where all these areas are necessary to comprehensively treat patients. This will require leading experts in all areas of health to come together. Groups such as the MedFit Network are collaborating with medical leaders and are dedicated to raising the bar for personal trainers by defining how the medical fitness professional of the future can support the necessary shift. Those who are filled with passion and purpose for the medical fitness model of the future will see the monetary rewards of their exceptional work as the demand will outnumber the caregivers.

Webinar with JR Burgess

Join JR for the webinar presentation, Impact, Results and Income Opportunities to Enhance Your Coaching or Medical Fitness Center.


This article was featured in MedFit Professional Magazine.

JR Burgess found his purpose for helping people be free from pain at a young age. JR has played an integral role in replicating a proven integrated model of care in more than 80 clinics worldwide. He is driven to make the greatest contribution by changing the way healthcare can be delivered by integrating profitable, regenerative, functional and lifestyle medicine into clinics world-wide. He is a husband, father, two-time #1 bestselling author, and international speaker.

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The Essential Ingredient to Sticking With It…

If you’ve got this “special sauce,” you’ll overcome any obstacles placed in your way to perform your best…anytime!  Regardless of whether it’s sticking with lifestyle change to improve your health, a nutrition plan, cutting back on smoking or drinking, adhering to a medication regimen, following through with physical therapy appointments, or adhering to an exercise program, this essential ingredient will make all of the difference.

Female-Trainer-and-older-male-client

The Commodification of Medicine and Fitness: The Good, the Bad, and the Ugly

The need for medical and fitness services/products continues to grow. In the United States, and around the world. The corporate and industrialized delivery of medical and fitness products/ services continues to grow to meet increasing demand. Innovations in medical diagnostic technologies, surgical procedures, biomaterials, and medicines help individuals live longer, and with a higher quality of life. Technology and scientific research are propelling fitness product/service innovation with digital activity monitoring apps . . .

Geriatric-Elderly-Fitness

What does the word “geriatric” mean to you?

geriatrics\ ˌjer-​ē-​ˈa-​triks  , ˌjir-​\ : a branch of medicine that deals with the problems and diseases of old age and the medical care and treatment of aging people.

What does the word geriatric mean to you? Oftentimes, it comes with a negative connotation. It’s time to change the perception of this word in the fitness industry.

In the medical fitness space, we seek to align with doctors and health professionals.

Geriatric medicine physicians (Geriatricians) work to promote health by preventing and treating diseases and disabilities. To a great degree, this includes improving functional abilities and independence in their activities of daily living. With the rapid growth of the older population in the US, the demand for geriatric medicine is higher than ever.

Physicians specializing in geriatric medicine work closely with interdisciplinary teams, including physical therapists and fitness professionals, to implement care plans that will improve quality of life. This is where a properly educated fitness professional can enter, collaborate with doctors and make a huge impact in the lives of this population.

Senior Fitness vs. Geriatric Fitness

Senior fitness is popular in the fitness industry and many organizations offer education for working with seniors — but it’s primarily focused on seniors who are “generally healthy”.  Senior fitness is centered on preventative measures to maintain existing health as a person ages.

But not all seniors fall into this category. In fact, most do not. Geriatric fitness is for those who are not healthy,  who need guidance with fitness and lifestyle changes to improve degraded function so they can perform activities of daily living and be independent.

Why Specialize?

Specializing in geriatric fitness allows you to reach a huge market (there are over 70 million baby boomers with 10,000 people reaching age 65 daily!), but you’ll also find it to be a fulfilling part of your career. You’ll find creating programming for this group intellectually stimulating and challenging. You’ll also find it emotionally rewarding — helping geriatric clients make small improvements in their health will have an enormous impact on their quality of life, independence and well-being.

You’ll also offer peace of mind to caregivers — often adult children — as they are frequently the ones seeking an educated fitness professional to help their aging parent.

It’s time to see the word geriatric in a new, positive light. A personal trainer specializing in geriatric fitness is helping a senior maintain independence, prevent life-threatening falls and manage chronic health conditions to live their highest quality of life through their golden years.

Become a Geriatric Fitness and Lifestyle Specialist

Align yourself with the medical community and become a Geriatric Fitness and Lifestyle Specialist! Check out MedFit Classroom’s first of its kind online course for fitness professionals.

 



References

Physical therapist gesturing thumbs up besides senior woman on yoga ball

Medical Fitness – A Win for Professional and Patient

Medical Fitness is a growing trend in health care. Medical Fitness helps extend basic healthcare from the classic and formal model of a person being a patient, receiving treatment and being discharged entirely, to after-care professional services. Medical Fitness is the integration of ongoing fitness, wellness and preventive care under the supervision of health professionals such as physical therapists, exercise physiologists, personal trainers, nutritionists, acupuncturists, chiropractors, massage therapists, mental health practitioners, health and wellness coaches, yoga professionals and more.

Medical Fitness is appropriate for many types of conditions such as arthritis, diabetes, orthopedic conditions, pre and post-natal, heart disease, fibromyalgia, stroke, cancer, mental disorders,  and others. When properly implemented, Medical Fitness is a win-win for both patient and health professional.

Physical therapist gesturing thumbs up besides senior woman on yoga ball

Medical Fitness Advantages for the Patient

First, after discharge from the formal healthcare world, the patient can be referred to a variety of health professionals educated in the patient’s condition, providing both a continuum of care and a multi-discipline approach. For example, a person discharged from physical therapy after a total knee replacement might be referred to a certified personal trainer facility educated in post-rehabilitation of a total knee to continue to make further functional gains and improvements. If that person needed help with weight loss, perhaps a referral to a nutritionist would be included. If they also had issues with coping with their diminished function, a consult with a specialist in mental health might be provided as well.

Second, many times the medical facility in which care was provided will have a Medical Fitness component associated with it. Direct referral to this type of facility can provide the patient with security and confidence, being familiar with the facility and with the knowledge that the new health professional is familiar with their condition and diagnosis.

Medical Fitness Advantages for the Health Professional

First, by being part of a Medical Fitness community the health professional can refer a discharged patient for follow up care, secure in the knowledge that their patient will be cared for by an ancillary care professional who is trained and certified to provide a proper continuity of care plan along with the appropriate goals and treatments.

Second, by referring to a Medical Fitness multi-discipline team, the health professional receives security that if their patient has any other issues, those concerns will be addressed. For instance, with the example of the total knee replacement patient needing assistance with weight loss or nutrition consults, (treatments that don’t fall under the umbrella of physical therapy), the physical therapist is assured their patient will be helped to achieve a better transition back into their “non patient” status.

Third, when the health professional refers their patient into a Medical Fitness wellness and preventative care environment, the chance for overall improved outcomes is increased. Patients learn better self-confidence in caring for themselves, taking charge of their own health and lifestyle. If a patient’s condition begins to backslide, the wellness program professionals can help make sure the patient gets referred back to the health professional in a timely manner.

In conclusion, Medical Fitness benefits all involved. Quality of care is improved. Patients receive access to multi- discipline care and can learn to take charge of their life. Health professionals receive security of proper continuity of care and gain improved patient outcomes.


Douglas Feick, PT is a licensed physical therapist in Texas, with emphasis in orthopedics for over 15 years. He is President of BioEx Systems Inc, a software company providing software solutions for physical therapists, athletic trainers, chiropractors, dietitians and personal trainers. His hobbies include scuba diving, raising bees and he is an avid skydiver.

med-fit-client-doctor-exercise

Healthcare Through Fitness

A discussion of medical fitness is rooted in an understanding of the health benefits of fitness and exercise. The documented benefits are endless and include management of chronic disease, management and prevention of osteoporosis, improved mood and sleep disorders, stress relief, management and prevention of obesity.

Health agencies across the spectrum of public health and disease-specific organizations recognize and promote exercise and fitness as an integral part of the management of chronic disease; diseases that include diabetes, cardiovascular disease, Parkinson’s, depression, multiple sclerosis, and arthritis, among others.

If fitness and exercise are well accepted as part of the management strategy for multiple diseases, why is it that access to organized exercise plans, and fitness professionals who can help implement those plans, are not a standard part of the medical treatment paradigm? Why is it not a standard benefit covered by common medical insurance policies?

The reasons are multifactorial and a reflection of the overall healthcare conundrum in our country today. Let’s focus, however, on how to make a change. We need to focus on how to integrate fitness professionals into the medical paradigm. A perfect model for this is an integrative medical fitness center.

What is a medical fitness center? It is a fitness facility with a multidisciplinary staffing approach and has the following characteristics:

  • Regular medical oversight by a medical director
  • Practitioners with nationally-recognized certifications and training in the care of chronic disease
  • Comprehensive health assessments and exercise prescription
  • Exercise classes geared toward specific medical conditions

These centers bring together credentialed staff in a collaborative way to provide exercise prescription plans specific to the needs of an individual with chronic disease.

The concept of the medical fitness center is not new; many currently exist in communities throughout the United States. However, an understanding of their importance in the context of the current healthcare environment has grown. The idea of creating “medical homes” that are collaborative across disciplines and provide a comprehensive healthcare approach is now being recognized to provide a high standard of care while simultaneously decreasing overall healthcare costs. This is true specifically for high-risk individuals who suffer from chronic disease.

Further integration of medical fitness centers, and broad access to exercise and fitness resources, will hopefully become standard of care and widely accessible to all individuals, especially those with chronic disease. This integration will inherently bring fitness professionals into the paradigm of healthcare and promote healthcare through fitness.


This article was featured in MedFit Professional Magazine. 

Dr. David Kruse attended medical school at UC San Diego, after graduating from UC Berkeley. He holds board certifications in family and sports medicine. He practices sports medicine with the Orthopaedic Specialty Institute, in Orange, CA. Dr. Kruse is the Chief Medical Officer for the MedFit Network and on the Medical Advisory Board for the MedFit Education Foundation. He is currently a Team Physician for USA Gymnastics, Orange County Soccer Club, and Biola University. Visit his website, krusesportsmd.com

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The Power of Collaboration in the Quest for Cure

Let’s start with four statements I’m willing to call facts:
1. Chronic disease afflicts the majority of American adults over the age of 45.
2. People with chronic disease choose a visit with an allopathic physician (conventional medicine) as their first course of action.
3. A pharmaceutical prescription is the first course of action after linking symptoms and biomarkers to a commonly diagnosed disease (type 2 diabetes, hypothyroidism, hypertension, hypercholesterolemia, etc.).

deep-breathing

The Secret To Improving Mental Health With Physical Activity 

When I first entered the field of performance coaching, terms like building resilience, develop focused attention, manage sustainable energy levels and strengthen our emotional intelligence were sought after areas of development not only in elite athletic training; but also, executive development. 

As the demands of life rise for our clients, the best way we can support them is by designing health and fitness routines that combine all the elements of health and performance.  Our clients are seeking our expertise on how to “feel” better physically, mentally and emotionally. And the one tool that links the mind, body and brain is BREATH.