Altruism, localism, pragmastism

Second-year physical therapy student Karlie Wardner looks to bring her skills to rural North Dakota soon.

Karlie Wardner is a pragmatist. And maybe a bit of a homebody.

And that’s okay, admits the second-year Doctor of Physical Therapy (DPT) student from Grafton, N.D.

“My main focus is geriatrics,” says Wardner, making the most of her summer study break at home in Grafton. “But in a rural community, you have to serve all populations. So, really, I’ll be seeing everyone in this area.”

As Wardner suggests, this focus on geriatrics and rural healthcare – but a commitment to serving community needs broadly – is as much a matter of mathematics as it is simple pragmatism. Yes, nearly 22% of North Dakotans are age 60 or older. But that leaves 78% of a largely underserved population that is not in the “older adult” category.

Rural therapy

All of this is why Wardner is learning how to treat both older adults and younger clients – and looking to stay in North Dakota to practice after she graduates.

“I recently completed the LSVT BIG certification, which is for individuals with Parkinson’s disease who are typically part of the geriatric population,” Wardner continues. “At the clinical rotation I did last summer, most of the individuals that I saw who were in the geriatric population had total joint replacements, low back pain, or Parkinson’s Disease. So that’s what I’ve seen, and it’s all very common in this area.”

Also common in the area, though, is a shortage of not only physical therapists but most other health providers.

This fact makes it harder for providers who choose to practice in North Dakota – or any rural area – to justify specializing in a certain type of problem or patient. They will, after all, be seeing it all.

North Dakota winters notwithstanding, part of the local provider recruitment struggle, adds the chair of UND’s Department of Physical Therapy Cindy Flom-Meland, is the region’s geography.

“Recruiting and retaining physical therapists in rural North Dakota can be challenging due to location, the potential for isolation, and, depending on the size of the clinic, limited professional support onsite,” Flom-Meland says, referencing a recent American Physical Therapy Association survey that reports a 10% average PT vacancy rate among practices of all types. “A multifaceted approach that addresses financial, professional, and personal factors is needed to aid in recruitment and retention.”

Many area clinics understand this well, Flom-Meland adds, and work hard to implement targeted strategies for young therapists like Wardner in an effort to foster a supportive professional environment.

“This way we can ensure that our rural communities continue to receive the essential physical therapy services they need.”

Relationship building

Serving such needs is exactly what Wardner has in mind.

Introduced to physical therapy after working her way through a number of sports injuries, Wardner explains that she found herself drawn to geriatric care generally not long after taking her first job in high school.

“My first job was working at a nursing home, and I worked there throughout high school and college,” she explains. “I feel like there’s so much to learn from older adults, from their stories, their experiences. I just really enjoy that population.”

Part of that enjoyment, Wardner says, comes from getting to know clients well. In fact, the prolonged interface with clients is part of what attracted her to PT over other health professions.

“I love getting to know the patient,” she smiles. “I really saw the impact that a physical therapist can make on someone’s life. They see their patients multiple times a week, for 45 minutes at a time. I just like that aspect where you really get to know the patients and you can have a direct impact on their life.”

It is this relationship-building that, Wardner says, helps clients trust her when she’s both asking them to do difficult physical acts and referring them to other health providers – which Wardner estimates constitutes a significant portion of the therapist’s role.

“Obviously we can’t provide direct psychological support, but we can talk to them and ask questions,” says Wardner, referencing patients’ needs for nutrition and dietetic services, billing assistance, and even psychological assessment. “If you don’t get to know your patients, you’re probably not going to find out what their ongoing needs are. Then you may not be able to get them to another professional who can help.”

‘Mental toughness’

After all, helping clients recover from injuries, illnesses, and accidents is often as much of a mental challenge as a physical one, concludes the outgoing co-president of UND’s Physical Therapy Club.

“The rehabilitation side of therapy is about getting stronger physically, but so much of it is building up mental toughness,” she says, noting how a lot of patients aren’t prepared for the emotional difficulties of therapy. “I experienced it myself, so I help clients understand that you have to go over those mental hurdles as much as anything. I feel like that’s something I can help future patients with well.”

Fortunately, for both Wardner and her future patients, the aforementioned small-town geography and cold weather questions are the very “hurdles” that help build mental toughness in so many North Dakotans.

“Coming from a small town has instilled the value in me to develop strong relationships with my peers,” Wardner concludes. “I appreciate the small class sizes in UND’s PT program because I have been able to bond with my classmates quite well – we go through all the ups and downs together. Because of this, I have been able to develop great friendships over the past two years. And I hope to help others face their challenges with courage as my physical therapist taught me.”