Dr. Jean-Michel Brismée: The advice is to stay curious and to seek out knowledge and seek out opportunities and strategic partnerships, and then your career oftentimes takes off in ways that you would’ve never expected or imagined. Sometimes those partnerships pay off years later as well. One of the most exciting things is for a young clinician to go to a continuing education course. Or learn something new and be able to apply it right away with their client and see an immediate change.

Dr. Gina Fick: Welcome to the PT Rebels podcast. This is the place to learn how you can become a PT rebel and take charge of your own health and wellness. We will help you find answers to your questions about pain, injury, and the path towards healing in the most efficient and effective way possible. I’m your host, Dr. Gina Fick.

Welcome back to the podcast everyone. Today I have a very special guest, someone that I’ve known for a long time, and it’s a honor and privilege to have Jean-Michel Brime with us today. Jean-Michel as a physical therapist and professor in the doctorate of Philosophy and Doctor Science in Rehabilitation Sciences program. Texas Tech University Health Sciences Center in Lubbock, Texas. Dr. Smay teaches at the health Sciences Center in the areas of neuro musculoskeletal care, and he is involved in clinical research in orthopedics, manual therapy, and the movement sciences.

He has instructed over 100 courses and conferences nationally and internationally in advanced orthopedic medicine and manual therapy of the spine and extremities, and has published over 150 papers in the peer reviewed literature. He is the program director of the International Academy of Orthopedic Medicine in the United States, in the fellowship program in orthopedic manual physical therapy. He is the editor in chief of a journal of manual manipulative therapy and remains a clinical practice in outpatient orthopedics at University Medical Center in Lubbock, Texas.

Jean-Michel is probably one of the most, or the most influential mentor that I’ve had in my life, and it’s an honor and privilege to have him on the podcast today. Jean-Michel, welcome. Thank you so much for joining us today.

Jean-Michel: Thank you, Gina. Thank you for inviting me.

Dr. Gina: Of course. Jean-Michel, tell us a little bit more about yourself.

Jean-Michel: When I came to the United States, I originally, physical therapy in Europe is more connected to physical education. He’s more connected to occupational therapy. And so I did my educational background in in Europe, and then I came here to go to graduate school. And I must say that during my graduate school and while I was working, I just learned a lot. And I kept developing myself and I was curious. I kept wanted to know more things, so I started in the clinic. I was working just to pay for my school, and then I had, one of my colleague at Texas Tech was Phil Sizer, and then we were working together doing things in the clinic. Then he asked me, Hey. Could you come teach with me too at Texas? Taken, I started there in 1997, and that’s where I had you as a student in the class. And from there I completed my doctorate at that time. And so then I teach, so right now what I’m doing is I’m about a third of the time I’m in the clinic. I do about 12 hours a week in clinical practice at University Medical Center. I do about a third of a. Education, teaching courses with post-professional colleagues. So colleagues are physical therapists or occupational therapists at Lake Trainer. They go for a PhD and a cd. I teach in this program at Texas Tech and that I do clinical research.

Dr. Gina: Again, it’s just an honor to have you, because I have known you since 1997 and Jean-Michel, uh, I can attest to his just curiosity. For knowledge and really worked very hard to be the very best physical therapist and clinician that he could be early on. That was evident to me as one of my professors early on, and it was just really an inspiration to see. The path that he took in education and he has really just been a mentor to me along the way. And that’s one of the things I wanted to touch on today is the power of of mentorship and how finding good a good mentor can really change the path and trajectory of your career as a physical therapist.

And one of the things that I remember about Jean-Michel, he was always, he would sit around the office even after we were done with class. He was always at the Health Sciences center, but he would sit and talk with Phil Sizer and Dr. Phil Sizer is also a long-term mentor of mine. Just a amazing professor and amazing person, as well. Said, oh, I remembered getting Michelle sitting and talking with Phil and asking a lot of questions, and he was so passionate about it and Phil was so passionate about it, and that energy is contagious. And so as a young person, I just remember thinking, oh my goodness, I wanna soak all of this in. I just wanna learn as much as I can. From mentors such as these, and I’d had the honor and privilege to be able to stay in touch and in contact with Jean-Michel for a very long time now, and to be able to continue to benefit from his knowledge and wisdom.

One of the questions, Jean-Michel, that I have for you is in terms of mentorship, what value do you place in that for young clinicians and what do you think that should look like for physical therapists starting out in their career?

Jean-Michel: I believe mentoring colleagues or being mentored is, I think is very important. And I was telling you earlier, one of my student in the post-professional doctorate conducted a studies Matthew from New York, and he published a study on the burnout of physical therapist in the United States. In the clinic. He sent more than 90,000 email. To a physical therapist, and I don’t remember, we got back four or 5,000 of them. And so we use a validated questionnaire about assessing burnout and at the end we ask one single question at the end of, OR questionnaire, do you feel burnout? Yes or no? And 50% of the colleagues stated they felt burnout. And I couldn’t believe it because wow. I work here at Texas Tech, at University of Medical Center with my patient in the clinic. I see all my colleagues. I don’t feel anybody’s burnout. And maybe they are, I don’t know.

But he told me he was from New York. He said, my colleagues and I, we are not surprised. And we looked at mentoring people, so physical therapists, mentoring others though being clinical instructors. Working in a, a residency, I’m working in a fellowship program mentoring others or physical therapist that start and they finish and they in a residency program or they being mentored by others. And we look to see if mentoring or being mentored helps to decrease the burnout. And we found out that these two traits, the physical therapist that provided mentoring who were mentored. Were less likely to be burned out.

So my, my message to the young physical therapist or the physical therapist with a lot of experience or expertise is stay engaged. Take students and they’ll bring new ideas, you’ll mentor them and it’s something that you can do that will keep your interest, that will keep your progressing with. Your skills, keep learning. They’ll decrease the burnout, and I think they’ll keep you interested in the profession and interested in these changes occurring within the profession and also how we treat patients in the clinical setting.

Dr. Gina: Thank you for that wisdom. I am so interested to hear of that study because I’ve seen it clinically, especially when clinicians. Don’t pursue continuing education opportunities or if there aren’t students in the clinic, there’s not that level of excitement. And I think it’s so easy for physical therapists to become burnout, especially if they’re in a high volume or PT mill type setting where they’re just treating patients nonstop from seven in the morning till five or six o’clock at night, and they just do that over and over. They don’t specialize in a certain area or they don’t decide to pursue continuing education consistently.

And so I think one of the things that I’ve learned in my own career, I’ve been involved with continuing education most of my career, Jean-Michel, you know this, but I graduated from the Health Sciences Center in 1999 with a master’s degree, and then started almost a little over a year later in January of 2002. Started a Doctor of Science program in physical therapy at Texas Tech, so jumped right back into education because I was so passionate about really just being the best physical therapist I could be. I remember talking with Phil Sizer at one of the IAM courses, and I just said, I, I just feel like I need more. And he said, we have the perfect opportunity for you. And so I joined the SCD program. It was probably one of the best things I could have ever done for my career.

And then after graduating in 2006, continued to. Take education courses, but also started the fellowship program in 2017. And that fellowship program with the IAOM was also a huge blessing in my life. And thankfully, I got to have Jean-Michel as a mentor directly in my fellowship program for several years and just a turning point and instrumental. Gaining that fire again and excitement for learning and knowledge and learning about the new research out there. And so I think physical therapists who continued to really. Pursue the latest and greatest evidence and knowledge and treatments for their clients. That is very motivating and exciting and helps to decrease that burnout.

So hearing of that study is really eye-opening, but I can attest to seeing that personally in the clinic and kind of hearing the buzz and the word on the street of clinicians feeling burnout. I think it might’ve been the Aon Conference in 2022. They were talking about the number of physical therapists have actually left the profession. Jean-Michel, you can correct me, but I heard that they estimated that it was around 30% that had left the PT profession after COVID. Did you hear a similar statistic?

Jean-Michel: Yeah, just quite a bit. That just it didn’t work or people just with the work, it was the constraint. They say it was too much. There’s too much to deal with. Too much change. Some people say, well, it was enough for them and they retired. There’s also been the switch from, we are physical therapist, we are people person, we are social people. We connect socially, we people, we touch people, we help people. And I think some people didn’t go too, it didn’t go too well to the session. Virtually or without having this touch or this contact, this direct contact with their clients.

So I think for certain population, for some physical therapist and certain patient, it’s very useful, but you miss a, a part of it when you don’t have direct contact with the patient. And I practice in Texas, some areas are really more remote and sometimes. You can get virtual session with some patient that make it feasible for them to get some physical therapy virtually. But if you have the potential to have the patient in the clinic to touch the patient to explain, there’s a plus to that. And some of us have been able to easily accommodate that, and some physical therapists have had a hard time with these changes. Some patients also also have a hard time with this. I think it’s a question of what fits the best to what patients, but we need to be aware that there are changes occurred and some, some patient and some therapists had a hard time to accommodate with those.

Dr. Gina: Yeah, I noticed that as well. One question I had for you, how did you see a change in education during that time at the health sciences Center when you had to shift from. In-person learning to remote, was there a change or a drop off in test scores or maybe the overall quality of physical therapists across the country? What changes did you notice as professors at the health sciences Center? Not only during COVID, but also after?

Jean-Michel: Yeah, so what we noticed on the education part is during COVID and the the PTs. The United States that were educated during the COVID pandemic, the scores overall on the board for the licensure. The score dropped overall across the line. It dropped. And you like how come the material was quite similar, but we’re doing virtually. And so we notice that the people that don’t have any issue with concentrating and. Watching video and being active learners, those did fine with going from physical attendance to structured lecture and lab and those I have more issue with being an active learner that more distracted.

For example, when you lecture, they may be there, but then when you come to the lab, it’s like who listen to the lecture? And so some that are less active learner. Will benefit a lot less from a lecture online that they will be in the classroom. Why? Because in the classroom, the instructor is there. You cannot be listening to music or doing whatever playing with your dog, your cat. This you are in the classroom. And so people, for example, you talk about student that would have very smart, but they have a DHD. For us, we can listen to the lecture easily online and being active, but for people that have a difficulty to focus, if you’re in front of the screen, nobody sees you. You can do whatever you want so you can listen to it or you can just not listen to it.

So people in some program, physical therapy, we have at Lake training and occupational therapy, the people that didn’t do as well overall on the test when it went virtual. It dropped a lot more and they lost a lot more students at that time. So I think, again, virtual is an option. It’s good for certain students, but it’s not good for all of them. And when we went back to the classroom, some students were really relieved and I think we had the same in the clinic. The patient were glad to be back in the clinic.

Dr. Gina: You’ll see in the clinic. In the past, in our clinic, we had a lot of private rooms and then we did a remodeling. And so we had about 10 private rooms and a little gym. And so we got rid of some of the private room and now we have five private rooms. Two of them are for the women’s health therapist, and we have three other private room, and we, uh, alar to gym. The reason we did this is so when the patient come to physical therapy, and I believe you have that in your facility as well, they don’t come just to see you, but they have the opportunity to socialize not only with you, the therapist, but with the other patients, Hey, are you doing, Hey, how is this?

And so when they come to the clinic, it become a place for treatment. Where we can touch the patient, where we can inform our patient, where they can socialize with also the other patients. And I think when you have other patient, you talk about other topics and you don’t focus as much on you and on your pain. And I believe, and again, maybe not for everyone, and we have some private rooms, but the social part of our job is important. And I hope we can keep this. I love this. The change that we made in our clinic was really beneficial.

Jean-Michel: Yeah. That’s one thing that I was just talking with someone else about today is just the power of community. I think that there’s a lot of power in clients hearing other people’s stories in the clinic. If you’re alone at home and you’re doing something virtual, you don’t get to hear about the other clients who are also may potentially struggling with the same issue. Um, you can’t really relate. You just know that you have pain and. You’re not sure if anyone else has had this before, but if you’re in a clinic type setting where you can get a cup of coffee and maybe chat with someone else that they tell you that, oh yeah, I had that same knee pain a few years ago, but Jean-Michel was really helpful and instrumental in helping me return to running, and they start to develop a sense of community and trust inside that clinic, and I think it’s extremely powerful experience for our clients to be able to form those relationships.

And it goes a long way in forming that. Trust in the physical therapist and also in that clinical setting. And so I think you really touched upon something that we’re trying to do in our practice as well, so that people know even if they’re not injured, they can come into our practice. They can come in and, um, sit in our recliners and get in our recovery roots and have a cup of coffee or have a glass of water. Check in and form a sense of family here in our practice. And that’s been instrumental and I think in our patients’ recovery as well. And I hope that that keeps going.

For us, we are really trying to do a lot of seminars and classes so that we are inviting the public into our practice and our community, not only to get to know us, but to also get to know our other members of our community here at Vic PTM performance. I think that not only helps our clients, but I think it also helps our clinicians and maybe that’s something that goes. Towards preventing burnout as well, is just having the clinicians be excited about working in a place like this. And so that’s one of my hopes is that clinicians can get excited about that as well.

One thing that I reached out to the IOM and Jean-Michel about a few months ago was hosting courses in our facility because. I’m looking at ways to improve employee retention, but also create excitement amongst our staff and amongst our communities. Jean-Michel is going to be teaching a eCourse in November for us. We’re very grateful for that, and I think one of the reasons is going back to burnout. I’m looking for ways to decrease burnout and improve overall retention with our clinicians here and our practice.

Speaking on that. Jean-Michel, can you touch a little bit about. The types of continuing education that you do in orthopedic manual physical therapy?

Jean-Michel: Oh yeah. So I’m teaching a PhD in an SCD program and the, the SCD program is directly linked to the International Academy Orthopedic Medicine, uh, which is a program that teach orthopedic manual therapy for the extremities and the spine, and that also offer courses about motor control to the. Upper and lower quadrant and strategy, communication, how to communicate with your patient, and I think it’s really critical, not just focus on one aspect, but we call it the complete clinician.

20 years ago, if you didn’t do manual therapy, you are not a good therapist because at that time they say the evidence was showing you had to do manual therapy. If you didn’t do it, you’re not a good clinician. Then progressively they say no. A lot of the patient have like chronic pain issue, have more issue related to the neural system, the neural drive with peripheral central sensitization. So the neural system is working a little bit overboard too much. I say, do we still need to touch the patient? And then the therapist started saying, no, we shouldn’t. Here’s the manual therapy. We should just talk to our patient, provide exercise, and I’m like, no.

There’s like different type of patient that have different type of preference. I’m in a clinic where I work a lot with patient that more dependent on the system. They don’t have a lot of money. Some of them have difficulties to afford. You’re going to see the evidence here. You should see the patient three times a week. I’ve got some patient, if they can come once a week, that’s all they can afford to put the gas in the tank. And so I’m going to see them one time a week. Not because it’s the best, but because it’s the best I believe for them.

And on these folks, when they come to the clinic, they may be less. The research shows that the poorer the patients are and the less educated they are. The, the lower their outcome after surgery. For example, right now we’re doing a study on upper limb surgeries and we are looking at different construct, like we are looking at pain function, and we are looking at satisfaction. And so the research is showing that the lower socioeconomic status and the lower education predict lower satisfaction in patients. The less educated you are and the poor you are, the less likely you’re going to ask question to your therapist or to your physician. The therapist is going to spend less time or is going to be less likely to answer question because you don’t ask any question.

Everybody is a little bit different, but I would say for the physical therapist, make sure you look at, if I go to your clinic. In Denver. That’s the reason I’m excited to go there, to teach there because the population that you see in athletes, motivated, educated, those folks will ask questions. When you give them a home exercise prep, they’re very likely to do it because they want to get back or they want to get back to the highest level of performance. While my patient. If I give them one or two exercise, that’s probably the best, and if I give them 10, they’re for sure not going to do them. If I give them two and they like to do it, I’m more likely to do that, although the evidence will tell you, no, you should give more. I’m going to only give that to them because I believe with them I’m going to get the best retention and the best, more compliance and a better satisfaction as physical therapist.

We tend to look at function, the quick dash, the neck disability index, the ry, whatever you use, and the pain. That’s our mantra. And there’s one construct that we usually don’t look much at is satisfaction. When my patient come in the clinic, I see a lot of patient with chronic head pain. They’ve had pain for months or years, and if they come with a seven of an eight, they come in my clinic. They may leave the clinic with a five or a six. They don’t get out of my clinic with a zero over 10, but when they come, they’re in pain. Their function is slower. But when they leave, there’s something that change. They’re happy, they satisfied with the five, and we talked about this, but they feel good about the five. They can do more. And that’s what we worked on. And they’re happy.

And if you work with a lot of patient that have. More dysfunction, more chronicity of the symptoms, more central sensitization work. You work on function pain, but work on the satisfaction and having that social environment in the clinic where you see other people you socialize will help also with the satisfaction of the patient being less focused on their pain. That’s my message.

Dr. Gina: I love that message and I think the message is, being the complete clinician that you’re talking about is so important. And I think that takes time. I think it takes time and education to know how to best communicate with your patient, to know how to best interview your patient to listen. I think early on we wanna. Talk a lot when we’re younger, and I think one of the gifts of wisdom as we get older is the gift. Just being able, able to listen better and to listen better to our clients and to interview them and really listen to their experience, especially those with chronic pain they’ve been through a lot mentally, physically, emotionally, and to be able to listen to them helps earn their trust because they start to realize that you actually care.

And beyond caring, if you can identify. Their pain’s really coming from where are their pain generators? Once you are able to correctly identify their pain generators and where that pain is coming from, if you can then provide some really solid solutions to how you can alleviate their pain and give them hope. Phil is famous for saying, I think at this point when he talks to his clients, he tells them, you have to believe you can get better. That’s the very first thing I need you to do. Jean-Michel, you’ve said the same thing. Our patients need to believe that they can get better, but that also comes with a trust in us that we can help them get better.

And so I think that one of the things that I value so much from my mentorship with you and Texas Tech Health Sciences Center and the IAOM is that you help me become more of a complete clinician to where not only can I listen to the patient well, but also provide them. Some real tangible solutions for their pain and their dysfunction, and that includes both manual therapy, corrective exercises, neuromuscular training, the whole picture. And I think that’s the message that we wanna send, I think you and I, is that it’s not one of the other, where it may have been 20 years ago, all manual therapy, if you were a good pt.

Then it transition to don’t touch your patients as much and just do exercises. Who needs manual therapy? I think the message that we’re both sending is it can be both. And it not only needs to be both manual therapy, movement-based therapy, but also the well-rounded clinician who can take that patient from start to finish and really develop that collaboration and trust with a client. And that’s probably the most valuable thing that I feel like you’ve been able to help me do is become more of a complete clinician.

Going back to the value of mentorship, it’s invaluable, um, because the number of lives that you’ve been able to touch yourself as a physical therapist, as an educator has really grown into all the people that you’ve been able to help educate throughout the years. Thousands and thousands at this point. And I’m just one of them. But then I’ve been able to in turn, affect, hopefully, positively the lives of our clients and now as a business owner, not only affect the lives of our clients, but also mentor. Young clinicians and that’s the gift that, that we can keep giving. And so thank you for giving me that gift and also for being able to give that to others through mentorship and education.

It’s, um, allowed me to be a private practice owner. I, I feel fully confident in saying that and allow me to have the clinical model that I have now. Jean-Michel, if I could just ask one final question. I like to ask our guests this a lot ’cause I think it helps to bring things full circle, but. If you could tell your younger self anything as a young clinician now many years later, what would you tell your younger self just starting out in practice?

Jean-Michel: I would say be curious, ask question. Just keep questioning things, keep asking questions. We have done a lot in the area of treatment and you may not see that as much in your clinical setting. I think as physical therapist, we also need to work on prevention. Most of my patients have a huge amount of comorbidities. I would say more than 50% of my patient have high blood pressure, high triglyceride have neuropathy, or they pre-diabetic or they diabetic, and. What can we do to improve the health of or patient, the health of our population?

And I’m telling you, because in the United States, you may be in Denver where you experience that less than here in West Texas. But in Europe, when the patient go to physical therapies, they walk to physical therapy. When they come to where I am in Texas. They take the car. The people are not educated to do more on walking and moving, going to places, and I think we need to be more proactive in that. I went to school in the Catholic University of Luva. There were no cars in the city. The people that had a car to park outside the city or they were like parking. Underground, but in the city, everybody was walking or had a little, you know, electric bike or a bike, but there was no car. And so I think we need to work more on the aspect of prevention means movement, nutrition, sleep, quality of life, and we need to do it with all our patient population, at least educate our folks.

And then. For the young therapist, make sure you stay curious. You keep asking questions. Go to a mentor. Follow a mentor. Keep as you educate other people, but stay engaged with the profession because it keeps evolving. And I believe in the last, the, the, the next decade there, there’s going to be a lot more coming and you’re gonna be at the verge. You’re going to be the next generation. Just keep moving forward. Look forward. He will keep changing, it will keep improving.

Dr. Gina: Absolutely. I think that’s fantastic advice, and I think seeking out opportunities for mentorship and for learning and for growth. When you do that, those opportunities will find you and sometimes it allows you to have exponential growth opportunities in your career as well that you would’ve never expected. And like Jean-Michel said, I think the advice is to stay curious and to seek out knowledge and seek out opportunities and strategic partnerships. Then your career oftentimes takes off in ways that you would’ve never expected or imagined. Sometimes those partnerships pay off years later as well. One of the most exciting things is for a young clinician to go to a continuing education course or learn something new and be able to apply it right away with their client and see an immediate change.

It’s so exciting and it’s validating. And really helps relight that fire as physical therapists. So if you are a physical therapist out there, that you’ve been in practice for a while and you’re feeling burnout, try to learn something new, find a new niche or idea that you wanna pursue and take a continuing education course on that. Or help find a solution for your patient that maybe no one’s been able to find, maybe you could be the one that helps to find that solution. You never know where that could take you.

Jean-Michel, thank you so much for your wisdom today, and I’m sure we can talk a lot about a lot of different types of topics, but I think today it was really valuable for our listeners to hear about the power of mentorship and how physical therapy is evolving and has evolved and how we can be instrumental. Helping physical therapists continue to learn and grow. And thank you for your dedication to the profession and to us as physical therapists. You’re amazing and incredible and I appreciate you so much, and I know that my colleagues do as well. And we can’t wait to have you here in Denver in November, and we’ll have a very fun time.

For those of you who are looking to sign up for a continuing education course, please go to the I-A-O-M-U-S website. It’s IAO m-us.com, and you can sign up for the knee course that will be held right here in our practice in November. It’s something that you don’t wanna miss. Jean-Michel is a senior professor and faculty for the IOM, and he is very gifted at teaching and we also get to have some fun after the classes and go to dinner and talk and hang out. Look forward to that. Jean-Michel.

Jean-Michel: Thank you for inviting me, Gina.

Dr. Gina: Of course. Pleasure. It’s an honor. In the meantime, stay well and healthy and. Uh, to do what you do best, and we look forward to seeing you soon here in our clinic.