Most of us practicing clinicians can confidently say that we strive everyday to get the best outcomes. It helps promote our profession, our private (or hospital-based) practices and honestly, our own ego. I chose my first job to mentor under a skilled, experienced clinician and continue to strive to become better everyday. I am seeking additional training opportunities and continue to stay active online to continue learning, just like everyone reading this post. Doesn’t the phrase, ‘if you are not getting better, you’re getting worse’ fit in here?
What got me thinking about this is after scanning a research study by Julie Whitman et al 2004 JOSPT.
Here is the quote from the conclusions:
With the standardized protocol utilized in this study, it appears that the therapist-related factors of increased experience and specialty certification status do not result in an improvement in patients’ disability associated with low back pain.
Without getting into too much detail on this study (as the authors used a standardized protocol of manipulation (the highly unlikely positive results from a Chicago style manipulation) or stabilization exercises (this in itself is known not to improve outcomes). Plus a standardized protocol limits the clinical reasoning that a more experienced clinician can draw from.
But it does bring up some points. How much experience and training yields the peak point in getting the best outcomes or do we all hit a ceiling effect?
I always heard though that the more experienced and ‘better’ you get, the more likely you will get referred the more difficult patients and therefore your outcomes level out. Is this true?
I don’t have the answer but the drawing below may spark some conversation. What do you think of the 5 year mark showing a plateau?