“back to the future”
Post on 17-Sep-2016
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TRANSCRIPT
EDITORIAL
"Back to the Future"
The Nathalie Barr lecture is alwaysone of the highlights of the annualmeet ing for me, and Lynnlee Fullenwider's speech in Ottawa was in thatgrand tradition. You can read the textof her message later in this issue, butI want to use the Barr talk as a springboard for a feeling that has beenbrewing insideme for some time.
What famous'historian once saidthat to study the history of a greatpeople is to study the lives of thegreat men and women of their times?When one reads the names of the 17Barr recipients, along with the founding 6, one is viewing the leadershipof the first generation of hand therapists. This group of trailblazers hasmade its mark on the world of handrehabilitation through writing andteaching. Being of that first generation myself, it is difficult for metasay, but we are growing old, and ourbest professional days and contributions are largely behind us nO\-l Eachyear you will see our number dwindle as retirement and ill health exacttheir natural toll.
There is nothing !.lew ·h ere, ofcourse; every 20 to 25 years a newgeneration comes on the scene to fillthe void left by those who must handdown the baton. The assumption isthat there will always be that nextgeneration to accept the baton andcarryon the forward motion. Looking back at the first generation iseasy, looking forward for the nextgeneration of leaders is what givesme pause.
Who are these young turks whomwe will need to sustain the movement? Stop a moment and try to generate a list of names of the shiningstars of the next generation. When Itry to name them, my list is shockingly short. Maybe I fail to see themout there blazing the trails becausethe view from my ivory tower isfoggy. Maybe.
It always has been relatively easyto pick out the leaders of hand rehabilitation just by checking out the
faculty roster of the annual Philadelphia meeting. Read that list foryourselves; "The Old Guard"remains the backbone of the therapyfaculty. This is not a slam on thePhiladelphia meeting. It remains thenumber one educational event in allof "Handom." But where is the nextgeneration? To the Philadelphiagroup's credit, there is new leadership in the house that Hunter andMackin built. But are there othercenters producing nationally recognized leaders to supplement the"Philadelphia Phew"?
If my suspicion is correct that thenext generation has yet to distinguishitself and be recognized, the nextquestion is why? .1 can think of several possibilities. Let's rule out onepossibility right off. Is there a "braindrain"? I would say absolutely not.There is every indication that in thepast 10 years the average applicant tophysical therapy and occupationaltherapy schools is far brighter than Iand my contemporaries. The profileof aspiring therapists is high. Thatprofile is of the pool of applicants,but not necessarily the pool of graduates who eventually gravitate towardcareers in hand therapy. What ofthese? Of course, we don't have IQand GRE scores for the younger handtherapists of today. My guess wouldbe that hand therapy attracts a sample of therapists from the entire poolthat probably describes a typical bellcurve, which is to say representativeof the whole. In other words, they areas talented as my generation.
What of their ambition? Here Ibegin to question today's therapistversus those of my day. The NathalieBarr types were driven individuals.We wanted to make a name for ourselves. In my. limited experience, Idon't pick that up from today's therapists. I'm no expert on the "Cen X"profile, but a willingness to go theextra mile does not seem to be a partof it. To "be somebody," you have towork at it.
Do the next-generation stars haveopportunity to shine? Again, I suspect that some Significant changeshave occurred to the landscape thatmay make it tougher to gain recognition these days. First, there is theadvantage of the first generation ofhaving high-profile physicians toserve as mentors to aspiring therapists. My generation was blessedwith a generation of surgeons whoalso were trailblazers and teachers,such as Brand, Peacock, Madden,Burkhalter, and Hunter, to name afew. Their public appearancesallowed opportunities for the therapists working in their clinics to present the rehabilitation aspects of thesurgeries being discussed. Thesephysicians put pressure on the therapists to speak out. In today's clinicsmanaged care has acted as a seriousdeterrent to this type of collegial relationship by reducing the physicians'and therapists' time for "extracurricular activities" such as writing andteaching.
Managed care also can take theblame for reducing the continuingeducation business, which reduces apotential speaker's exposure. Tobecome a star, one needs a platform;one of those is the podium. Anotheris the written word-the pages of thisand other scholarly publications.Managed care and diminished physician-therapist mentoring have maderesearch more difficult. To list all thedifficulties of producing good clinicalresearch is beyond the scope of thisessay, however.
Finally there is a subtle change thatmakes it more difficult for this generation to distinguish itself. The first generation took all the obvious topics andran to the head of the class with them .Flexor and extensor tendons were thevehicle that established many reputations. Likewise RA and metacarpalphal angeal arthroplasty, Dupuytren'sand sensibility, and more recently thewrist. What's left to uncover is themore difficult material, such as the
January-March 2003
elbow, carpal tunnel syndrome, andcomplex regional pain syndrome.Some grouse that all the good (easy)topics are gone. Maybe. •
I'm certain that the above list is notan exhaustive list, but it is a place tostart us thinking about the hurdles tobe overcome if we are to replenish
2 JOURNAL OF HAND THERAPY
the inevitable fading of the first generation. I choose not to think of whatis to become of hand therapy if ourstars do not come out and shine.
Correspondence to Kenneth R. Flowers,PT, CHT, Editor, lournal of Hand Therapy,875 La Playa, No. 278, San Francisco,CA 94121;e-mail: <[email protected]'m>.