Julie Wiebe’s ongoing professional evolution is simultaneously unique and motivating. I was fortunate enough to interview Julie and, as expected, the topics were wide-ranging – from Pelvic Health to Physical Therapy Residencies to Teaching Abroad. As you may already know, Julie is a heavy hitter in the #PelvicMafia. Read her blog post for more info: The #PelvicMafia: How It All Began... She runs a #cashPT clinic in Los Angeles and has a wonderfully informative website that’s well worth your time.
You’re in for a treat. Enjoy the interview!
First, what did you have for breakfast today?
Eggs, Toast and fruit.
What initially sparked your interest in Physical Therapy?
As long as I can remember I wanted to be in medicine. I was always the doctor when we played hospital and Emergency One was my favorite television show (revealing my age!). My dad was a medical researcher and I remember him coming home with a blood stained lab coat, it fascinated me and fueled the dream. I was planning my path to medical school, and took a Health Careers class my senior year in high school. I was excited to see doctors in action as we rotated through different departments of the hospital. Never once did I see a doctor work with a patient. But when I rotated through the physical therapy department, I saw the practitioners face to face with patients, physically interacting with and guiding them. They were in the trenches, that’s where I wanted to be. It clarified HOW I wanted to do medicine…I wanted to walk the path alongside the patients. Physical therapy was a perfect fit. More on my my dads inspiration here: Ode to My Father…
Pelvic Health is a growing niche, and that’s a good thing! All professionals go through a growth trajectory. What was yours? How did you end up in Pelvic Health Rehab?
I came to pelvic health from the outside-in, starting as an orthopedic and sports medicine practitioner with a hazy memory of giggling through the 2-hour women’s health lecture in PT school. Then I had my first baby (now 11). I was quickly humbled by the physical challenge of recovery and the sense that something just wasn’t right inside my body after I had my daughter. My ortho skills and background were not cutting it to help me recover or return to fitness. I recognized that if I was having trouble recovering with my professional background, the climb for other women had added challenge.
I began to investigate what happens to a woman’s body during pregnancy and beyond. The “core” was just coming on the scene around then. It was clear that the loss of connection with the deep core elements was a critical and underlying issue for many of the typical pregnancy and postpartum orthopedic complaints, as well as common women’s health issues. The pelvic floor is a part of that core system, so there was an existing, natural link between the women’s health and the “core crazy” sports medicine worlds. Bringing those two worlds together became my passion. My clinical niche became helping women across the lifespan recover from injury and pregnancy and return to fitness and sport through programming that integrated the pelvic floor vs isolating it. What I have learned from helping women rebuild a solid central foundation, can be applied in multiple populations, because everyone needs central stability for efficient, effective and powerful movement and fitness. Oh, and everyone has a pelvic floor.
My ‘trajectory” has given me a unique path and voice in pelvic health. I am not a traditionally trained internal pelvic health practitioner. I intervene externally with a focus on treating the pelvic floor like we treat all the other muscles in the body to return them to fitness and sport: functional training, neuro re-ed, coordination, form, plyometrics, sport specific training, imagery, etc. Because I came into the pelvic health world backwards, I didn’t know you “weren’t” supposed to do that. So I unintentionally pushed the boundaries out of pure naivete.
You had the tremendous opportunity to teach in Oman. Now that you’ve had 9 months to reflect on the adventure, what are your biggest take-aways from the experience? How has it changed the way you view the world? (Readers, click here for Julie’s blog post on the trip.)
I have done mission work domestically and in other parts of the world, Africa and Mexico, and have a true heart for populations that are underserved and marginalized. An experience in Africa before I became a PT, committed me to not just caring for folks hearts but their bodies, too. My experience in Oman only confirmed that desire. Women’s health and maternal health are areas of great need here in North America and throughout the world. Here we do have resources, and lots of us working towards educating and empowering women towards optimized health, wellness and fitness. Oman is a great example of a highly resourced Arab country, with very progressive attitudes towards women (education, employment, driving, etc.) but limited practitioners to help. There are TWO pelvic health practitioners for 2 million Omanis and 1 million ex-pats (lots of Europeans live there). There is great need. I am trying to support them from afar.
When I returned I talked to my Missions pastor about my trip and we began a conversation about creating medical teams from within our church. The first one to meet a request he had received from an Egyptian partner church. They needed practitioners to go into Kurdistan to a Syrian refugee camp for those who had fled the conflict in their home country. One of the major needs was for women’s health care givers because it is primarily women and children that have been displaced. September 2014 was the month we had kicked around going. Various things got in the way, and the trip never got off the ground. But it has not escaped me that ISIS is parasitically enveloping that part of the world right now. I am glad we and others (especially other Arab nations) are stepping in to stop the horror. Love that the lead pilot from UAE is a woman. Chicks rock! We had folks from many of the Gulf Coast Countries at our course . That kind, funny, smart, amazing group of people is who I see when I watch ISIS gain ground. We only see a perspective of the Arab world that highlights the extremists. ISIS is not representative of all Arabs or the warm and welcoming Arab culture and people I was exposed to.
You also had the opportunity to spend some time abroad prior to re-establishing your practice in the US. Tell us about this experience and its impact on you.
My Canadian husband, our two Can-american anchor babies (aka half-breeds as my husband calls them) and I moved to the Greater Toronto Area from Los Angeles in 2006. We lived there for about 3.5 years for a job for David. We took the opportunity for all sorts of reasons, but one of the biggest was it gave me a chance to stay home full time with our little ones. I LOVED it! I kept my professional brain moving by spending their nap times reading research and books. It was actually my organic food habit that drove me back to work, so I started seeing patients a few mornings a week once my son went to preschool. I patterned my practice after my friend and now teaching partner, Shelley Mannell, who saw patients out of her home. Canadian PTs have so much more autonomy than we do here in the States. I could hand patients an invoice and they would hand me a check, it was like a dream. Also, they have very reasonable documentation expectations on practitioners. It was an awesome little part time gig I could work around my motherhood. Honestly, the system I teach was built in the basement of my house in Oakville, ON. I could treat the way I wanted to, take my time, not worry about insurance, not charge for theraband (a huge pet peeve)…it was awesome. My practice slowly grew, and I took on more patients as my kids went to more and longer school days.
When the opportunity came to return to the States, my husband and I acknowledged that our shared nationality is Californian. When I got back I worked briefly for a previous employer at her great clinic. It was fun to try out the strategies I had developed on women with a more generalized ortho/sports med population. I slowly started seeing a few patients on the side and started teaching more, allowing me to make the leap to seeing patients again on my own….and I haven’t looked back. My time in Canada really gave me the know how and confidence to pull it off. My time out of the madhouse of a traditional outpatient ortho setting gave me the chance to build the clinical model I teach. I am so grateful for that period of time.
What is your response when you hear this question: “Why doesn’t your clinic participate with my insurance?”
I know because I talk about the pelvic floor I am quickly identified as a pelvic health person (and usually folks assume I am an internal therapist). The approach I take is truly integrative with multiple systems in the body: breathing mechanics, sensory input, balance, alignment, muscular coordination, gait, and so on. So I am kinda out of the box and non-traditional in my approach to all sorts of stuff. I don’t just treat pelvic health, I treat the whole body/person that the pelvis/pelvic floor just happen to be in. I say that to say…by the time folks get to me they have usually done a traditional course of PT somewhere (and all sorts of other things). So folks are willing to try something new, out of the box and willing to pay for it. And because it is my own biz, I can modify my charges if the cost is a challenge.
So, honestly, I can’t say that I have been asked that question that much. I explain to people that as a solo practitioner managing the whole insurance thing is beyond my capacity, I’d rather just do the PT part :). Most of my patients have had a decent return from their insurance for my services as an out of network provider (50-60%; varies of course). I also have a consultative approach. I don’t see folks 2-3x/week. I see them once every week or two, with longer stretches as we progress. My goal is independence and I start working toward that at day one with a model of care that keeps them in the drivers seat with education and exercise (brain work and bodywork). I am not getting them better, I am guiding them through their steps to recovery.
What is your perspective on PT residencies? (Good, bad, necessary, excessive?)
I remember the day before I graduated from PT school I wasn’t allowed to treat a patient and the next day I was. But I guarantee I didn’t know anymore the day after graduation than I did the day before. That’s sort of crae-crae. I was incredibly fortunate to work at an awesome clinic and all the experienced PTs mentored me going over my schedule with me once per week. But not everyone has that kind of first gig. So yes, I am pro reforming our educational model. I think we have all acknowledged that the DPT thing hasn’t quite worked out like we thought it would. Particularly the expectation that being called doctors would some how change the public or co-professional (doctors) perception of us. Creating a true entry level degree that led into a residency program, modeling the path physicians must tread or similarly in Canada where new lawyers have to “article” for a few years, might have really established our expertise in a new and noteworthy way. These professions acknowledge that new grads only understand things to a certain level. Experience is the best teacher, guided experience even better. But to reconsider this we need to think about the expense of the programs, deferring loans through the residency programs, salary scaling, etc. It is complicated to consider a re-vamp, I get that, and I don’t have all the answers. But I think our model needs to change, somewhere.
Congratulations on “The Pelvic Floor Piston: Foundation for Fitness” DVD! What were the biggest challenges of this project? What would you do differently if you were to make a 2nd DVD? (Click here to read Julie’s blog post on the DVD)
Thanks! It was honestly the culmination of years and years of work with many stops and starts. I am very grateful to all the people and challenges that brought it to life. Some of the roadblocks that kept it from happening sooner allowed me more time to learn, more time to sort through cues, to fail and try new things with patients, to think through how to present it, how to piece it together. The whole thing was one big, huge learning curve. I had no idea all what was involved in production, editing (SO much editing), printing, graphic design, scripting, cost, etc. Roadblocks, and mishaps all along the way. The fact that we got to a real live DVD was nothing short of a miracle. I’m still learning, mainly about marketing, another huge learning curve.
DVD #2 and hopefully #3 are in the works, at least in my head. The goal is for this to be a series. The first one was designed to be a part of a research study (another HUGE learning curve) so I had to limit how much info to give so that it could be achieved independently in a short amount of time. I had to keep it very focused on incontinence. But the reality is the continence control system is the same system that creates central stability, which impacts all sorts of issues-balance, gait, joint mechanics, performance, diastasis, prolapse, etc. Next time I hope to hit some of the topics I couldn’t really explore that might have muddied the water for someone trying to interact with the material in the research study.
I am also hoping that a pediatric series is on its way. Parents are left holding the bag with helping their kids with challenges. My peds partner, Shelley Mannell of http://www.heartspacept.com, and I hope to meet some of those needs with a peds focused program for home.
You give 10% of business profits to charitable causes. Andrew Carnegie said “It is more difficult to give money away intelligently than to earn it in the first place.” How did you narrow down the choice of charities to the two that you selected?
Honestly, I look for women, mom, and childrens charities that tug on my heart strings. Groups that deal with women’s and maternal health really hit home. I also know lots of folks that are involved in compelling charities and I try to support their amazing work. I do try to do a domestic and an international charity, but that doesn’t always happen. Some notable groups/causes that I have interacted with recently include: One Girl Launchpad campaign to help girls get feminine products to manage their periods, otherwise they miss school for a week (http://www.onegirl.org.au/what-we-do/launchpad) . She Dances supports a home in Honduras that rescues girls from sex trafficking (http://shedances.org). James Store House helps kids in Los Angeles and New Orleans transition when they age out of the foster care system. http://jamesstorehouse.org
Unfortunately, all this isn’t as impressive as it seems, I don’t make that much money :). Please consider helping them out!
The profession of Physical Therapy has seen its share of fads and themes in the last couple decades. Which ones were the most memorable to you?
VMO, Iontophorsis, phonophoresis, empty can, Isokinetic machines, TA isolation vs trunk bracing, patellar tracking, Q-angle, lumbar stabilization (the world before the core). The big theme/fad I am on a mission to change is the idea that the pelvic floor acts alone to perform its traditionally understood functions (control pee and poo, sexual performance, and keeping our organs in). The pelvic floor is just one piece of the puzzle and does SO much more. It is a part of every move that you make and a part of the “core”. We need to start treating it that way.
Private Practice, teaching, DVD, webinars… You’re a busy lady! How do you manage to make time for yourself & your family? What advice do you have for someone as busy as yourself?
I have a very messy house.
Honestly, I am not sure I can advise or share any wisdom here because this is a constant challenge for me. I just try very hard to keep my priorities in check. It is a daily choice and it is hard, and I am not awesome at it. I turn down more work and opportunities than you can imagine, it took me three weeks to return these answers to you, I need to exercise more, my labrador retriever could use more exercise too and my kids eat chicken nuggets more often than I would like to admit (they are organic and gluten free…but still). My work day is the kids school day, and it isn’t always enough to keep up. But bottom line, I love what I do and the way I get to do it. I am so incredibly grateful I get to participate in both meaningful work and still get to be present and available with my kids.
I have taken steps to try to keep it managed. I try to only teach one weekend per month, because it is a lot on the fam when I travel. Although, the kids are really starting to dig daddy weekends. Let’s just say they aren’t as organic and gluten free focused. But I try to balance my travel by consistently volunteering in my kids classroom on Monday AM so that they can count on mommy being right there the next day even if I was gone for the weekend. Also, I did cut back my clinical schedule to make room for the bigger projects that ultimately have a larger impact like teaching, creating resources, research and writing.
My husband is also incredibly supportive of me and my mission, and our family as a whole sort of approaches it that way. He funds the mission with his work and solo parents when I travel, which allows me to work the way I do and have flexibility to be with the kids. So if anyone has ever received benefit from what I do, you honestly have David Wiebe to thank. He’s a catch and I am grateful.
What big ideas/simple ideas/basic concepts do you believe will help all Physical Therapists become better/smarter/wiser?
Step outside your typical population and learn from the other specialties. I have gained so much from my partnership with pediatric specialist, Shelley Mannell. We jokingly refer to our collaborations as our own private Combined Sections Meeting. How many shoulder courses can you take, really? Explore neuro or peds or womens health and see what a different perspective can do to shake up your clinical reasoning.
You’ve just traveled back in time to when you were 20 years old, and are sitting face-to-face with yourself. What advice would you give yourself?
Change is an evolution, not a revolution. Be patient, and stand strong even when you are swimming against the tide.
Never stop learning.
Stop cursing like a sailor.
Stop dating that guy. Wait for the Canadian….(I would sort of trail that last one off into a whisper, then slink back into the shadows….)
Favorite books and/or authors? Recommended readings?
Pubmed. Enough said.
Life is an adventure. Describe one of your most memorable adventures so far.
I love to travel. David and I went to Hawaii for our 15th anniversary, our first trip like that since our honeymoon. And the kids and I drove from California to Texas stopping at the Grand Canyon, Petrified Forest, Painted Desert, and Carlsbad Caverns on our way to spend Thanksgiving with my mom and brother. If we won the lottery, I would honestly homeschool my kids while travelling the world….and maybe get my PhD. Never stop learning, darn it.
What a phenomenal interview! Julie, thanks for taking the time to share your experiences and perspectives. Congrats on your amazing & supportive family, and I wish you the best of success on your current & future projects. Let’s do this again someday.
Get in touch with me @Cinema_Air