This week’s non-clinical spotlight features a population health physical therapist who works in Arizona!
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What is your full name, title, and company name for your current, primary role?
Lori Pearlmutter, PT, MPH, CPHQ
What additional roles do you currently have?
Manager North Central AZ Accountable Care
Where are you located?
Prescott, AZ for work, Flagstaff AZ for personal life
Where did you go to PT school, and what year did you graduate?
What did you do when you first finished school, and for how long?
My first seven years involved working in a teaching hospital in Tucson (University Medical Center).
Accepting that job was the best decision I could have made. It provided so many wonderful opportunities and I never said no!
Early on, I began attending orthopedic and rheumatology clinics and met a brilliant rheumatologist who became a dear friend and mentor. He valued rehabilitation professionals and included me in presentations, encouraging me to serve on boards.
He was instrumental in my taking on an advisory role for Novartis Pharmaceuticals and the Chair position of the Governor’s Council of Arthritis and Musculoskeletal Diseases.
An OT and I developed an arthritis program at the Canyon Ranch Spa in Tucson.
There was so much going on. In addition to seeing a variety of patients in the acute care hospital, where I led the charge in developing the outpatient services (along with having a group of home health patients), I did the following:
- Taught medical students, residents and fellows
- Helped develop a physical exam with a DO that we shared with orthopedic residents
- Became the occupational health and ergonomic expert
- Spoke about health care topics to every group imaginable
- Published research on osteoporosis and exercise, as well as geriatric strength training.
I was also active in the AZ PT Association and the Arthritis Foundation. Leadership roles included being a lead and coordinator in the acute care area and then in occupational health.
In what setting(s) did you work, and what types of patients did you treat?
I pretty much did everything: acute care, home health, outpatient orthopedics, chronic pain mgmt, arthritis, etc. etc.
I worked in numerous settings, and jumped into everything early on, aligning myself with a great team.
I did mention teaching med students, residents, and fellows, but a few of us also created a training program for some of the first patient care technicians who supported the nurses in the acute care settings. Very quickly I was asked to take on leadership positions.
What did you enjoy about your early roles? What didn’t you enjoy?
I loved the variety.
I loved teaching, research, doing presentations and developing programs. I loved teaching the providers and collaborating on the floors in the Acute Care hospital, but also really enjoyed the camaraderie in my outpatient clinic.
I have always enjoyed treating patients—but never had any desire to do it full time, and I tended to like the more complicated patients.
I was not the go-to person for sports medicine and later, a physician told me she would send me to Germany to be trained in lymphedema management. I declined and said I just didn’t like focusing on one area of treatment.
What else have you done since then, prior to your current role as population health director?
After that job, I moved to Flagstaff, AZ and was the manager and then director of a large hospital department which included PT, OT, SLP, cardiac RNs, and wellness instructors.
I applied for and directed a Susan G. Komen grant for 9 years ,which led us to develop a cancer rehabilitation program.
We created one of the first PT in the emergency Department programs, a robust ICU program, a large pediatric program, wellness classes, and then a pulmonary rehab program.
I continued to be the go-to person for ergonomics, and made the recommendations for the chairs the hospital purchased (as well as other equipment).
My staff treated all ages, from neonates to elderly, in every aspect of the continuum of care. We worked in every department, and on every floor of the hospital. We had an inpatient rehabilitation facility (IRF) a skilled nursing facility (SNF) onsite, and we also provided care to an offsite SNF. We had hospital clinics and freestanding clinics that were within Flagstaff—and as far as 100 miles away.
When I began working at Flagstaff Medical Center, wound care was disorganized—but, with time, we created an interprofessional program that was unique, with PTs actually being hired into the WOCN department.
After many years of developing a state-of-the-artdepartment (which I have to say had a terrible reputation when I first began working there), I was laid off along with many others. The reasons were not business reasons but purely political.
Since then, I have done process improvement, directed a hospitaldepartment in a rural critical access hospital in Northern AZ (which brought me back to my roots of outpatient orthopedic care), was the director of rehab for a SNF, the quality manager/care management supervisor etc. for a federally qualified health center (FQHC), and am now the director of an accountable care organization (ACO).
When and why did you decide to do something non-clinical?
I think I was initially encouraged to take on some lead/coordinator roles by my boss—and of course by my rheumatologist friend and mentor.
When I first began at University Medical Center, it was small and a bit of a hot mess. PT techs provided much of the care, and the outpatient department was completely disorganized.
I decided that was not going to be the type ofdepartment for me and worked to create something that reflected the care I wanted to provided.
I created a physical space and a scheduling system, and also assured proper documentation. I am sure I made many mistakes, but I also learned so much.
Did you have any mentors along the way?
Yes. Dr. Gall, the rheumatologist—who sadly passed away a few years ago—saw something in me and encouraged me constantly. I am not sure I would have been so confident without him. He included me in every presentation, and never let anyone forget I was available to help.
Often, when a resident or fellow would come out of a room after seeing a patient he would get annoyed and tell the OT and me to “go teach him/her how to do a physical exam.” He so appreciated the knowledge of OTs and PTs.
What led you to move on from that first job?
I met a DO who had developed a musculoskeletal exam with a PT and wanted my help with teaching to med students, residents and fellows. I loved that teaching component. When I took my second job, I did it because I wanted to educate and be in leadership. As time went on, I realized that I really enjoyed developing teams, mentoring and finding the things people are good at that they may not know they are good at, and putting them into uncomfortable situations.
Seriously I love helping people find their voices/skills. I love taking a team (like I started with in my second job) that is fighting all the time and not working together and then years later see them become a well run, collaborative team of people who feel supported and respected.
It is not much different than patient care, just on a bigger scale. So, it doesn’t matter to me what I do, just so I am using my skills to make things better. I will say that leadership is very challenging and makes me question myself everyday. And I have learned so much about who I am.
What are you doing these days?
I am running an Accountable Care Organization (ACO). My daughter often asks me, “What do you do, again, mom?” I have to say, “Heck if I know!”
The world of Value Based Contracts and Medicare Shared Savings (the ACO I run) is complicated and complex.
But I have learned a lot on this road. It has been hard during COVID, since we are based on collaborating with multiple practices and hospitals. That said, we have succeeded at the biggest reason ACOs were set up through the Affordable Care Act (ACA) in the first place — and that is to save money.
I started in July 2019, and in 2019 our ACO made shared savings (split money saved with Medicare) of over two million dollars—and in 2020 we received four million in shared savings. We are a very small ACO, which makes it particularly remarkable.
ACOs have saved billions for the Medicare Trust Fund, and have demonstrated good quality in the process. In the three years I spent as the Quality Manager for the FQHC—my last job—my team and I were able to more than triple the money we got from Medicare Advantage and commercial plans as incentives for our quality metrics.
This all sounds like gobbledygook, but what it meant for me was more care managers to help underserved patients, many of whom had many social determinants putting them at risk of poor health outcomes. I know of several instances where the care managers literally saved a life because of their intervention. This makes me feel very proud.
Are you still treating patients, or are you solely non-clinical?
I am solely a non-clinical physical therapist now. When I was at the FQHC, I went to work at a SNF on weekends to keep my hand in the practice—but since I now work 95 miles away from home and have to drive back and forth each week, its a bit too much to keep a PRN clinical job.
How long have you been a population health director?
Since July, 2019.
Did you get any special certifications or training along the way to help you get into your current role?
I got my master’s degree in public health (MPH) while I was running the large rehabdepartment.
Then, when I worked at the FQHC, I got a PCMH-CCE. That’s a patient-centered medical home content expert certification. PCMH is a type of accreditation that practices and organizations can receive for providing collaborative, high-quality care. They are certified by the National Committee for Quality Assurance.
Then, I got a CPHQ (Certified Professional In Healthcare Quality) and then a LEAN Six Sigma green belt.
This was all in the course of 19 months! And, in my present job, the learning is NONSTOP. I go to constant webinars and trainings and ask, ask, ask my team to help me navigate this world.
How did you find your population health director job?
I could write a book about my journey after being laid off, very disrespectfully, after 20 years of absolute loyalty.
I was not young, and I was genreless. My background isn’t typical, and I was also trying to branch into different areas that were also very new. But—I recommend to always use connections.
The only reason I got ANY of my 8 job offers that I got over the course of four and a half years is because I contacted people I knew to help. It is actually disturbing, because not everyone is like me (extroverted, social, well-connected, privileged with an advanced education and an advanced vocabulary), so not everyone gets opportunities when times get tough.
It bothers me that in our culture, incredibly skilled, hard-working, talented people may not get a chance the way the job market is set up.
I was so disappointed by the tendency of HR recruiting programs to spit applicants out of the system for the lack of one item or the lack of a word or two.
I must have written/filled out 150 resume/cover letters/applications. But there was privilege do do this that I cannot deny (see below). And I still struggled to find a job!
- I had the time and energy to make job hunting a primary focus.
- I was safe in a nice house, not at risk of eviction
- I had a good computer and a lawyer husband who could review all my documents
Did you do anything special to your resume and cover letter to land the population health director job?
This is embarrassing, but I did leave the PT off my name at the top of my resume when I applied to my present job.
It was in the body of my resume, of course, but I was Lori Pearlmutter, MPH, CPHQ for that purpose.
I proudly put PT on everything now, but at the time I wondered if it was actually typecasting me. My boss at the FQHC was an MPH with no clinical background—but seemed to consider that my PT degree diminished the importance of my MPH!
I try to explain that having a clinical degree and background is an advantage in the work I do, esp my last two jobs and my job in Boston as a Process Improvement Advisor. Sometimes the discussion is helpful, but sometimes it has harmed my chances, so the conversation has to be thoughtful with the right people.
An HR friend—whom I consider one of the best trainers I have met—told me early on to avoid having my resume look like a list of job descriptions.
People often write things like “After-school tutor: taught children math after school.” That’s literally the definition of a tutor.
As someone who has also hired hundreds of people, that is of no help. Better to quantify things and write: “Tutored five children in math, all of whom increased their grades by 20%.” Or say something else about the results you produced, like the fact that all your students scored in the 90th percentile on their SATs.
Make sure to always lead with accomplishments. We know the donut maker makes the donuts; what we want to know is how delicious they are…so delicious people have traveled over 100 miles to get them.
What was the interview like for the population health director role?
For my present job, I was interviewed by something like 7 different teams (in one interview only one person showed up out of 5 or 6) for two straight days. It was grueling, but actually quite enjoyable.
I used the time as an opportunity to learn about the ACO’s challenges and successes, and also to learn a bit more about value-based care. Some of the interviewers used terms I didn’t know, but I knew them by the end of the interviews!
I used to be a modern dancer in another life and someone once told me to restructure my thinking and consider that auditions are free classes. I was taking 2-3 classes a day—and on my waitress salary in NYC, they were expensive.
So, if I removed myself from the outcome, I actually enjoyed the auditions. I think interviews have to be the same. A chance to learn, meet people, open up my eyes to other things. A class for life!
I always tell people you are interviewing them as much as they are interviewing you. Also, go into the interview trying to find out what problems/challenges they have and then figure out how you are the person to solve that problem.
I thought my background in PT and also in many areas of value-based contracts would be of use. They had mentioned some problems with communication between departments, so I told them about challenges we overcame between nurses and therapists or other departments and therapists, and how we made things better. They also wanted to not lose money and I have been very successful in managing large amounts of funds.
Figure out how you can help them. And be yourself. I know that sounds cheesy, but if you try to fit in to a culture that is really not aligned with you, you will hate the job. And then it would be better to just go sell shoes or read books to children.
What are some of the things you did to stand out, take initiative, and advance in your career?
This is very hard for me to answer, but here are a few thoughts:
- I have always been the most enthusiastic/optimistic person around, and my attitude is a lot of it.
- I went for advanced degrees and certifications.
- I have volunteered to do public speaking for organizations, state, national and international conferences.
- I have spent time learning all I could about my job and even though I went into several positions as a newbie, I have come out as an expert.
I also think my years of being a dance teacher and choreographer, a camp counselor and youth group leader prior to becoming a PT were the beginnings of my understanding of process.
Plus, the lack of any real leadership in my first position gave me a space to jump in and do what I could. I could only go up!
I can tell you’re an optimist, but you’ve gone through some stuff, too! What has been a big challenge of your career?
It was challenging to be laid off for no real reason (business-wise).
It’s also tough when you hold a position that is then eliminated.
I’ve also been in the position where you’re told you are expected and wanted to do certain things. The interview is filled with all of these ideas and plans for you. But then you get into the role and they don’t really want you to do any of those things you discussed.
Oh, and I’ve walked into a job and found out that the problems I was having were the same things that caused the last three people to leave.
Why do you think healthcare jobs — even non-clinical ones — can feel so thankless and unfulfilling?
Healthcare is in a difficult time.
Throughout the country, people are leaving jobs in healthcare because of the way they have been treated for years. It’s a bit of a moment of reckoning.
I am at the end of my career and seeing many high-level problems, but I do try to remain upbeat and optimistic.
How have people reacted to you leaving patient care?
I left clinical care quite early in my career.
As I have mentioned, many people supported me—but unfortunately, those people were rarely PTs.
Early on in my career I was told by PTs in various words to “stay in my lane.” I was criticized for working so closely with physicians and one PT even said, “Physicians are not your friends!”
I have received the most pushback about my non-clinical career from other PTs.
A professor I had told me I wasn’t a real PT because real PTs have to see patients!
PTs have not seemed to keep up with healthcare changes and have “stayed in their lanes,” which is a detriment to the PTs, the profession, healthcare, and our population.
I have been on my soapbox for years, explaining why we need to take on more leadership and non-traditional roles. While it is getting better, we have so far to go.
I have voted for many Board of Directors at the APTA and so often they say, “I am a real PT, I treat patients every day.”
That is getting slightly better, but not fast enough.
I tell everyone that as an ACO Director, I bring my PT sensibilities to the job every day. It is who I am, not just what I do.
The recent good news is that I brought on one PT private practice into the ACO and the owner as well as another PT in the hospital connected with the ACO are on the ACO Board of Directors. Woohoo!
What’s a typical day or week in the life like for you? What types of tasks and responsibilities fill your time?
UGH, too much office time. Due to COVID.
My dream would be to spend more time in the practices, helping them to improve their processes to enable them to do better treatment.
Right now, I have lots of clerical and admin work, making sure all the CMS guidelines are followed.
What are some of the rewards of being a population health director? What are the biggest challenges?
Rewards – I LOVE my team.
I really do like having control of my own schedule in this job.
Challenge is I am alone a lot, especially as we are doing more remote. That is a COVID issue. If not for COVID, I would be with others so much more. I do the best when I am working alongside other people.
My ultimate challenge is dealing with the slow pace of healthcare change.
It makes me want to scream. People act like it is changing quickly. NO, it is not. Take if from someone who has been in it for 35 years.
How did your clinical background prepare you for this role? Which skills transferred?
Being a clinician makes me focused on quality:
- Understanding the importance of good documentation
- Asking questions
- Focusing on prevention.
The RN Case Manager on my team always says, “If we keep the patient at the center, we will do the right thing.” That is what I used to tell my PT, OT, SLP, RN, etc. team, and it is still essential.
I do truly think that PTs understand population health and social determinants of health better than any other healthcare provider, but unfortunately we have let others tell us what these things are.
My first internship was at an inpatient rehab facility (IRF). My first day on the job, I had to explain to the whole team why or why not the patient could return home, including physical space of their house, if they had indoor or outdoor plumbing—as we had many people returning to homes on tribal nation land—if they had family issues, money for food, gas etc.
The team of social workers, nurses, doctors looked to me—the not even a PT yet—to help them navigate this process!
Now, suddenly, this holistic view of social determinants of health and population health—all of it is part of our national dialogue—and PTs have somehow been left out! Or we let ourselves be pushed out.
Roughly speaking, how are the hours and pay compared to patient care?
Hours and pay are better, but it requires a lot more responsibility and you deal with more problems.
Pay is based on the market and responsibility. I used to tell my rehab team, “When the you-know-what hits the fan, I am the fan!”
I got paid more to take the hits and do what I needed to do to remove barriers to doing their jobs. It makes sense that such a person makes a bit more.
Also, my work is salaried, so I work as much as I am needed. I am always available by cell. I don’t expect that from my team.
What type of person do you think would do well as a director of population health?
Someone who is optimistic, but also patient and pragmatic. Healthcare moves at glacial speed prior to global warming.
Someone who can enjoy the small accomplishments and understand your job vs. your life’s work.
I may not be accomplishing what I thought I was there to do, but it is often revealed later why we are in places we are.
Do you work remotely or onsite?
Does your organization hire PT, OT, or SLP professionals into non-clinical roles? If so, what type of roles?
Yes, I created the job description for the case manager and it can most definitely be a PT.
Right now, I have three nurses working as case managers, but that is not a requirement.
Also, I did have a data analytics person open recently. While the salary was low compared to a PT position, I would have been very happy to hire a PT. I am trying to change things, step by step.
Did you read any books, take any courses, or do anything special overall to get you where you are today?
I do like to read some leadership books, but many of them are not based on any research—quantitative or qualitative—and unfortunately, many seem to be written just to get sold.
The best leadership book I ever read is “Leadership BS” by Jeffrey Pfeffer. He is a Stanford professor and the title is exactly what the book is about. He bases his finding on research and admits there isn’t much. What we think we look for and think we want in a leader is not actually the reality.
I am a voracious reader of historical fiction and non-fiction.
I especially admire people like Atul Gwande and Siddhartha Mukherjee., who are not afraid to shed a light on what we don’t know about healthcare (or are not doing well).
I listen to oodles of social psychology and behavioral psychology podcasts. They have helped to understand that the seemingly weird behavior we see in people (especially during COVID) is actually quite normal and may be adaptive.
I love all the Freakonomics, Hidden Brain, Esther Perel. I listen to Dan Carlin’s Hardcore History, but I also like political podcasts if there is something to be learned and not just screaming into the void The Branch about work being done between Palestinians and Israelis in Israel (that stopped and it is so disappointing) gave me hope during my long walks throughout the pandemic.
I meditate every morning and read spiritual thoughts by people I consider to be great philosophers. I think poets, artists, writers of fiction, podcasters have so much to say about the human condition.
And, of course Netflix binging! There have been gems there, such as The Good Place.
I think having an open mind to learn whatever we can from all the brilliant people that are out there is key. I don’t think we need to limit our reading/listening. There is something to be gained from it all.
And, of course, I listen to PT Pintcast, which every PT should know about.
And then I am a big comedy buff. I am on the road a lot and listen to many many comedians on Sirius and Spotify.
And as far as course, TONS. And I signed onto every webinar I could find when I first started this job.
What is a typical career path for someone in population health?
Oh goodness, I think I have said, I am not at all typical. I was pushed out onto a path and didn’t leave any cairns to get back, so I ended here. Everyone’s path will be different!
What is next for you? What are your high-level career aspirations?
I am toward the end of my paid career and would like to use my experiences to help in some way. Haven’t figured it all out, but do have at least one non-fiction book in mind.
What would you like to change most in your profession, and why? How would you propose doing so?
I want PTs to stop pigeonholing themselves. Get out of your lane if you wish!
I have said in the past that we are too happy. I learned this from a Freakonomics podcast, I believe.
PTs are often considered one of the three happiest professions in the country. STOP BEING SO HAPPY. Get a little disgruntled, and wonderful things will happen.
Editor’s Note: Don’t worry, the disgruntled thing is happening!!! 🙂
Nurses and MDs and others have pushed themselves into high-level leadership. We need to be there, too!
What career advice would you give yourself that you wish you had during school?
My dad was an excellent PT, and he gave me lots of advice about respecting patients and understanding others are autonomous individuals and have much to offer. I think that has helped wherever I have gone.
I wish, though, that someone had told me to be a bit more selfish with my own aspirations. I did do so much I wanted to do, but I also thought a bit too much about what others wanted from me.
Do you have any special advice for others who want to follow in your footsteps?
Look deeper and figure out who you really are.
And nothing has to be permanent. I had one job for 20 years, then five jobs in four years!
Want to learn more about population health and public health? Check out Non-Clinical 101!