Physician therapist Craig Rudikoff works with a patient at the Denver VAMC. Photo from the Nov. 20, 2020, VAntage Point blog
DENVER — Like many of his fellow physical therapists, Craig Rudikoff, PT, DPT, came to his profession through simple familiarity.
“I hurt myself so much growing up that I saw my fair share of physical therapists,” Rudikoff said. “One of the things that appealed to me was the ongoing relationship I had with each of those therapists. Between that and treating people and improving their quality of life, that’s what drew me to the profession.”
After completing a residency at Johns Hopkins Hospital, followed by two years as a clinical physical therapist, Rudikoff took a job at the Denver VAMC in 2016. “I couldn’t think of anything more professionally rewarding than giving back to our veterans and those that have sacrificed so much.”
Rudikoff’s life at VA started off purely clinical, seeing 12 to 13 patients a day, mostly in orthopedics, which is his specialty. However, he quickly took on a more administrative role and became involved in local and national projects to help solidify PT’s place in VA’s clinical ecosystem. It’s this effort that led to him being named the 2020 PT of the Year by VA’s Physical Therapy Field Advisory Council.
In 2017, Rudikoff was elected as the VA representative to the federal section of the American Physical Therapy Association (APTA). The federal section represents VA, DoD and the public health service.
At the time, VA did not have an established scope of practice for physical therapists. Everything from examination techniques to what interventions or referrals physical therapists were allowed to provide could differ from one VA network to another.
“Every facility was free to operate as it saw fit,” Rudikoff explained. “There was no national standard for how everyone should be practicing.”
For example, the Denver VA is in one network, while the Fort Collins clinic, which is only an hour away, falls into Wyoming’s hospital network. Theoretically a veteran could have very different PT experiences, depending on which facility they went to.
As VA’s representative at the APTA, Rudikoff helped put forward a recommended scope of practice, a version of which was adopted by VA this year.
At a local level, Rudikoff has helped embed PT into the primary care experience. At the newly-opened Jewell Clinic in Aurora, which Rudikoff helped outfit with state-of-the-art PT equipment, veterans can now get same-day PT service when they come in for a primary care appointment.
“There’s research out there that says the sooner you get folks in [for PT care], the better the outcomes and the less you have to see them,” Rudikoff said. “We’ve gotten tons of positive feedback from providers as well as from veterans. We’ve created a very collaborative model.”
Those same-day appointments weren’t “one and done,” Rudikoff noted. “We were able to schedule follow-ups as needed. We’d get folks in the door sooner, achieve better outcomes and in theory lighten the load for the rest of our PT staff.”
That embedded system has been disrupted by the pandemic, with primary care physicians relying as much as possible on telehealth. Rudikoff and the rest of the PT clinic have adapted as well, doing initial evaluations in person for veterans comfortable with coming in and then moving to telehealth for follow-ups.
“Right now our current guidance is to be at about 25% in person, and we’re doing pretty well with that model,” Rudikoff said.
For the most part, veterans are happy to be seen in person and are equally flexible about moving to telehealth.
“We make these decisions in conjunction with patients. It’s a very collaborative form of care,” Rudikoff said. “Folks have been doing their [PT] homework and we’ve been seeing positive outcomes. When they know there’s a [telehealth] appointment on the books, there’s some form of accountability there.”
While Rudikoff expects care to return to mostly in-person once the pandemic is over, he appreciates having PT telehealth as a potential tool, especially for veterans who find it difficult to make it to a VA facility regularly.
“We have a lot of rural veterans who live out on the plains or in the mountains, and it’s difficult for them to reach any clinic,” he explained. “It’s also great for folks who have difficulty traveling [in general]. I think it will open up a lot of doors.”
Rudikoff said he would like to see more collaboration between primary care and PT once the pandemic is past and in-person appointments are the norm again. According to him, there’s a strong push by VA’s Eastern Colorado Healthcare System to move the idea of embedding PT into primary care into other clinics in the network.
Rudikoff stressed, however, that this initiative, and his award, were the result of a joint effort. “The award I received is certainly more of a reflection of our staff here and our hospital as a whole,” he said. “We continue to motivate and inspire each other to do bigger and better things and to provide more quality care for our veterans.”
