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Re: Why is APTA membership so low?
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Re: Why is APTA membership so low? - August 17, 2005 4:00:00 AM
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SJBird55
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We all know I haven't read his work of 300+ pages (nor do I want to).
That sentence I wrote is the one that pissed Drew off, and I do believe what I wrote.
I remember when I did my thesis (not as large of a project)... but we had to know what n value we needed for our pilot AND what n value we needed for the actual study in order for the power to be there. We had the opportunity to have a greater n value and by golly we took it. Drew did not word his statement on his n value in a manner that indicated that 12 was his magic number. Wording that he got tired of hearing the same themes is not a statistical justification that 12 was enough of an n. I'm just applying common sense here, I'm not statisitically analyzing anything.
He didn't answer how he captured the 12... but in my uneducated, qualitative opinion, I believe that hitting up the practice area of the majority of non-members throught the States might hold more information from a qualitative view. Orthopaedics is the largest area... personally, I would have wanted a lot more than 12 AND I would have wanted a more homogeneous group on why the largest chunk of PTs weren't members. In other words, I see it just as Rick does.
In my opinion, Drew basically did a qualitative pilot study. Information can be gained from a pilot study, but it is from that study that stuff gets tweaked and fine tuned to perform a larger study. In my opinion, to generalize the findings as if it is all fact and the whole truth as to why non-members are not members is wrong.
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Re: Why is APTA membership so low? - August 17, 2005 5:44:00 AM
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JLS_PT_OCS
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Qualititative research is conducted MUCH differently than quantitative research. It is in many ways more difficult to do and more difficult to data analyze. This may be why no more than 4 or 5 people are really doing it at the moment.
Much of the good qualitative research done lately (there was a good one on 'expertise' in physical therapy a year or so ago in one of our journals) has used similar n values. From a quantitative standpoint, this looks like a pilot study with small power and therefore would be of questionable value. However...
It is only when you understand Drew's description of quantitative research with a followon qualitative study that you understand 12 subjects is more than enough.
We cannot use qualitiative means to criticize quantitative research, and vice versa. It's not apples and oranges. It's like cats and oranges.
SJ seems to be approaching the qualitative aspects of the study with quantiative criticisms, which are not appropriate to the research type.
All tone and other issues aside, that seems to be the central issue.
This strikes me as an opportunity for education.
Having just started my DPT and just getting a fix on exactly what qualitiative research is, I am not a good person to do that. I simply don't understand it well enough.
Drew, would you care to give me (and by extension, others) a quick rundown of the major differences Quant vs Qual? That might advance the debate a bit, I think.
Thanks.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Why is APTA membership so low? - August 17, 2005 6:36:00 AM
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SJBird55
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Jensen and Resnik did an awesome qualitative study... no where in their paper did they use being tired of the same theme as a reason for their n value. They used the FOTO database to calculate outcomes for patients with lumbar diagnoses... and supposedly there were a total of 930 therapists involved. The number of therapists involved in the analysis was substantially less than the thousands Drew mentioned. Then, they used the SPSS software to randomly select 30 therapists from each the "expert" group and the "average" group. That means that of the 930 potential therapists, they actually contacted 60 therapists randomly! Now THAT is a much larger number than the 12 Drew used, especially considering they have less of a pool to draw from. Of course, Resnik and Jensen didn't get all 60 to participate... it ended up being 6 from each group (expert and average). They did mention that "the number of participants in the qualitative study was not determined a priori, but was guided by the data analysis process" which does make sense, because from their quantitative study they would initially have no idea how many therapists would be in either grouping. And, in a qualitative study there are no guarantees that someone will participate - but they did some awesome work. They may have had only 6 in each group, but by golly, they made a valid attempt to have a larger n value and definitely didn't let "seeing a common theme" dissuade them from interviewing as many therapists as they could. And I would be willing to put money on the fact that if ALL 60 therapists participated, Resnik and Jensen would have done 60 interviews. They were also very up front in the limitations.
Resnik L & Jensen G. Physical Therapy (2003) Using Clinical Outcomes to Explore the Theory of Expert Practice in Physical Therapy. pp 1090-1106.
We're all talking opinions. Drew's rationale on his n value doesn't impress me and is a very disappointing thing to have seen him write. And if no one else seems to see that kind of rationale as doing the bare minimum to get something completed, well, I guess none of you were raised as I was with the beliefs that were instilled in me.
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Re: Why is APTA membership so low? - August 17, 2005 6:59:00 AM
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Barrett
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Yes, now I see, my parents failed me.
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Re: Why is APTA membership so low? - August 17, 2005 8:21:00 AM
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dosrinc
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Drew,
I absoultely applaud your work and having spent 4 years working through a proposal then collecting and analyzing data on 60 subjects prior to defending the results before my dissertation commitee earining my doctorate and then reworking the research for submission to the PTJournal who 6 months later rejected it rather rudely I can say that I have been there, done that and plan to do it again. (By the way I can't tell you how many times I wished I could have told my commitee and especially the editors at PTJournal to piss off, that must have felt great). My only question was about your conclusion that non-members would become members if they could do section only or section first membership. This is an interesting thought but I don't understand how you came to this conclusion, please elucidate. Would there even be sections if there was no APTA?
As for those who feel like they are not represented well the only answer I have is to become active and change things. The current Women's Health section is an excellent example. A small group focusing on a speciality practice area pretty much came together and formed this section which is now one of the fastest growing in the APTA, they also wanted specialty certification, so what did they do? They put a committee together to work with the APTA to establish board certification and in the coming years you will begin to see WHCS's.
Duffy, I urge you to reconsider, join the APTA and the private practice section, go to the section's national meeting and there you will see the handfull of volunteers who are the only reason we aren't all working for Docs at this point. If you think POPTS are a problem now wait until you see what these guys have had to go through to limit them as they are now. Again, the same thing with PTA rights, who do you think got the rule that required in room supervision of the PTA in the PT owned private practice reversed? It was not non-members I can assure you of that.
Thanks, Rick
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Re: Why is APTA membership so low? - August 17, 2005 10:05:00 AM
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kragar
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Hey yeah, the guy worked hard...but these were some broad based conclusions based in an unstructured interview of 12 subjects. Really, this isn't a Physics PhD project and you can't really draw ANY conclusions, ZERO.
I applaud his hard work, and I don't want to take away from his paper, that isn't what the debate is about. Rather, this is NOT a study...you can't draw any kind of conclusion out side of the 12 people that were interviewed...which likely is not a cross section of applicants and provided for no annonymous answers.
Simply would have liked to know more about methods, because any such project, to hold any remote chance of being valid, should be reproducible.
Hey, once again, not trying to take away anything from his dedication and work.
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Re: Why is APTA membership so low? - August 17, 2005 11:04:00 AM
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Wisecracker
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The AMA has difficulty with membership with about 31% participation/membership.
The ACA has difficulty with membership with about 34% participation/membership.
I think this lack of participation in professional organizations is consistent in many professions and not solely a PT issue by any means. Lowering fees have been tried by the ACA and it did not have any net positive affect on membership.
In defense of SJ, I feel she has a valid point. I did not read anything into her comments that could be construed as inappropriate.
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Re: Why is APTA membership so low? - August 17, 2005 12:11:00 PM
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Randy Dixon
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"And if no one else seems to see that kind of rationale as doing the bare minimum to get something completed, well, I guess none of you were raised as I was with the beliefs that were instilled in me."-SJ
SJ-I'm sure you don't see the above as rude and insulting either. What you have implied is that now not only is Drew lazy and lackadaisical but now all of us were raised with inferior beliefs and values, unless of course, we agree completely with you, in which case it is assumed we were raised correctly.
I don't see anything wrong with questioning Drew's study or the inferences he has made from it. If you don't like the way he decided on conducting his study, then fine, ask him to explain, but assuming a superior tone and insulting constructs is still rude, not honest and straightfoward questioning. Defending your comments as simply seeking further explanation or honest criticism is either disingenuous or exhibits an inability to recognize social norms.
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Re: Why is APTA membership so low? - August 17, 2005 12:26:00 PM
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SJBird55
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I explained my belief system which must be different than everyone else's and THAT is turned into being wrong... give me a break, geesh. If no one else seems to see the n = 12 issue as I do, then you maybe you do have different belief systems than me. Stating my beliefs is not judging and it isn't saying anyone was raised incorrectly.. just different backgrounds and different beliefs. Mine is different.
Believe it or not, I'm socially normal. I'm a very confident person and maybe that is where I'm always being misread - my confidence is being taken as being a "superior tone and insulting." I also didn't put a single question in my last post... I reviewed a very good qualitative study in which the authors should be commended, but of course, THAT gets lost and ignored.
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Re: Why is APTA membership so low? - August 17, 2005 1:28:00 PM
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karmzack
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I agree that all health professional associations have a problem with membership. I found the following quote on a Podiatry forum from a past member of the APMA.
[QUOTE] Hey APMA, pay attention to me!
I was a member. I did pay my dues.
I stopped paying my dues as it was a choice between dues and food. And I talked to a Trustee who listened and wanted to know if he should send over"practice tips".
Such incredible bull ****!! Practice Tips when I am starving. Practice tips when my family is put out on the street. Practice tips. That was the extend of his comments and thoughs. Practice Tips.
Practice tips. What this profession has in terms of suggestions.
I am disgusted by the APMA leadership. I am disgusted by the APMA and some members.
The APMA makes cat vomit taste good. [/QUOTE]This much discontent is probably the exception
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Zack Solomon MPT, OCS, CSCS
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Re: Why is APTA membership so low? - August 17, 2005 2:47:00 PM
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Andrew M. Ball PT PhD
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For anyone interested, I’ve a great PowerPoint presentation on the ins and outs of both qualitative and quantitative research . . . and the many “flavors” of each. It’s a course that I’ve taught for several universities, and it’s now required reading for the medical residents at Charlotte Institute of Rehab.
I’d be happy to post if RehabEdge can figure out a way to do it, or if anyone can set up a quick website that would allow for it to be downloaded, as I really don’t have the time to personally e-mail it to everyone who might want a copy.
In answer to SJ, qualitative research is halted when no new themes emerge. It’s that simple. One doesn’t start out with an “n” that one needs to fill. The Jensen, however, was different. It was entirely qualitative while mine was an economic/qualitative hybrid. Furthermore, their study was part phenomenological part ethnographic, not the grounded theory (e.g. new hypothesis generation) that mine was. As such, their point was to describe the culture and phenomenon of expert clinical practice, cross referencing without outcomes, and future cross referencing between different types of therapists (e.g. expert versus non-expert). That does usually take about 40 to 60 subjects, while grounded theory generally takes less. They too stopped their study when no new themes emerged (which is what I was saying with my “tired of not hearing anything new” comment --- it’s actually a little more complicated than that). The difference is that they were trying to describe something, I was merely trying to generate possible hypothesis for further quantitative survey questioning. In other words, qualitative (grounded theory) is not qualitative (phenomenological) is not qualitative (ethnographic), in much the same way that quantitative (single subject repeated measures) is not quantitative (retrospective analysis) is not quantitative (randomized cross-over clinical trial). You may note, however, that I tried to call my 12 subject post-hoc phenomenological --- my council let it slide, but upon trying to publish in the Journal, I’ll let ya’ll in that Dr. Jensen quickly and unambiguously corrected me on the error . . . and was right to do so.
In other words, you’re no longer comparing apples to cats, but rather stuffed animals to dogs.
Rick, however, has a great question:
“My only question was about your conclusion that non-members would become members if they could do section only or section first membership. This is an interesting thought but I don't understand how you came to this conclusion, please elucidate. Would there even be sections if there was no APTA?”
This was not a de facto conclusion, but rather a repeating theme voiced among all participants. The conclusion was that the idea of entering APTA at the section level (e.g. marketing that way, but still having the price of membership as high as $179 with a portion going to support state and national activities, would result in a massive influx of new members that could (according to post-hoc economic analysis) be sustained and supported financially provided membership saturation didn’t rise above a certain level (I’ll have to look it up, but I think it was about 82% to financial break-even point if some critical assumptions were made).
Wisecracker brings up a good point about the lowering of ACA dues not having a significant impact upon DC membership saturation --- this point was not lost to the APTA when I made it at APTA headquarters.
Krager and SJ would actually have good points were the focus of the study the qualitative analysis --- it was not. The study was a hybrid of economic analysis with qualitative means to BEGIN to explain the why. The result of my study was simply that only 9% of the reason that non-members choose not to be members is price related. Prior to that, survey research suggested a number closer to 90%. My work turned that idea on it’s ear. The qualitative follow-up is best thought of as a grounded theory approach to writing the discussion as to why that may be the case and implications for future research. Nothing more.
That said, business decisions are sometimes made with this kind of information alone, and in the end, my PhD WAS as Healthcare Management degree offered through the school of business.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Why is APTA membership so low? - August 17, 2005 3:32:00 PM
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Nicole Matoushek PT MPH CSHE CEES
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Can I ask what is the percentage of Forum PT readers that are members of the APTA?
Are you also members of any Special Interest Groups?
Is there a way to run a poll on this forum to tally this, or has it already been done?
Thanks, I am really interested!
Nicole Matoushek, MPH, PT
[URL=http://www.ergorehabinc.com]www.ergorehabinc.com[/URL]
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Nicole Matoushek, PT, MPH, CSHE, CEES
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http://www.ErgoRehabBlog.com
http://www.ComputerAccessoriesOnlineStore.com
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Re: Why is APTA membership so low? - August 17, 2005 4:50:00 PM
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SJBird55
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Umm, Drew, according to Jensen and Resnik - they described their research as the grounded theory approach. They described stopping data collection when saturation occurred. (Which is a much different description to me, compared to stopping because they were tired of the same theme.) And, they did have a goal of at least 4-10 participants in each group which was why they randomly selected 30 therapists from each group.
Drew, all you presented seemed to be the qualitative portion (which I thought was the focus), so that's all I could comment on or discuss. Apparently you actually did a quantitative study which lead to your qualitative deal... you didn't originally communicate that though.
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Re: Why is APTA membership so low? - August 17, 2005 5:29:00 PM
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kragar
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I guess I just don't see how a "semi-structured" interview of a 12 person convenience sample can be used to determine much of anything. What is "semi-structured" anyway?
Did you consider an actual mailer or a "structured" interview? Just would add some meat to your conclusions.
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Re: Why is APTA membership so low? - August 17, 2005 6:03:00 PM
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Jon Newman
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According to Portney and Watkins (p. 241)
[QUOTE] This approach is called grounded theory research, in which the researcher collects, codes, and analyzes data simultaneously, identifying, relevant variables, and leads to the development of theoretical concepts that are "grounded" in the observations. These concepts are not based on preconceived hypotheses, but instead grow out of an ongoing, dynamic analysis. Each interview or observation builds on the previous ones until the data being collected become repetitious and no longer produce new information. As this process progresses, interrelationships emerge that lead to the development of theoretical concepts. [/QUOTE]Just FYI
jon
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Re: Why is APTA membership so low? - August 17, 2005 10:21:00 PM
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goodlooks58
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I have'nt had a chance to read the whole thread but I belive that I would and all PTs should pay $1000.00 each and demand the majority of that portion go to fight crap like the Arkansas case and just purely protecting the turf!!! Imagine 65000 PTs multiply by $1000 each. We can get the very best lawyers money can buy and get on an offensive mode for a change rather than take the crap like an abused spouse!!! If by paying $1000 per year buys me higher self esteem...so be it. So enough of the whinning we hear when a PT cannot "crack" a back and when our profession gets whipped by the chiros. It's happened in Arkansas and very soon it will happen in other states unless we give the right amount of money power to the people in APTA. If we do not like what they are doing in the APTA we vote them out!
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Re: Why is APTA membership so low? - August 18, 2005 1:44:00 AM
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Andrew M. Ball PT PhD
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Krager,
A mailer was considered. The problem with a structured survey or interview is that, going into the study, no one really knew what questions to ask. It's easy to look back in hindsight now that certain themes have presented themselves for future analysis . . . the problem is that at the time of my PhD study, no one really knew what those themes were. We knew that the idea that had been taken for granted up until that point was wrong --- but we didn't know why.
In a phrase, the state of the research wasn't far along enough to draft a quality survey (which frankly was my MBA training and I'd have been MUCH more comfortable with that, but my council wouldn't allow it). The qualitative study was considered a necessary pre-rec, prior to any survey research. We now have a few testable hypothesis to test with future survey research --- we didn't have that at the time. We would have been simply shooting in the dark, asking questions that we THOUGHT accounted for the 9%/90% disparity, but given how wrong we were with the first assumption, there was no reason to think we'd be any better at uncovering the truth with questions born from new assumptions. As it turned out, about 50% of the themes we could have easily guessed, but about 50% made sense and were obvious only after a participant articulated it.
In other words. Because no one really had much of an idea as to what themes would emerge that would account for the disparity between 9% and 90%, and because all we knew was that cost and price were not the same thing, a survey would have missed about 50% or so of possible hypothesis and told us little about how to fix the problem. Sure I could have drafted a survey (which was actually done in the preliminary stages), but I would have missed out on 50% of the reasons for non-membership that I'd not considered, and, like other survey researchers before me, been corrupted by good-looking stats born from a good-looking, but insufficient survey.
Semi-structured means that I had some topics that I wanted covered over the course of the interview, but that the conversation was allowed to flow without restriction --- allowing for new themes to present themselves.
Would it be helpful to post some of the questions that I asked, or a transcript of one of the participants?
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Why is APTA membership so low? - August 18, 2005 3:00:00 AM
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certMDT
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Nicole -
There was a poll on this topic about a month ago, but I don't see the results up anymore. It would be easy enough to put up another one, and as a moderator I imagine you could put a link right on the front page of rehabedge, significantly increasing traffic.
Charlie
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Re: Why is APTA membership so low? - August 18, 2005 3:52:00 AM
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Shill
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Hey all,
There would only be about 5-6 posts on this topic if we all agreed on everything. How much fun would that be? If you dont want debate, or dont want to hear people disagree or pick at your study, opinion, etc, then stay out of the kitchen.
Sometimes, if arguments arent well founded, they are simply better left ignored. Its like my kids teasing each other. If the teasee ignores the teaser, it stops. Reacting to the teaser adds fuel to the fire. It never ceases to amaze me how child like we are. (We = all adults, not just PTs).
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Steve Hill PT
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