Eric Blanchard

First off, I apologize if this topic has come up before. Bits and pieces seem to come up within the Starting Strength forum/resources/community but I wasn't able to find any discussion at length on the topic. I would also like to thank the Starting Strength community, particularly Mr. Rippetoe, Dr. Sullivan, Dr. Feigenbaum and Dr. Baraki for renewing my passion for strength training as I come out of residency and begin a family practice in Canada.

Why can't strength training be a part of primary care? I appreciate the challenges that were raised on the Barbell Medicine podcast re: producing high level, practice changing research, but do we really need such studies? I also agree that strength training is hard, people are lazy and that getting patients (let alone other HCPs) to buy-in to strength training is an uphill battle. However, considering the heavy burden of preventable diseases and increasing healthcare costs, it stands to reason that the system will eventually wake up to the fact that investing in strength training is good medicine. This is particularly true in a public, single-payer, system.

I'm excited about the new Steady MD initiative that Dr. Feigenbaum and Dr. Baraki are undertaking. This is a huge step in the right direction. I'm also envious of what Dr. Sullivan has going on. Why can't that be a part of a family medicine/ primary care practice? The potential legal, ethical and financial repercussions not-withstanding.

I live in a rural community of 4000 in Ontario, Canada, with a catchment of like 20,000. There are 6-8 practicing physicians at any given time. I am just starting off with 500 patients and will grow to a practice ~1500 over the next year. My goal would be to have a well-equipped gym in my clinic for my patients but don't see this being economically sustainable (not yet anyway) and the medico-legal implications are daunting. To overcome these limitations, I'm planning on opening a facility similar to what Dr. Sullivan has going on. Unfortunately, I will need to have a slightly broader membership initially to make the project sustainable. At first I may not allow my practice patients to join, as I'm not sure how best to navigate the patient-physician relationship in this setting.

Are there are other PCPs on this forum attempting to incorporate strength training into their medical practice? Any thoughts/ suggestions?

Pluripotent

I think it depends on what you mean by "part of primary care." If you mean that a physician-trainer would get reimbursed by Medicare or Canada Care (I forget what they call it), then probably never. These agencies would rather you die sooner to decrease recurring costs for the elderly (I know I'm cynical, but am I wrong?)

If you mean that physicians routinely recommend it to their patients.... That's also a tough question, because how many of them are going to recommend something that has a chance of actually making a difference? And since they won't be paid, and most people won't do it anyway...

I will tell anyone who I think is genuinely interested and/or I think might do it, so naturally it rarely comes up.

PhillyMike

Enjoy the read, it's a spooky ride ahead...

I recently was asked to interview for a strength and conditioning position working with a local physical therapist coaching hockey players. Why a physical therapist attracts that type of business from teams/coaches is a conundrum already but I figured I'd check it out.

The conversation started fine, we spoke about my previous experiences working with athletes and my education/certs. She asked me how I felt about the industry as a whole and I was honest. It stinks all over. I mentioned not once encountering anyone who has failed a crossfit cert, how the NSCA's "Journal of S&C Research" is cranking out embarrassing articles such as "what creates more abdominal muscle contraction: Single hand or two-hand kettlebell swings," or that 99% of my former exercise science classmates I wouldn't let train anyone I know.

She sat and agreed with me and then told me about the push in the PT realm: "To hopefully some day have a licensing program for personal trainers that the physical therapy community would have their hand in and it would hopefully include needing a bachelors in exercise science to be a personal trainer."

I told her that is a terrible plan, I trust my own clients I have coached over the years over anyone nowadays with their exercise science degree. If they could actually get that to work, Rippetoe would be considered unqualified to train people. Wtf? I sat through her telling me about how to train hockey players while never once mentioning anything to do with strength training but mostly interval training on a turf field, about her own career as a recreational running athlete, and how she trains a lot with TRX suspension stuff.

Spooky stuff, and she wants to dictate how we train people.

Lastly I wanted to say that I have learned absolutely nothing over the last 3 years from the NSCA but find myself reading everything Rip/SS posts on here or the Facebook page and can say I learn something probably every single time. I don't know when but I plan to put my name behind the SSC cert because just from the stuff you publish alone I feel like I owe you something and would love to drop the NSCA because the more serious coaches who leave the NSCA, the better.

Brodie Butland

This brand of licensure is particularly egregious. As little justification as there is for licensure, there is even less for licensure run by physical therapists, who specialize in people with physical disabilities. That's the shit sandwich that DC was about to bite into before Crossfit did a full court press on their city council. Would have been terrible for the city.