Entry-level degrees. Clinical education. Certifications. Dedicated hours of clinical practice. 

You are doing everything you can to increase your knowledge base, expand your clinical reasoning skills, and broaden your clinical experience. It's all moving in the right direction, just the way you had imagined.

And then, someone asks you: what do you do? Or perhaps it is phrased as "what does a physical therapist do?".

There is a pause. Of course, you know what you do - right?

Yesterday was a significant day for education in Texas. It was also a significant role model for health care, and we didn't even realize it.

HB 5 was signed into law yesterday. This legislation reforms public education at the high school level via revised testing, curriculum, and accountability. It was supported by TAMSA - Texans Advocating for Meaningful Student Assessments - a statewide, grassroots organization comprised of parents and other community members.

What is perhaps most intriguing about TAMSA is that it started as a group of eight moms from Austin and Houston who were concerned about state testing mandates. A group of angry moms turned into a movement that was a game changer in the Texas Legislature. Imagine that.

Now, take a moment to ponder what health care consumers could do with an effort like this. They could revolutionize health care.

Health care loves specialization. So does the world of health. Although this may allow clinicians and practitioners to become more focused on specific populations or procedures, it also creates a certain degree of fragmentation within the system. It forces a perceived necessity to do different things with different groups.

The broad expanse of health and health care is viewed as a cornucopia of disparate issues. Chronic medical conditions. Wellness. Fitness. Injury. Chronic pain. And countless other clinical entities.

We really have just one big health continuum. There is one common element to the health continuum - our daily battle against gravity.

They say that hindsight is always perfect. After celebrating 25 years as a physical therapist, and reflecting on those years, I have come to a realization, an epiphany of sorts if you will.

The profession of physical therapy is at a significant crossroads in this country. If we don't firmly and passionately define the profession - for ourselves and for consumers - then somebody else will, if they haven't already done so.

Our profession is struggling with the differences between "being" and "becoming". Therein lies the importance of “Vision Now”.

The NBA and NHL playoffs are upon us. This is the time when teams are looking for consistency, team work, and results. It is the time when your big money players need to shine, and your situational players need to step up at crunch time.

Non-evidence-based care (NEBC) is a big-name player in the starting line-up of health care. It gets a lot of minutes of game time. It makes a lot of money as a player, making it a significant draw on the team's salary cap. Sometimes it works, sometimes it doesn't.

With that in mind, let's send non-evidence-based care to the sidelines, once and for all. Here's how we might do it.

The physical therapy profession has been bedazzled by plenty of bright and shiny objects over the years. These shiny new objects have included degree escalation, alphabet soup certifications, and continuing education ranging from dry needling to visceral manipulation amongst many others.

All that has done is pull the profession further and further away from our unique value proposition. None of this has aided in defining the role of the profession for prospective consumers.

But, we can simplify all this with some simple branding.

You see, physical therapy is, first and foremost, a movement profession. Movement and function define what we do, long before degrees and certifications.

As I was walking out the door of my office one day last week, it caught my attention - the date on my diploma. There it was, the date it all started - May 28, 1988. It hit me with resounding clarity. I laughed and shook my head as I closed the door. Time sure does go by fast.

It's hard to comprehend that I have been a physiotherapist for 25 years today. That's a quarter of a decade. No wonder there are days when I feel tired.

I was once told that a person goes through, on average, five career changes in their lives. I have yet to hit the first one. With all jokes aside, it has been a long journey filled with great experiences, amazing patients, inspiring clinicians, and more challenges than I care to imagine.

After some reflection on the past 25 years, here are 25 thoughts - in no particular order - of some things I have learned along the way.

Words are powerful. Language is everything. And if you are going to map out a vision statement, it better use the right words and the right language. Otherwise, the meaning and intent can change rapidly and may in fact be counter to your original goals.

Which brings me to Vision 2020 and the seemingly incessant debate over the importance of entry-level degree relative to the development of the profession and its brand - and all of the variants on that theme.

I am convinced more than ever that the professional brand is, without doubt, far more important than the degree that you have attained to be a part of that professional brand. But what became readily apparent to me today during one of these debates is that the mechanisms underlying it lie not in skill or experience or degree. The problem begins with Vision 2020 itself.

The vision has gone awry. We're all starting to feel the effects of 10 words that truly make a difference - in intent, and in action.

The phrase "cash-based practice" has become a hot topic and trendy phrase lately. Many physical therapists have headed in this direction. My clinical practice has been cash-based since 2004.

There is a strange perception in health care that third party payment (via insurance) and cash-based practices are inherently different. Perhaps it is because of the perceived "skin in the game" that the patient has when they hand you cash (or a credit card) directly upon receipt of services rendered.

What is forgotten is that no matter how you cut it, both are cash-based. Worse yet, both are built upon a foundation of misguided incentives.