From Rural Private Practice to the Emergency Department

When I first met Dr. Keith Roper, I was roped in immediately by his affect, his clinical knowledge, and his patient centered approach. Learn more about how he transitioned from the “the only PT in town,” to a skilled clinician in a busy Emergency Department in an urban academic medical center.

Dr. Roper has worked for the University of Utah since 2016 and currently works at University Orthopedic Center in Salt Lake City, where he has a special interest in chronic pain.  He has spent over 3 years working in the University Hospital ED, specializing in back pain, general MSK issues, pain, vertigo, and falls. Prior to moving to Utah, he spent 26 years in private practice in rural Northern California.

Describe how you became involved in Emergency Department (ED) Physical Therapist Practice. 

I was treating a person for low back pain in the outpatient (OP) setting who was an Emergency Medicine provider.  They mentioned that back pain is challenging for them to manage and they felt that the type of care I had given them would be beneficial for people attending ED for back pain.  It started as a trial and proceeded to be positively received and grew from there.  

Describe your practice setting and ED PT model. 

We are an urban, academic, Level 1 trauma center with about 50,000 visits per year.  We had a collaborative care model with providers consulting me at their discretion.  At the time there was also an urgent care directly across the hall and I was frequently consulted in the urgent care setting as well.  I additionally advocated, as we all do, with the providers for patients I felt PT would be beneficial for.  One unique thing about my setup was that I kept one clinical day in OP and had rapid access spots for ED so that people could be followed up by the same PT that saw them in ED. 

Why do you think this is a valuable practice area?  

The personal and economic impacts of persistent pain are staggering, and persistent pain is a global epidemic.  Our current approaches to managing pain have led to catastrophic failure and a worsening of the problem.  The best way to reduce persistent pain is to improve management of acute pain and get people to the right place in the medical system at the right time.  

There is also an incredible burden from providing inappropriate or unnecessary care in our western medical system.  Research is demonstrating the value of having PT available in ED for reducing advanced imaging, reducing reliance on pharmaceuticals, and reducing downstream healthcare utilization.  Some of our unpublished data is suggesting that seeing a PT in ED can significantly reduce recidivism, or bounce-back to the ED.

What was the biggest adjustment for you in practicing in the ED?

I showed up day one with nothing, just me.  No equipment, no tools except my hands and my brain.  Learning to work around the other people coming and going, having treatments interrupted by trips to imaging, MD consults, etc, working on a hospital bed, having to educate the providers why they should use me and proactively seeking out people to be involved with.  

The unpredictability was a big one, having hours with no one followed by having several people at once and being able to triage and modify my interaction with each person to provide something valuable without impeding the flow/throughput of the department. 

Coming from OP, there was a challenge in thinking around just seeing a person once.  Of course I was referring to OP, but just figuring out what the one thing that the person needs most right now took some time to figure out. 


Do you have an area of specialty? 

I enjoy working with people who have pain.  Acute pain that is worrisome, or persistent pain that they are seeking answers for.  Because pain management/persistent pain is the area I am the most passionate about I did get a Therapeutic Pain Specialist Certification through EIM.

What barriers did you have to overcome personally and within your facility to practice successfully in this environment?  

My biggest barrier was convincing providers that I belonged there.  I was on loan from OP and had no connections with people in the hospital so I had to find my own way, make connections, figure out what I needed and how to get it.  I had to figure out what I was supposed to do and how to help people.  They had no idea how to utilize me and I wasn’t sure what I was going to do and had to figure things out on the fly.  

Also, the usual of getting past the impression that I was there to give massages or give people a bunch of exercises.  

What is your philosophy about what makes an ideal ED PT? 

Curious, confident, compassionate, creative, good communicator/educator, collaborative, flexibility, relationship building.  Thinking and managing people within something like a biopsychosocial framework. 

What was your biggest win in the ED?  

Convincing particular providers that I belonged.  At first, and for quite some time, there were physicians who didn’t utilize me at all and made it clear they didn’t feel I belonged.  When one of them would finally recognize/admit that I had been valuable in a patient encounter it felt like a big win.  


To this day I have providers tell me that they manage people differently based on what they learned from working with me, that feels like a big win. 


For More From Dr. Roper

Hear or watch our full interview. Connect with Dr. Roper on Linked In, or on Twitter @keithroperDPT.

Join Dr. Roper & Dr. Griffith for a free journal club this Tuesday night! Register here.