Research Roundup: Dr. John Childs

Dr. Childs is the founder & CEO of Evidence in Motion and partner in Confluent Health, which includes EIM; a network of 80+ physical therapy clinics; and Fit for Work, which helps employers decrease injuries and workers’ compensation costs. A graduate from the U.S. Air Force Academy, he completed an MBA from the University of Arizona and PhD from the University of Pittsburgh. Having served 20 years in the Air Force, Dr. Childs has collaborated on more than $10 million in grant funding and published more than 150 scientific papers. He is an Ernst & Young Entrepreneur of the Year Finalist, San Antonio Health Care Hero, and youngest ever APTA Fellow. Follow Dr. Childs on Twitter and other social media @childsjd.

What inspired you to go into research?

I was a physical therapist on active duty in the Air Force. I had been in clinical practice for ~4 years and was considering leaving the Air Force and pursuing a career in business. About that time, the Air Force offered me the opportunity to complete my PhD at the University of Pittsburgh. I have always been a lifelong learner so couldn’t turn down the opportunity to go back to school for additional formal education. Therefore, I didn’t intentionally set out to get into research, and the only “inspiration” was an opportunity that I couldn’t turn down. I easily said yes and would have gladly accepted any opportunity to learn. In other words, they could have offered me the opportunity to pursue an advanced clinical experience such as a residency or fellowship. I would have accepted on the spot. I basically got into research because it was the opportunity in front of me. I honestly can’t say I ever actively pursued a career in research. Research found me.

Is there anything you wish you would have known before you became a researcher?

I wish I knew how difficult it was to complete a PhD in 3 years (as a sponsored student by the Air Force, I had to be finished in 3 years). I could have better prepared my family to expect me to dedicate 60-80 hours a week to my studies. The other major piece of related advice is that you’re going to work extremely hard in any PhD program regardless of the rigor of the program and the caliber of the faculty and other PhD students. You also typically only get one opportunity to complete a PhD unless your family is crazy and willing to tolerate more. That being the case, I can’t emphasize enough pursuing a PhD in a program where you can actually learn how to do research and successfully compete for grants. This means finding a robust environment with a rich pool of mentors with a substantial track record of publications and grants. Too many individuals go through the motion of completing a PhD and basically end up no better off than where they started. It’s critical to complete your PhD having formed a network of colleagues and peers who you can collaborate with for the remainder of your career.

What area of study has your recent research been on?

I cut my teeth in clinical research, learning to perform clinical trials and identifying subgroups of patients with low back and neck pain who preferentially benefit from specific interventions. More recently, I have become interested in health services research, which examines how people get access to health care practitioners and health care services, how much care costs, and what happens to patients as a result of this care.

The problems in health care have as much or more to do with the process of care (ie, why a patient initially arrives to a certain provider with a particular problem and where they get “routed” to next) as opposed to the quality of care (ie, what intervention the patient receives).

The advent of “big data” such as large claims databases facilitate the ability to understand how patients access care and inform strategies for realigning processes of care that can improve outcomes regardless of the specific interventions that are used. For example, we’ve recently examined the implications of timing of physical therapy for low back pain and found that patients who see a physical therapist sooner rather than later consume significant less health care and therefore lower costs over the subsequent number of years.  

Can you describe how your research has evolved over the years, bringing you to where you are today?

Without being repetitive, I would describe the evolution of my research career as transitioning from one focused on clinical trials and prospective studies to more focus on health services research. One if by no means better than the other, and both play an important role in determining the value and benefit of physical therapy services.

What do you feel is the biggest hurdle between researchers and clinicians?  What are some solutions you see in overcoming these barriers?

I think Steve Rose the former Chair of the PT program at Washington University in St. Louis said it best many years ago when he said that “research needs more practice and practice needs more research.” You can’t have one without the other. Clinicians and researchers need each other and have to be in close contact and be willing to listen to one another.

There are still far too many academics who live in ivory towers and are disconnected from the real world. As such, they can easily design studies whose results will never practically have an impact on clinical practice. On the other hand, clinicians who are separated from a culture of research and evidence-based practice can easily be persuaded to chase the latest fad therapy as the next ‘magic bullet’.

Both clinicians and researchers have to resist the tendency to believe everything they think and keep an open but critical mind towards anything that sounds too good to be true. 

Can you give advice to students/practitioners, who may be considering a career in research, on how to how to find a school and researcher to work under?

There’s lots of debate about whether you can effectively pursue a career in research straight out of PT school or whether it’s best to be in clinical practice for a few years. If you’re interested in clinical or health services research, I don’t think there’s any substitute for several years of clinical experience, especially if you’re able to complete a residency and/or fellowship practice.

A few years of fast-paced clinical practice in a setting that values evidence-based practice will go a long ways towards keeping you from becoming an aloof academic living in an ivory tower designing studies that have no relevance for clinical practice.

If you’re interested in a research career more focused in the basic sciences, perhaps going straight into a PhD is more possible. However, even then, you should always look for opportunities to engage with and learn from clinicians.

At the end of the day, it’s about the patient. Anyone in research who is too far removed from the patient will be irrelevant to the real world

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