Recently registered Specialist Katherine Forch has always been deliberate in what she wants to achieve. From a firm decision straight out of high school to become a physiotherapist, to developing the role of physiotherapy in concussion research and treatment, to persuading the Board to recognise this field as a specialty, she has maintained a steady focus on improving outcomes for kiritaki and expanding the profession itself.
“My big thing is advocating that physiotherapists have a really good skill set for concussion because it sits across neurological and vestibular, pain and sports and MSK, and physiotherapists can offer a lot in these areas of practice” she says.
“As part of that I felt it really needed its own specialist designation. That’s why I approached the Board with that reasoning and they agreed with it.”
Kathrine’s work in the field started when she joined Axis Sports Medicine’s specialist concussion team as their first physiotherapist in 2016. “I got a call from Mark Fulcher at Axis who had just got pilot funding from ACC for a sports concussion clinic and was looking for a physio with vestibular expertise. I’d been recommended to him and it started from there.
“The Axis Concussion Service is huge now. We get about a thousand new patient referrals a year across eight sites and it all started from Stephen Kara, Hannah Crosswell and me working out of this rattly old clinic in the back of the cricket club rooms.
“In terms of my career and my development in the area of concussion it’s been a pretty steep slope as far as the change of practice that’s happened in the last 10 years. For me there was really an element of being in the right place at the right time to get involved with a clinic that was really at the forefront of changing how we manage concussion and working with some fantastic colleagues who have challenged and supported me.
“For example, we published a paper in 2020, where we found less than half of our very acute sporty cohort at Axis were better within two weeks. And so, we really challenged the time frame of ‘you’ll get better in about a week, and if you don’t, then you’re going to end up being a total mess’.
“At that time people were seeing their GP at maybe six weeks after their concussion still having symptoms and they were really concerned about that because they thought it was abnormal. But actually, we know now that’s a really normal profile. The brain’s quite a complex organ and it takes some people longer than others to recover. I think that’s been a nice thing to see through my career is that people’s expectations of recovery times have shifted.”
As a practitioner with specific expertise Katherine was already consulting and teaching in the field of concussion through her company Inner Level. Becoming a specialist was a natural next step.
“The specialisation pathway was developed to recognise people who are operating at the top of their scope or providing second opinions on escalated cases. I’ve been doing that for a wee while. The recognition is really nice but also the ACC revenue side of things makes it easier to sustainably deal with these complex cases that involve a lot of report reading and writing and follow‐up.
“The push from those early specialists to get the scope recognised by ACC was vital. It’s really been great watching the scope grow in terms of practitioners. We really are standing on their shoulders – they did so much advocacy and hard work. That’s one thing I’m excited about is being able to give back to that group.”
Katherine had a particular insight into the process of becoming a specialist as she had worked as a joint‐assessor for the Board on a past specialist application and used this experience to inform her own application.
“I tried to put myself in the position of the person marking it and be very clear about signposting how the evidence links to the competency because the clearer it is the easier it is to understand the context and assess it.
“I took the same approach to asking people for letters of support, I provided the competencies that I was asking them to provide evidence of. I don’t like wasting people’s time and so I think you should try and make things as easy and efficient for people as possible.”
Her other advice for specialist applicants is to make sure their application is reviewed. “I think that it’s a really good idea if you’ve got someone who’s willing to help you in regards to that. I have found this with some of my PhD writing that if you’re too close to it, another perspective is really really helpful. To make sure that what you are saying is clear to other people, not just yourself.”
Finishing her PhD is part of Katherine’s future plans but she also wants to find ways to further grow the profession. “Part of how I want that future to look is sustainable. The dropout rate of our profession is really high, and I think that to keep engaged and feel like you’re still growing, you have to develop a niche. It’s a natural thing. You just can’t know enough about everything or stay up to date with all the evidence about everything.
“I think that’s something we should all be encouraging, and that this scope and APP help make that possible.”
