Physical Therapy at UCSF: Raising the Bar for 75 Years

In the spring of 1945, a cohort of six students became the first to earn a Certificate of Completion in Physical Therapy from the Affiliated Colleges of the University of California in San Francisco. This once-modest program has since evolved into one of the top-ranked physical therapy departments in the nation and a center of interdisciplinary research and clinical innovation at UCSF.

Today, the UCSF Department of Physical Therapy and Rehabilitation Science has grown into a clinical department with three faculty practices and more than 30 faculty members. Its three-year Doctor of Physical Therapy (DPT) program – which forms the cornerstone of a pioneering partnership between UCSF and San Francisco State University – welcomes 50 students annually, and its academic enterprise has grown to include a PhD in rehabilitation science, three residencies, and a robust research program.

This dramatic transformation can be directly attributed to the women who have led the program for the past 75 years, says current chair Amber Fitzsimmons, PT, MS, DPTSc: “Over the course of almost eight decades, my predecessors – Margery L. Wagner, Irene Gilbert, Nancy Byl, and Kimberly Topp – worked to anticipate the needs of a changing health care system and mature our physical therapy program into the dynamic and flexible department we are today. Their advocacy and determination sustained our program through the most difficult times, and their visionary leadership ensured our ongoing growth for generations to come.”

1944-1970: Margery L. Wagner Lays the Foundation

In March 1944, the Affiliated Colleges of the University of California in San Francisco, as UCSF was known at the time, began offering their first classes in The Curriculum in Physical Therapy, a one-year program in the Department of Medicine. Six students began their studies, engaging in lectures and demonstrations in the departments of Pediatrics, Gynecology, Medicine, and Surgery. In 1945, they became the first to earn UC’s Certificate of Completion in the field.

Margery L. Wagner, a well-known and highly regarded physical therapist, worked with faculty members in the Department of Medicine, as well as colleagues from UC Berkeley, to develop and organize those initial offerings, largely to help address the medical needs of injured veterans returning from World War II. Six students began their studies, engaging in lectures and demonstrations in the departments of Pediatrics, Gynecology, Medicine, and Surgery. In 1945, they became the first to earn UC’s Certificate of Completion in the field.

Initially, applicants to the program were required to hold a bachelor’s degree. But in 1947, the University added the option of earning a Bachelor of Science degree in physical therapy for applicants who enrolled in the program after three years of college or university training. Wagner taught all of the physical therapy courses until 1950, when a second full-time instructor was added; a third was welcomed in 1952. Over the next two decades, Wagner and her colleagues worked to broaden the curriculum, keep abreast of changes in health care and education, and include many aspects of rehabilitation and care for the physically disabled.

1970-1983: Irene Gilbert Leads a Fight for Survival

Following Wagner’s retirement in 1970, Irene Gilbert, PhD, a Stanford University-trained physical therapist with a master’s degree in anatomy from UCSF, was appointed director of the program.

At the time, Gilbert was working to complete her PhD dissertation in anatomy at UCSF, but juggling the role of student, teacher, and administrator did not deter her. Inheriting a program with just two full-time faculty members, including herself, she set to work developing the UCSF physical therapy program to meet growing demand from patients as well as applicants eager to enter the profession.

Gilbert steadily increased enrollment and revised the curriculum to provide graduates with intensive training in evidence-based approaches to physical-therapy care. She instilled a deep commitment to lifelong learning and professional growth in her graduates, many of whom went on to academic research opportunities and competitive residencies in the US and abroad, and to lead industry innovations in hospitals and their own private practices.

Gilbert also was a staunch advocate for physical therapy at a time when the intensive, one-year program didn’t have a true home on the UCSF campus. Gilbert also was a staunch advocate for physical therapy at a time when the intensive, one-year program didn’t have a true home on the UCSF campus and was increasingly seen by administrators as in conflict with the university’s focus on doctoral-level study and research.

An article titled “Physical Therapy Needs Room to Breathe,” in the April 1973 issue of Synapse, the UCSF student newspaper, describes how the program’s three secretarial staff were squeezed into a closet-sized office on the fifth floor of UC Hospital, while male students shared a basement dressing room with custodial staff. Decrying the lack of support from the School of Medicine, Gilbert said, “Even if this campus doesn’t understand and know what physical therapy is or does, there are lots of other people who do.”

Despite these administrative pressures, Gilbert taught a full course load and was always available to help a student or colleague in need. Michael Moore, PT ’75, who went on to residencies at Kaiser Permanente in Vallejo, Calif., and in Norway before founding his own private practice, recounts how Gilbert made time every Friday to tutor him. “For the director of our program to put aside her time to help me meant so much. I can’t say enough about how generous that was,” Moore says.

Gilbert’s fight to save physical therapy reached a dramatic turning point in March 1978 when, following the expiration of a federal grant that funded two faculty positions, the School of Medicine announced that it would be cutting physical therapy’s annual enrollment in half: from 40 students to 20. An intense public outcry and lobbying effort followed, led by alumni and UCSF students in both physical therapy and medicine, as well as practicing physiotherapists, PT societies, and concerned citizens across the state who signed petitions and wrote letters to the state legislature as well as Governor Jerry Brown.

“For the director of our program to put aside her time to help me meant so much. I can’t say enough about how generous that was.” MICHAEL MOORE, PT '75

In June, the battle reached Sacramento, where the Ways and Means Subcommittee, led by Assemblyman John Vasconcellos, demanded that the UCSF physical therapy program be maintained at its 40-student level, else the entire UC health sciences budget be put on hold – an extremely rare case of Sacramento intervening to save a UCSF program.

With the physical therapy program at UCSF safe for the time being, Gilbert continued to update the curriculum to stay abreast of new developments in the field and changing educational standards. Gilbert was also deeply committed to the development of a master's degree in physical therapy at UCSF. Sadly, her ambition was cut short when she passed away unexpectedly in 1983.

After Gilbert’s death, physical therapy was once again placed on probation by the School of Medicine. But the program’s salvation would come in the form of Nancy Byl, an alumna and former UCSF clinician, whose vision and political acumen would finally demonstrate just how important physical therapy could be to UCSF’s long-term clinical, educational, and research missions.

1985-2007: Nancy Nies Byl Brings A New Vision

The sudden loss of Irene Gilbert in 1983 once again imperiled physical therapy’s place at UCSF. It was a difficult time for PT students as well, who were required to learn the same anatomy curriculum as their peers in the MD program but in a much shorter time frame and with very little professional recognition.

“At that time, you could only practice physical therapy with a physician’s referral. We weren’t even permitted to evaluate patients,” recalls Wendy Katzman, PT, DPTSc ’06, an alumna of UCSF’s Doctor of Science in Physical Therapy (DPTSc) program and professor emeritus who began her career as a practicing physical therapist in the 1970s.

Into the leadership vacuum at UCSF stepped Nancy Nies Byl, PT, MPH, PhD, FAPTA, a visionary clinician and scientist who would elevate the research mission of physical therapy at UCSF, establish and nurture a thriving faculty practice, and create a pioneering educational partnership with San Francisco State University.

An alumna of the BS program (Class of 1963), Byl recognized early in her career that, as she put it, “very few people in health care knew much about physical therapy.” After earning a Master of Public Health degree in medical care administration from UC Berkeley in 1969, she carved out a new role for herself at UCSF, telling the chair of the Division of Community Medicine, “I think you need somebody in physical therapy to be part of your team.” She soon joined the faculty, teaching in the clerkships in ambulatory care for medical and pharmacy students. Every morning, before the medical students came to see their patients, she would leave them notes: ‘You might refer this patient to social service.’ Or ‘This patient might be able to benefit from strengthening exercises and the use of a cane,’ planting the seeds of cross-disciplinary clinical training that would later become standard practice at UCSF.

Byl’s varied career took her from San Francisco to Guam, where she taught deaf students while stationed there with her husband, a naval officer. In her quest to understand everything she could about the confluence of physiology and brain health, she earned numerous degrees and fostered trailblazing research partnerships, doing work that has impacted our understanding of stroke, brain trauma, Parkinson’s, and even wound care.

After serving as director of rehabilitation at Pacific Medical Center and Children's Hospital and earning a PhD in special education, Byl returned to UCSF in 1985 to take the reins of the struggling PT program.

She immediately began instituting changes that would ensure the physical therapy program’s long-term stability and propel it to new heights. Her experiences as the first physical therapy consultant in UCSF’s medical clinics would prove integral to the program’s future.

“Nancy was savvy,” says Katzman, “She understood that demonstrating the value of physical therapy as part of a medical team was the key to bringing the department to a stable place on the campus.”

By 1990, Byl had established a faculty practice that assumed leadership of outpatient physical therapy services for UCSF Medical Center. In 1993, it became an official clinical department within the UCSF School of Medicine, which, as Byl recalls, “was almost unheard of at the time because there hadn’t been a new department added in the School of Medicine in more than 20 years.”

While the physical therapy faculty practice helped to secure the department’s place on campus, its long-term impact is much more profound, says Kimberly Topp, PT, PhD, FAAA, a faculty member who would succeed Byl as chair.

“The faculty practice is crucial to every aspect of our work,” Topp says. “It is a service to the community, providing outpatient care to nearly every patient who comes through UCSF. It supports the transformative research of our faculty and students. And our Doctor of Physical Therapy students train in the faculty practice, gaining invaluable experience with patients in an outpatient setting.”

At the beginning of her tenure, Byl made another savvy move: She began working with colleagues at San Francisco State University (SFSU) to develop a joint master’s degree program. This pioneering program, which admitted its first full class in 1990, brought a diverse new influx of students to UCSF, who in turn would have the exceptional opportunity to practice in a large academic medical center.

By 1998, the joint Master of Physical Therapy program had evolved into a Master of Science degree, acknowledging the robust scientific research component and intensive coursework. Beginning in 2002, qualified students could continue their clinical training with the DPT program, while the DPTSc degree, a research-based program that launched the same year, solidified the department’s commitment to physical therapy research and innovation.

“I’m proud of the spectacular faculty team we assembled and that our bid to become a clinical department in the School of Medicine was successful,” Byl recalls. “We were able to elevate the overall quality of our program by creating the post-professional DPT and offering the DPTSc degree, which led to greater academic strength and financial stability for the program.” Katzman, who earned her DPTSc during Byl’s final year as chair says the research and mentoring opportunities she had at UCSF were wonderful: “During my doctoral program, I had a mentor who was a physician in the Department of Medicine and a research mentor in the Institute for Health and Aging as well as mentors in my own department. Nancy’s leadership was crucial to that integration.”

2007-2018: Kimberly Topp Forms New Connections

For more than two decades, Byl had steadily improved the department’s financial resources, academic standing, and profile on campus. When she stepped down in 2007, the program looked to Topp to lead as the next chair.

Topp, who earned her BS in physical therapy from Northern Arizona University and her PhD in anatomy and cell biology from UC Davis, joined the faculty in 1993 after completing a three-year postdoctoral fellowship in neurobiology at UCSF. A faculty member with a joint appointment in anatomy as well as in physical therapy and rehabilitation science, Topp began leading innovations at UCSF long before stepping into the chair role.

“As the lead for the anatomy curriculum in the School of Medicine, Kim started integrating physical therapy students into medical student anatomy training,” Katzman says. “This is a huge innovation that Kim initiated. Now all of UCSF’s medical school graduates recognize the contributions and expertise of physical therapists because the physical therapy students are involved in teaching them.”

Topp quickly moved to build on the accomplishments of her predecessor. “I was able to pick up where Dr. Byl left off,” she says. Topp oversaw the transition of the joint UCSF-SFSU master’s degree into a new, entry-level DPT program, ensuring that all UCSF physical therapy graduates had doctorate-level training. With an ever-increasing number of students coming to UCSF eager to lead research in academic and industry settings, Topp transitioned the DPTSc degree to a PhD program that welcomed its first students in 2017.

To meet growing demands for postdoctoral training opportunities, Topp tapped alumna Erin Green, PT, DPT ’09, to develop and lead the first physical therapy residency, in orthopedics, which launched in 2018. It was so successful that two more residency programs soon followed – the acute-care residency at UCSF Medical Center and a sports-medicine residency through UCSF Benioff Children’s Hospital Oakland. Topp also helped design the Anatomy Learning Center and the interdisciplinary Clinical Skills Center at UCSF’s Parnassus Heights campus.

Under Topp's leadership, the PT Faculty Practices expanded to support more than 35 clinicians and include locations at UCSF campuses across San Francisco. “What I value and respect about the program,” says Green, who is now an assistant professor in the Department of Physical Therapy at CSU Sacramento, “is that everyone is committed to excellence and growth. Nancy ran the program at a high level, and you could see improvements every year. Kim continued that legacy when she took over.” Under Topp’s leadership, the PT Faculty Practices expanded to support more than 35 clinicians and include locations at UCSF’s Mission Bay and Mount Zion campuses and at UCSF Family Medicine at Lakeshore in southwest San Francisco. The physical therapy core faculty grew to 20 members who had joint appointments in anatomy, neurosurgery, orthopaedics, and radiology and biomedical imaging, among others.

“Kim recognized the importance of interdisciplinary collaboration and research,” Katzman says. “While Nancy was focused on getting physical therapy recognized as a clinical practice and academic program, Kim got us integrated into clinical training and research across the campus. We’re connected with the School of Medicine; our students have interprofessional education experiences with students in the schools of Dentistry, Medicine, Nursing, and Pharmacy; our PhD students are able to do electives in labs across campus – these interdisciplinary educational opportunities are unique to UCSF.”

Topp was equally committed to maintaining connections with alumni. “I was so impressed and taken aback by how Kim reached out to me and other UCSF graduates,” says Moore, who was one of several alumni that Topp recruited as volunteer instructors. “She had a personal touch that made us want to participate.”

Topp stepped down as chair in 2018, but her focus on interdisciplinary partnerships has had a long-term impact on the amount of research funding generated by the department’s faculty. On average, UCSF physical therapy faculty members – several of whom are also UCSF graduates – receive annual research funding that far exceeds the national average in the field.

“Collaboration has always been an important pillar of our department,” Topp says. “And as the department continues to grow, opportunities will arise for additional residencies and for research-focused faculty members in many areas at UCSF, including the neurosciences, informatics, robotics, pelvic health, geriatrics, and social and behavioral sciences.”

2018-Present: Amber Fitzsimmons Looks to the Future

A commitment to stay on top of emerging patterns in health care and education has been a hallmark of the UCSF physical therapy program since its inception and continues today under Fitzsimmons’ leadership.

“At UCSF, we believe that movement is foundational to every system in the body and is a core element of overall health,” she says. “Our field has an enormous opportunity to use movement as the first line of defense for many types of disorders, including chronic disease and the impact of persistent pain – rather than opioid use, for example.”

As part of that effort, Fitzsimmons acknowledges the continued need to adapt to changing health care delivery models, which includes the pursuit of virtual physical therapy – a crucial innovation in the age of COVID-19 – and other types of digital health technologies.

The department is also incorporating principles from precision medicine and genetics into the field of rehabilitation, “It’s important for us to be familiar with these concepts and translate them to the types of individualized dosing we provide for rehab,” Fitzsimmons says.

Building on the achievements of Byl and Topp, Fitzsimmons envisions a comprehensive program in which patients throughout the UCSF Health system – from acute care to post-acute rehab and outpatient ambulatory services – will be able to access the department’s expertise in occupational, speech, and physical therapies. Expanding these services would also create new opportunities for interdisciplinary training between UCSF’s physical therapy, nursing, and medical students, she says.

“This kind of holistic, comprehensive program was inconceivable in 1945,” Fitzsimmons says, “but the progress of the past 75 years has laid the foundation for making it a reality.

“Our department is thriving now,” says Katzman, “Colleagues across UCSF respect our program and rely on the expertise that we bring to the table. And our faculty, students, and alumni are prouder than ever to be associated with physical therapy.”

Green agrees, “You can speak with alumni who graduated 20, 30, even 45 years ago, who still feel connected on a professional and personal level to the Department of Physical Therapy and Rehabilitation Science at UCSF. It’s a palpable and lifelong connection.”

 

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The Evolution of Physical Therapy Education at UCSF

• 1944: Physiotherapy course first offered
• 1945: Certificate program in physical therapy established
• 1947: Bachelor of Science degree in physical therapy first offered; becomes only the second bachelor’s-level degree offered at UCSF (the first was a BS in nursing)
• 1989: Joint graduate program with San Francisco State University (SFSU) established; first offering is a Master of Physical Therapy (MPT) degree, followed by a Master of Science (MS) degree in physical therapy
• 1993: Program in Physical Therapy becomes the Department of Physical Therapy and Rehabilitation Science, a clinical department in the School of Medicine
• 2002: Two new programs launch: the Doctor of Science in Physical Therapy (DPTSc) degree and a joint Doctor of Physical Therapy (DPT) degree with SFSU
• 2007: Joint DPT program with Fresno State University welcomes first class
• 2017: UCSF replaces the DPTSc program with a PhD in rehabilitation science
• 2018: Department’s first residency, in orthopedics, is approved
• 2019: Acute-care residency begins at UCSF Medical Center

Recognition and Accolades

The women leaders of physical therapy at UCSF have been recognized nationally for their expertise.

• Margery Wagner was elected the first chairman of the American Physical Therapy Association’s (APTA) nominating committee, an important driver of research efforts in physical therapy.
• Nancy Byl was named an APTA Catherine Worthingham Fellow.
• Kimberly Topp served as president of the American Association for Anatomy and helped create benchmarks for excellence in physical therapy education within the American Council of Academic Physical Therapy.
• Amber Fitzsimmons is a fellow of the National Academies of Practice with expertise in interprofessional education, health equity, diversity, and inclusion.

UCSF and SFSU: Remarkable Partners

2020 also marks the 30-year anniversary of the first full class to enter the joint physical therapy program at UCSF and San Francisco State University (SFSU). Here are some of the colleagues who have ensured its growth and success:

• Roberta Bennett, PhD, SFSU professor of kinesiology, collaborated with Nancy Byl to develop the program’s structure and curriculum
• Ann Hallum, PhD, PT served as the program’s first chair at SFSU
• Marsha Melnick, PhD, PT, UCSF/SFSU doctor of physical therapy (DPT) program chair from 1997 to 2002, helped lead the development of the joint Doctor of Physical Therapy Science (DPTSc) program
• Linda Wanek, PhD, PT, UCSF/SFSU DPT chair from 2002 to 2020
• Jeanette Lee, PT, PhD, current UCSF/SFSU DPT chair