WoW Woman in Women's Health I Liz Miracle, Head of Clinical Quality and Education at Origin
Liz Miracle, PT, MPT, WCS is the Head of Clinical Quality and Education at Origin, the leading provider of physical therapy for maternity, menopause and sexual health, with deep expertise in the pelvic floor and full body.
Liz is a Texas native and graduate of Texas Woman's University School of Physical Therapy. She began practicing pelvic floor physical therapy in 2006 and has since received her Clinical Specialization in Women’s Health from the American Board of Physical Therapy Specialties. Liz was honored to both teach nationally for and chair the Academy of Pelvic Health’s Pelvic Certification committee. She has served as an Assistant Clinical Professor for the University of California San Francisco's Graduate Program in Physical Therapy since 2010 and collaborated on the creation of the first smart pelvic floor exerciser, kGoal.
After running her own practice for a decade, she was excited to join Origin Physical Therapy where she works to implement the highest standards of evidence-based care and help train the next generation of pelvic floor therapists.
When not exploring innovative ways to help her patients, she is at home hiking the hills in the North Bay of San Francisco with her husband and daughter.
Tell us a bit about your background and your projects so far.
At age 16, I chose the path of physical therapy with the lofty goal of treating basketball players in the NBA. I never imagined I would be working in women’s and pelvic health with a focus on quality and education. Within a few months after graduation from PT school I realized this was the specialty for me and worked for four years to achieve certification in pelvic health and from there my board specialty in women’s health. I then opened my own clinic and simultaneously joined the joint graduate PT program at the University of California San Francisco/San Francisco State University as an assistant clinical professor where I continue to teach PT students about pelvic floor health. Soon after, I began writing and teaching nationally for the Academy of Pelvic Health of the American Physical Therapy Association. That led me to my role chairing the committee that creates the educational materials for certification in pelvic health I myself had first received many years ago. All the while, I had a vision for creating a smart pelvic floor device that people could use without the need for the expensive outdated equipment that PTs would typically send their patients home with. I was fortunate enough to have a patient of mine introduce me to a team of engineers working to achieve the same thing. We joined forces and brought the first smart pelvic floor device, kGoal, to market. All of those ventures were in service of making pelvic floor physical therapy more accessible. When I met Carine Carmy, the CEO of Origin, I knew that their mission and vision were aligned with mine. I left behind my private practice of 10 years to join and have been so excited to be a part of this amazing team dedicated to reducing stigma and increasing education for women and people with vaginal anatomy about what happens to their body and pelvic floor at every stage of life
How did you get into this industry? Has it been an easy industry to get into or have you had many challenges?
After graduating from PT school, I became interested in pelvic health because of a conversation with my college best friend who was entering the field of obstetrics. She had a patient who had pain with sex, but she couldn’t find “anything wrong with her” and wanted me to join her on the quest to right this wrong. I was in! To become a physical therapist there was a clear roadmap to follow, but to specialize in a niche and land a job required much more tenacity and a bit of good luck. While it was challenging along the way, I feel fortunate that my foundations were in pelvic health, a specialty typically held by women. As a result, I didn’t encounter the same challenges of prejudice and wage gaps that women who attempt to enter the technology sector directly often face. After four years of patient care, I eventually decided I could positively impact more people's lives by teaching others the skills I had and became hooked on the idea of education. This was challenging because there was little room for personal development outside of direct patient care in the role I was in at the time. This catapulted me into starting my own practice to allow me the flexibility to pursue my expanded vision of what I wanted to achieve. Establishing myself as a knowledgeable provider in the Bay Area opened up opportunities in technology for me that were truly a combination of preparation meeting opportunities and being in the right place at the right time. It definitely wasn’t easy, holding down a second job while running a clinic to make ends meet, always wondering if I would need to live out of a combo of my treatment room and car. I’m grateful I found something I loved so much that I could endure the difficult times to experience the wonderful. I am also immensely grateful to every person along the way who had a hand in helping me make it in this industry because I know it wasn’t easy for them either.
How long did it take you to be where you are now? What was the biggest obstacle? What are the challenges of being in the industry you are in?
It took me 24 years to get where I am now. When I graduated from PT school there were very few clinics focusing on pelvic floor health in the U.S. The biggest obstacle I encountered was that nobody wanted to hire someone without pelvic floor experience and nobody was willing to provide the experience. Luckily things have changed. In Origin’s recent State of Pelvic Floor PT Report, we identified 2 major challenges. The first is the lack of talent to fill open positions for the 40 million+ women and people with vaginal anatomy who need care for pelvic floor dysfunction. The second is the fact that pelvic PTs are committed to compassionate care and face a high risk of burnout. I’d add to that, that reimbursement rates make it difficult to facilitate the ability for PTs to provide the 1-on-1 care that patients need at a salary commensurate with the years of training pelvic floor PTs have.
What are your biggest achievements to date?
One of my biggest achievements has been joining Origin as the Head of Clinical Quality and Education. Everything I have contributed to and accomplished thus far has led me to this place. Origin’s goal of expanding care nationwide is one I feel deeply connected to. Currently, pelvic health is primarily provided by clinics that do not take insurance and can only serve a small geographical location. While that model allows the PT to provide one-to-one care and provide themselves with a reasonable salary, it does not make the care accessible to the 40 million+ women and people with vaginal anatomy who need it. Origin is working to change that by increasing access and education. There has also been a misperception that once you scale the quality of the care you provide can no longer be matched. We plan to disrupt this line of thinking with proper quality metrics and 1-on-1 care.
What are the projects you are currently working on?
Currently, I’m working on refining Origin’s recently launched virtual postpartum care offering. The World Health Organization recommends people receive postpartum care three times in their first six weeks after birth. Currently, birthing people can expect to have one planned check-up visit in their first year postpartum. In our program, patients receive an average of six visits over three months providing them with:
Guidance on how to care for themselves in the early days of postpartum
Information on what is and isn’t normal around bodily functions like urination, bowel movements, sex
Knowledge of how to perform everyday activities like caring for and feeding a baby
An actionable plan for returning to exercise
Exercises and behavioral interventions to address any issues that arise
We see this care as setting the standard for what every birthing person deserves to have access to in the postpartum period.
We’re also working on a partnership with the Global Women’s Health Initiative (GWHI) to improve BIPOC maternal health outcomes. Data from the Centers for Disease Control and Prevention (CDC) shows that the maternal mortality rate for Black women in the U.S. is more than three times higher than that of white women. Black infants are also twice as likely as white infants to die before their first birthday.
Supporting the education and training of BIPOC doulas working in underserved communities can help prevent these devastating losses.
I’m also concurrently assisting in refining the programs available in the new sit-on-top biofeedback device, BOOST. It is the only smart pelvic floor biofeedback device of its kind that gives users the ability to see and feel what their pelvic floor muscles are doing without inserting something vaginally, making the technology more accessible to all. One of the features I love about it is that if you are working together with a pelvic physical therapist, they can recommend a custom program for you to follow, a feature other smart pelvic floor devices do not have.
Is the #WomenInTech movement important to you and if yes, why?
Absolutely. First, I believe the world deserves to have products designed and delivered by those who are using them. Selfishly, as a mother, I want my daughter and all young girls to be able to see women doing important work in technology so that they can be inspired and have a model for what success looks like. Fundamentally, women bring a valuable perspective to technology that not only provides a diversity of thought and culture but also positively impacts the bottom line.
What will be the key trends in your industry in the next five years and where do you see them heading?
I see a trend toward more virtual care on the horizon. Much of what we do can be achieved through behavioral intervention and teaching people how to feel in their own bodies what needs to change. People are busy working and taking care of families. The time they have for self-care is precious. Avoiding the time it takes to travel to a provider, find child care, or take time off work is a barrier we can break with virtual care. This is even more important in our niche when people sometimes travel hours or out of state to find a provider due to the lack of providers in the field. The inability to practice across state lines has been one of the biggest barriers to achieving a national virtual presence and our state legislatures have not moved quickly enough to address this issue. Origin has painstakingly worked to solve this unmet need.
What is the most important piece of advice you could give to anyone who wants to start a career in this industry?
It’s still a relatively small niche. Get out there and meet people. I got my first job in the field because I was brave enough to attend an urogynecology conference alone and sit down to have a conversation with people I didn’t know. You have to put yourself out there in order to get something back. I’ve learned in life if you don’t go after what you want or ask for help the answer is always no, but if you try, it just might be a yes. It’s also helpful to offer yourself up to help others. Even if you think there can’t possibly be anything you have to offer someone else who is much more experienced than you, there’s a chance you are actually able to provide some much-needed support opening up the door to possibility.
Who are three inspirational women in your respective industry you admire?
I admire MJ Strauhal, my mentor, a woman of integrity who really taught me what it was like to be someone truly dedicated to teaching evidence-based physical therapy. I picture her in my mind, pulling behind her a carry-on suitcase completely full of research articles in case anybody needed to photocopy one to understand the source behind the recommendations she made. She is someone who lifts others up to where she is, by pushing them to be better and to understand the reasons why. She helped teach the very first course I ever took and selflessly gave her time to guide me as I learned how to teach others.
I also admire Sara Reardon, aka the “Vagina Whisperer.” Sara and I have grown up in this field together. I admire the time she’s spent giving back to our profession by serving as a board member of the Academy of Pelvic Health, volunteering to support birth workers in underserved communities, teaching other therapists through continuing education courses, and normalizing the conversation around pelvic health through her work in social media all while being a mom to two boys and running her own clinic.
Most of all, I admire the late Elizabeth Noble who I feel so fortunate to have been able to attend a course before her passing. We consider her to be the Godmother of our industry. She essentially brought pelvic health physical therapy to the United States from Australia and started the Academy of Pelvic Health. Her many books and contributions shaped our field.
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This interview was conducted by Marija Butkovic, Digital Marketing and PR strategist, founder, and CEO of Women of Wearables. She regularly writes and speaks on topics of wearable tech, fashion tech, IoT, entrepreneurship, and diversity. Follow Marija on Twitter @MarijaButkovic and read her stories for Forbes here.