Autonomous Physical Therapy Practice

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In light of the (potential?) new PTCAS essay question, I've been researching Autonomous Physical Therapy practice and was wondering if anyone out there wanted to weigh in?

What does everyone think of the idea?
Do you really think its possible/probable that it will be enacted by 2020?
Are some states more likely to enact than in others?
Are you in favor of it given that it seems there would be a big increase in responsiblity (but also independence) for PTs?

I'm not looking for anything I can use in an essay. I'm just looking for real life, personal opinions from PTs on how they think it would affect their lives/careers and if they think it's really going to happen...

Are you aware that many states already have this?

No.
That's not what I've gotten from the things I've been reading.
I thought that was why it's "Vision 2020" because it is things they hope are enacted by 2020?
And everything I've read talks about it as if it's something being considered, not already in place.

What states already have it?
I'm not referring to Direct Access. I know many states do have that.

In the state of WA we recently enacted legislation that provides Direct Access however it can hardly be called that considering that almost every patient has to get a prescription from a Doctor for their insurance to cover their treatment.

The profession has done a great job getting legislation passed however because of they way things are set up, the insurance companies have all the power.

We need to begin to demonstrate that PT is a cost effective manner of treatment so that the penny pinchers at the insurance companies will lighten up.

But Direct Access and Autonomous Physical Therapy practice are not the same thing...?

Originally Posted by Kismet426

But Direct Access and Autonomous Physical Therapy practice are not the same thing...?

What is the difference between autonomous PT practice and direct access?

Yeah the main problem is insurance companies. They require an MD script for reimbursement, as they don't trust our ability to rule out/red flags.

Originally Posted by NewDPT31

Yeah the main problem is insurance companies. They require an MD script for reimbursement, as they don't trust our ability to rule out/red flags.

"Yeah the main problem is insurance companies. They require an MD script for reimbursement, as they don't trust our ability to rule out/red flags."

Again, that's not true in every state

It doesn't matter if PT is direct access unless insurance companies cover the cost. I think direct access (with insurance coverage) is a great idea and would help a lot of people. My dad has back pain sometimes, but doesn't bother to see a physician for it because all they do is give him pain medication anyway. But if he could go straight to a PT and learn some exercise for his back, I think he would. More people would choose to see PTs for the little things (which is good, because that is before they turn into big things). Some PT clinics even offer weight management help-if insurance would cover that, that would be great.

Physicians wouldn't want direct access PT because they want the money that comes from giving surgeries, drugs, and even the cost of the initial visit when the physician refers the patients to PTs. Physicians have a louder, more respected voice than PTs, so we don't have a chance there. Unfortunately it's not about the patients, it's about whose in power (compared to us, physicians and drug companies are) and how those in power get the most money. I think we'll see insured direct access PT when those with power in the health system start caring about patients more than their pockets. Unfortunately, I don't see that happening anytime soon. interesting article on the subject: http://blog.myphysicaltherapyspace.c...ee-market.html

Originally Posted by puppypaws

What is the difference between autonomous PT practice and direct access?

To me, direct access is legislation designed more for the patient than the provider. It gives the consumer the freedom to chose who they see when. As providers, we support it because it gives us better business.
Autonomous pt practice is designed for the provider. It's a goal that targets the healthcare profession and seeks to try and show PTs are able to operate independently instead of under or "below" if you will the direction of MDs/DOs.

I disagree with the notion that direct access is the only way a PT is autonomous, especially in the outpatient world whenever a patient comes to PT they are there under their PT's supervision most of the time there are no MDs in the facility thus putting the PT in an autonomous situation....

First of all, I don't think that the characterization of the physicians wanting the $$ for the initial evaluation is accurate most of the time. Sure there are some, but the docs in our clinic would rather not see that tennis elbow patient.

Secondly, more and more insurance companies are allowing PT without a referral. Have your patients call the customer service line on their insurance card and ask if PT requires a referral. Lately, when my patients have done that, they are more likely than not to actually have functional direct access.

As far as am I comfortable with PTs being autonomous? I don't think that any good health care practitioner is ever autonomous. We are always a member of a team. Are we responsible for our actions and interventions as a professional? ALWAYS. If a physician orders something that we professionally do not agree with it is our obligation to our patient, ourselves, and our profession NOT to do it. We need to recognize what is "other" or something outside our scope. Are there PTs who I don't think do much problem solving, absolutely. Do the vast majority recognize when there is a red or yellow flag? absolutely.

I am personally fine with PT direct access and until someone demonstrates that PTs miss more serious things than primary care MDs, DOs, DCs, FNPs, or PAs then let it happen. People aren't going to come to PT for digestive problems, general malaise, excessive weight loss, yellow eyes, cough etc . . . They are going to come for aches,pains, and injuries. We are good at that.

How did I complete my ptcas application in November 2011 and I really don't remember seeing or hearing about said essay question! Wtf! I did not answer a question such as this in my application. Oh god

Originally Posted by wjs010

How did I complete my ptcas application in November 2011 and I really don't remember seeing or hearing about said essay question! Wtf! I did not answer a question such as this in my application. Oh god

It will be for next cycle not 11-12

Oh good! But damn I'm still gonna have to do it


Sent from my iPhone using SDN Mobile app I will accept any pt school at this point. I cannot sleep

I did not want to hi-jack this thread but I did have a question that is an offshoot of this topic. I started a thread if anyone would mind chiming in.

I know this forum isn't meant for pre-PT/application posts, but the new PTCAS essay question is a current issue in the PT world and I am really hoping to glean some wisdom from you seasoned professionals. The new essay question is:

"Autonomous practice is a goal of the American Physical Therapy Association. What does autonomous physical therapy practice mean to you and what characteristics do you display that would allow you to contribute to this practice goal?"

I would like to start by saying that any input would be a huge help! As I understand it, the major limitation right now is insurance companies unwillingness to pay for PT without a physician's referral- is this correct? And will this problem be solved through legislation, or privately, through appeals to the insurance companies themselves? I think I understand the goals of autonomous practice, but any information on the more controversial aspects or specifics would be fantastic.

Also, on a side note... I currently work as a therapy assistant at a chiro office. Since chiropractors are allowed autonomous practice, I would really like to include some of my experiences there in my essay, but I am concerned about how the PT world looks at chiropractic medicine. Would it be better to downplay the chiropractic tie instead?

Thanks in advance for your time!

Originally Posted by hoosier24

I know this forum isn't meant for pre-PT/application posts, but the new PTCAS essay question is a current issue in the PT world and I am really hoping to glean some wisdom from you seasoned professionals. The new essay question is:

"Autonomous practice is a goal of the American Physical Therapy Association. What does autonomous physical therapy practice mean to you and what characteristics do you display that would allow you to contribute to this practice goal?"

I would like to start by saying that any input would be a huge help! As I understand it, the major limitation right now is insurance companies unwillingness to pay for PT without a physician's referral- is this correct? And will this problem be solved through legislation, or privately, through appeals to the insurance companies themselves? I think I understand the goals of autonomous practice, but any information on the more controversial aspects or specifics would be fantastic.

Also, on a side note... I currently work as a therapy assistant at a chiro office. Since chiropractors are allowed autonomous practice, I would really like to include some of my experiences there in my essay, but I am concerned about how the PT world looks at chiropractic medicine. Would it be better to downplay the chiropractic tie instead?

Thanks in advance for your time!

I would be very disinterested in considering you for PT school if you put you were a "therapy assistant" for a chiropractor. Immediate turn off for me. You are a chiropractic assistant, or chiro tech.

Originally Posted by Fiveoboy11

I would be very disinterested in considering you for PT school if you put you were a "therapy assistant" for a chiropractor. Immediate turn off for me. You are a chiropractic assistant, or chiro tech.

I think you can mention your chiro experiences in a general sense (interacting with patients, satisfaction of helping people, etc.), but keep the chiro-specific references to a minimum in this case. And I agree with FiveO; go with chiro assistant, not therapy assistant.

(By 'you' I mean the OP)

Thanks for the input, I will try to figure out a different way to describe it... To clarify, I am referred to as the therapy assistant within the office because I work specifically with the therapies (exercise instruction, Graston, e-stim/ultrasound) and work with a PTA. There is a separate chiro assistant that does most of the paperwork, x-rays, myovision, foot scans, etc.

Originally Posted by hoosier24

Thanks for the input, I will try to figure out a different way to describe it... To clarify, I am referred to as the therapy assistant within the office because I work specifically with the therapies (exercise instruction, Graston, e-stim/ultrasound) and work with a PTA. There is a separate chiro assistant that does most of the paperwork, x-rays, myovision, foot scans, etc.

Therapy assistant sounds fine to me. I cannot imagine a school during the application process and interview would find this offensive at all. I know the Univ I have been faculty for would not, although that is only 2. Faculty and Adm Cmte know that your job title is not picked by you; you just work. Likewise when we hear applicants tell us they progress exercise programs as a PT tech, we know the applicant has no idea this gets very close to illegal in our state, and borders on unethical for sure. But that is the PTs issue and not the Tech who is not licensed and just doing what they are told.

But back to the original question. Sandstrom (Phys Ther.2007;87:98-110) may have some information you may find useful. The article is a little old, but may give you a starting place for your essay question.