Physical Therapy or Physician Assistant

[lawguil]

I wonder what the likelihood of PTs being added to the NHSC list actually is. People have strokes in undeserved areas as well. I guarantee they would be filling needed positions.

I suspect there is a reason and can only speculate. My initial thought is that perhaps their isn't a shortage of PT's these same areas that are underserved by medical providers.

Again I don't know the numbers, but my expereience tells me that a PT can serve a fairly large population.

As an example, I'm from rural New England. In my hopetown their are two PT practices (outpatient) and 2 nursing homes. One of the PT practices provides for all inpatient care at the hospital.

My guess is that the entire area is served by about 12 PT's or less.

Compare that to the nubmer of primary care providers...it's probably over 100. I know of about 25 NP/PA's, mostly NP's. They are in such need for PA/MD's, but they can't recruit them. They leave faster than they can get them. Sometime I'll try to figure out the actual numbers......L.

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[Dr 14220]

If you have ever been in an outpatient ortho clinic you would know that most of time the diagnosis sent by the physician is crap (sorry but thats the best description I could think of) and often very vague. As far as taking history and performing physical exams, we do that better than any PA and most of physicians. I lost count of how many times a pt said that their physician barely even examined them. And as far as PTs not being able to prescribe meds, thats great! Thats the essence of our profession! We treat our pts one-on-one instead of shoveling pills down their throat. And in my opinion, this drug-dependency is one of the main causes for americans' poor health in general.

That is a joke--i hope. if not then its just laughable.

A physician or PA working in say, emergency or internal medicine is trained to examine and workup complaints involving every organ system in the body.

but yea. if i ever see a patient with a vague compliant such as abdominal pain or chest pain....ill see if i can run down a PT to do the history and physical....your clearly the best at doing such.

listen, some of my best friends are in the PT program at the same school where i am in the PA program. they know a ton (much more than i do) regarding musculoskeletal and sometimes neurological disorders. i know this, and expect it, because afterall--this is what they learn in PT school. at the same time, i know i can take a much more thorough history and perform a physical exam in every organ system to cover hundreds of possible internal disorders to rule in/out a diagnosis. i can do this better than them, and they would agree--because...this is what we learn in PA school. give me a break.

and yes, medication is totally useless. why should medical providers prescribe all those anti-hypertensives?? they should totally just let the patients go into heart failure or stroke out--those idiots!

 

[lee9786]

Medication has its place but is often overutilized in our society creating dependence. Diet and weight maintenance are secondary concepts people like to ignore but are the source to a number of problems contributing to the escalation of healthcare costs. This being said even if everybody ate a healthy diet with a healthy BMI people are still going to have cancer, HTN, CVD. For this they go to the MD/DO,PA,NP for medical diagnosis because like dr. said this is not what PTs learn in school. Which brings up the concept of direct access. Do PTs learn the necessary knowledge and skill in PT school needed to handle the responsibility of direct access? I hope so. Otherwise it will never happen because people will be getting injured leading to people getting sued increasing malpractice insurance for PTs which will increase costs all in the face of continual decreasing reimbursement from third party payors making the business model for PT utterly unsustainable. Maybe I'm overthinking this. I wonder if the APTA has.

 

[lawguil]

That is a joke--i hope. if not then its just laughable.

A physician or PA working in say, emergency or internal medicine is trained to examine and workup complaints involving every organ system in the body.

but yea. if i ever see a patient with a vague compliant such as abdominal pain or chest pain....ill see if i can run down a PT to do the history and physical....your clearly the best at doing such.

listen, some of my best friends are in the PT program at the same school where i am in the PA program. they know a ton (much more than i do) regarding musculoskeletal and sometimes neurological disorders. i know this, and expect it, because afterall--this is what they learn in PT school. at the same time, i know i can take a much more thorough history and perform a physical exam in every organ system to cover hundreds of possible internal disorders to rule in/out a diagnosis. i can do this better than them, and they would agree--because...this is what we learn in PA school. give me a break.

and yes, medication is totally useless. why should medical providers prescribe all those anti-hypertensives?? they should totally just let the patients go into heart failure or stroke out--those idiots!

I don't believe anybody took soccer31's "opinion" seriously! A PT is sort of a non-medical specialist of the musculoskelital system....that's it.

 

[lawguil]

Medication has its place but is often overutilized in our society creating dependence. Diet and weight maintenance are secondary concepts people like to ignore but are the source to a number of problems contributing to the escalation of healthcare costs. This being said even if everybody ate a healthy diet with a healthy BMI people are still going to have cancer, HTN, CVD. For this they go to the MD/DO,PA,NP for medical diagnosis because like dr. said this is not what PTs learn in school. Which brings up the concept of direct access. Do PTs learn the necessary knowledge and skill in PT school needed to handle the responsibility of direct access? I hope so. Otherwise it will never happen because people will be getting injured leading to people getting sued increasing malpractice insurance for PTs which will increase costs all in the face of continual decreasing reimbursement from third party payors making the business model for PT utterly unsustainable. Maybe I'm overthinking this. I wonder if the APTA has.

Lee9786, I agree for the most part....for reasons already analyzed to death regarding why a PT should or shouldn't have direct access - I agree with the point of view that PT's should have direct access. When PT's recieve a generalist medical education and can order an appropriate workup and iterpret the results....then I would agree. However, PT would then become a specialty within medicine.

I believe direct access has more to do with making money and little to do with patient care.

 

[janky]

We promote healing by natural methods, something that would help many people rather than force feeding medicinal cocktails. go PT

 

[Dr 14220]

We promote healing by natural methods, something that would help many people rather than force feeding medicinal cocktails. go PT

that is a nice idea, but completely naive and idealistic. for example, take an obese person who does no exercise--say this person had diabetes and high blood pressure. ...

obviously, the best thing this person could do is eat better and exercise, in order to lose weight, and lower their blood pressure and blood sugar. at their appointment with the MD/DO/PA/NP--THEY ARE TOLD ALL OF THIS!!!! do u think these providers are really force feeding these people meds?? NO!!!

they write them scripts for meds that lower their blood pressure and blood sugar, so that the patient doesnt go blind, have a stroke, suffer from heart or kidney failure, etc....

step into reality my friend

 

[lawguil]

We promote healing by natural methods, something that would help many people rather than force feeding medicinal cocktails. go PT

Are you another student?

 

[lee9786]

We promote healing by natural methods, something that would help many people rather than force feeding medicinal cocktails. go PT

Sounds more like go DC.

 

[lee9786]

Lee9786, I agree for the most part....for reasons already analyzed to death regarding why a PT should or shouldn't have direct access - I agree with the point of view that PT's should have direct access. When PT's recieve a generalist medical education and can order an appropriate workup and iterpret the results....then I would agree. However, PT would then become a specialty within medicine.

I believe direct access has more to do with making money and little to do with patient care.

I think you mean PTs shouldn't have direct access. I knew what your meant though.

My criticism is that they didn't seem to add the education necessary to handle the responsibility of direct access when implementing the DPT programs. I guess they felt what they had in the curriculum was enough to handle the responsibility.

I don't think the APTA fully respects the potential devastating effects misuse of direct access could have on this profession and their practice. What if reimbursement for direct access occurs and PTs start missing "other" and just begin treatment? Not only will malpractice insurance increase, but patients won't trust PTs for this responsibility and just go through the physician anyway. So the rationale for making more money could be negated.

I'd personally like to see more classes added to the DPT curriculum that are relevent as well as start mandating continuing education classes that test for competency in this area. I'd feel better about my potential educational investment. It seems though that the APTA has bigger issues at hand. Medicare cuts are right around the corner and the president of the orthopaedic section of the APTA is under fire for poorly representing PTs.

 

[MotionDoc]

I think you guys are seriously misinformed.

Adding classes to the DPT program for the reason you are speaking would do nothing but turn Physical Therapists into "bad doctors." What programs that have switched to the DPT have done, which warrants direct access, is add a differential component throughout the curriculum that trains PTs to screen for underlying medical conditions that present as MSK conditions.

A PT does not need to be trained to cover all the elements of a medical differential by any means...as is what you fellas are implying needs to happen before direct access is warranted. However, a PT needs to recognize (and this is what is promoted throughout the DPT curriculum) that "PLACE MEDICAL CONDITION HERE" can look like cervical radiculopathy, and if a patient is not responding to treatment and/or presents with signs and symptoms that cannot be explained by the MSK diagnosis, then the patient needs to be referred out to his GP asap.

What I am trying to say, and I hope is clear in this message, is that you don't need to train PTs to be experts in every system of the body in order to warrant direct access, or else like lawguil added, PT would just be a specialty under medicine. What PT programs are currently doing is molding a healthcare practitioner who is not only an expert in MSK injury and rehabilitation, but also fluent enough in non-MSK issues to understand what is or isn't indicated for PT.

And, Dr. 14220, as far as soccer31's post regarding PTs performing better workups and taking better history's than PAs and Physicians: I believe he was referring to only MSK issues. His statement that many scripts given to PTs in that arena are useless is correct. They are often vague and many times just plain wrong...but again, a GP isn't trained to perform as complete and proper MSK workup as a PT...I hope this makes sense and ties back full circle with my earlier statement that PTs don't need to be experts in every other body system to have direct access...otherwise I could make the ludicrous case that GPs shouldn't have direct access to MSK patients because they don't have the proper training...

...The fact of the matter is that GPs are trained to recognize when PT is indicated without needing to know exactly what the MSK issue is or its course of treatment. As such, PTs are trained to recognize when a referral to a MD is indicated, even if they don't know what exactly the medical issue is.

I apologize if this was a bit rambling...typed up and sent via phone.

 

[soccer31]

That is a joke--i hope. if not then its just laughable.

A physician or PA working in say, emergency or internal medicine is trained to examine and workup complaints involving every organ system in the body.

but yea. if i ever see a patient with a vague compliant such as abdominal pain or chest pain....ill see if i can run down a PT to do the history and physical....your clearly the best at doing such.

listen, some of my best friends are in the PT program at the same school where i am in the PA program. they know a ton (much more than i do) regarding musculoskeletal and sometimes neurological disorders. i know this, and expect it, because afterall--this is what they learn in PT school. at the same time, i know i can take a much more thorough history and perform a physical exam in every organ system to cover hundreds of possible internal disorders to rule in/out a diagnosis. i can do this better than them, and they would agree--because...this is what we learn in PA school. give me a break.

and yes, medication is totally useless. why should medical providers prescribe all those anti-hypertensives?? they should totally just let the patients go into heart failure or stroke out--those idiots!

I guess I should have been clearer, but when I said that we do a more throughout physical exam I meant musculoskeletal of course, which it is what we do. I assumed that was implied, but apparently not. Thanks MotionDoc for realizing that.

As far as meds, Lee9786 also understood what I meant. No, of course you are not going to let a patient die, but our society created a dependency to it and the general population sometimes think that is the only way they will "get cured".

 

[soccer31]

I think you guys are seriously misinformed.

Adding classes to the DPT program for the reason you are speaking would do nothing but turn Physical Therapists into "bad doctors." What programs that have switched to the DPT have done, which warrants direct access, is add a differential component throughout the curriculum that trains PTs to screen for underlying medical conditions that present as MSK conditions.

A PT does not need to be trained to cover all the elements of a medical differential by any means...as is what you fellas are implying needs to happen before direct access is warranted. However, a PT needs to recognize (and this is what is promoted throughout the DPT curriculum) that "PLACE MEDICAL CONDITION HERE" can look like cervical radiculopathy, and if a patient is not responding to treatment and/or presents with signs and symptoms that cannot be explained by the MSK diagnosis, then the patient needs to be referred out to his GP asap.

What I am trying to say, and I hope is clear in this message, is that you don't need to train PTs to be experts in every system of the body in order to warrant direct access, or else like lawguil added, PT would just be a specialty under medicine. What PT programs are currently doing is molding a healthcare practitioner who is not only an expert in MSK injury and rehabilitation, but also fluent enough in non-MSK issues to understand what is or isn't indicated for PT.

And, Dr. 14220, as far as soccer31's post regarding PTs performing better workups and taking better history's than PAs and Physicians: I believe he was referring to only MSK issues. His statement that many scripts given to PTs in that arena are useless is correct. They are often vague and many times just plain wrong...but again, a GP isn't trained to perform as complete and proper MSK workup as a PT...I hope this makes sense and ties back full circle with my earlier statement that PTs don't need to be experts in every other body system to have direct access...otherwise I could make the ludicrous case that GPs shouldn't have direct access to MSK patients because they don't have the proper training...

...The fact of the matter is that GPs are trained to recognize when PT is indicated without needing to know exactly what the MSK issue is or its course of treatment. As such, PTs are trained to recognize when a referral to a MD is indicated, even if they don't know what exactly the medical issue is.

I apologize if this was a bit rambling...typed up and sent via phone.

100% agreed! Thanks for putting all together. Schools are training students to recognize "red flags" and signs of non-msk injuries/disorders that would prompt to a medical referral, not to give a medical diagnosis.

 

[lee9786]

My information comes mostly from PTs themselves. Some are currently in practice and some have decided to move on to become PAs, MDs, or DOs. Basically the latter says that PTs don't know what they don't know. So with this information I've come to a conclusion that the education, thus the DPT, could be lacking in content to effectively train PTs for handling the responsibility of direct access. I sure hope that your right. To be honest out of the eight or so PTs I've shadowed, none have seemed all that confident in this transition to the DPT. Then again most of my volunteering has been in the hospital and nursing home where direct access doesn't really mean much. Two of the PTs though worked in an outpatient, orthopaedic setting (one BsPT, one MsPT), the setting in which direct access is supposed to help the most. btw the intent of my last post is basically increasing the knowledge base required for successful differential diagnosis. It had nothing to do with making PTs bad "doctors"/physicians. It had everything to do with making PTs good "doctors"/DPTs working in their scope of practice. Anyways like I said I hope you are right motiondoc.

 

[lee9786]

.

 

[MotionDoc]

My information comes mostly from PTs themselves. Some are currently in practice and some have decided to move on to become PAs, MDs, or DOs. Basically the latter says that PTs don't know what they don't know. So with this information I've come to a conclusion that the education, thus the DPT, could be lacking in content to effectively train PTs for handling the responsibility of direct access. I sure hope that your right. To be honest out of the eight or so PTs I've shadowed, none have seemed all that confident in this transition to the DPT. Then again most of my volunteering has been in the hospital and nursing home where direct access doesn't really mean much. Two of the PTs though worked in an outpatient, orthopaedic setting (one BsPT, one MsPT), the setting in which direct access is supposed to help the most. btw the intent of my last post is basically increasing the knowledge base required for successful differential diagnosis. It had nothing to do with making PTs bad "doctors"/physicians. It had everything to do with making PTs good "doctors"/DPTs working in their scope of practice. Anyways like I said I hope you are right motiondoc.

Lee, I understand your concern, and see where the individuals you have talked to are coming from. The truth of the matter though, is that many are just misinformed and spread the negativity they heard elsewhere. I can't comment on every DPT program out there, but the ones I am familiar with take this following statement, and well...smashes it to bits:

PTs don't know what they don't know.

These individuals must think the following: the APTA woke up one morning, decided that PTs needed direct access in order to remain competitive, then promoted this new DPT program that trains future PTs for the rigors and challenges that direct access will pose, then only added a 3rd year filled with fluff to most programs, and these reputable institutions of higher learning agreed because they wanted to rob broke graduate students of an extra year's tuition.

The truth: The curriculum change to the DPT was a complete philosophy change. In my program, about 1/4 of my professors are orthopedic surgeons, sports med physicians, or GPs. They are among the best at what they do in the area, and are the coordinators of the "medical" aspects of the curriculum. This is not only true of my program...

So, ask yourself, would you rather believe a physician and PTs who heard second-hand that the DPT was a bunch of fluff from someone who just didn't care enough to get it, or from physicians and PTs who have not only bought into the DPT program change, but also shaped it?

 

[lee9786]

I want to hear the latter but what I hear is more the former. Basically an added radiology and pharmacology course with additional clinical time to meet minimum standards. The transition from MSPT programs to the DPT required very little change in academic personnel to meet those standards. The relative ease of the transition as well as the additional revenue that could be generated made it a no brainier for programs to advance. The degree is not necessarily an advance in education but more a better representation of the knowledge base that PTs hold. The name is to help gain political leverage and has nothing to do with producing a better PT compared to the BS or MS counterparts. Like I said this is just what I hear. It doesn't mean its true. I'm sure not all programs have done the minimum in hopes to add additional revenue to their programs. One does have to consider the source though. Maybe this is all just ludicrous. I don't know.

 

[PUPPYBOY3765]

I've thought about PA quite a bit in the past year, even after applying (and getting accepted) into PT schools...The salary and cost of school is very appealing - getting paid 25-33% more and paying for a year less of school and starting the career earlier can make a very big difference.

I also never realized that PAs can be involved in surgery, etc. I always thought they only worked in family practice (my gyno is actually a PA, and I assumed that that's all they did, and that never remotely appealed to me.) When I observed an ACL reconstruction and there was a PA helping out and doing part of the surgery, it intrigued me.

There are several reasons I've decided to do PT over PA - first, I know I only want to do ortho work. If I could only work on dancers the rest of my life, that'd be great (hence my username). I know that's not possible, but I've come to love working with all types of patients with orthopedic issues, and working with dancers is just an added bonus to the job. While in PT school I know I'll have to do neuro and inpatient and all that jazz, but that's just a year or so, not even....I can still focus on ortho. Even still, those other areas still relate back to orthopedics and the physical movement sciences. But, if I were to go to PA school or med school, I'd have to learn a lot of things that are so far out of my interest that I just wouldn't want to do it (like OBGYN, internal med, urology, emergency med, etc.) Anatomy has always been a favorite subject of mine, even as a little kid, and one of my anatomy professors who teaches at a Chicago med school said that PTs know the most anatomy out of all the medical professions (except maybe anatomy professors at med schools).

Secondly, I feel like if I were to go to PA school it'd be a bit of a cop-out. Nothing against PAs - I totally understand why people would do it (I thought about it), and I have some close friends who are going that route. For me though, I feel like I'd be looked down upon by my family for not going the med school route. I'm even getting a bit of that now for doing PT instead. I know PA school is also very competitive, but if I were going to go there I may as well go to med school. I know financially it makes a lot of sense to do PA instead of med school, but I wouldn't want to spend all that time and then not be able to be my own boss/have the ability to be my own boss. I wouldn't want to be someone's assistant, even though I know a lot of PAs practically practice on their own.

Not to mention, PA school requires organic chemistry, and I just really don't want to ever take it Just kidding, that's not a main reason, but it definitely is influential. haha.

As a PT I know that I can be an autonomous practitioner, as the previous poster pointed out. One day I want to own my own integrated practice, and as a PA I couldn't do it without an MD or DO on board.

One day I may go back to PA school maybe....after I am done with the PT thing (I know my body won't be able to take it for too long - I'm already falling apart and I'm not even in school yet). As a PT I will get to do what I love, and only have to worry about learning what is interesting to me (anatomy, kinesiology, etc.). I can still watch surgeries (which I love to do) since I'll be sucking up to MDs for referrals, without the stress of med school.

These are just my thoughts. lol.

There are many PA schools that do not require Organic Chem and physics. Although, ochem is a very interesting course.

 

[lee9786]

The first course in Ochem is not that bad. It's a lot of memorizing and paying attention to detail.

 

[lawguil]

I think you guys are seriously misinformed.

Adding classes to the DPT program for the reason you are speaking would do nothing but turn Physical Therapists into "bad doctors." What programs that have switched to the DPT have done, which warrants direct access, is add a differential component throughout the curriculum that trains PTs to screen for underlying medical conditions that present as MSK conditions.

A PT does not need to be trained to cover all the elements of a medical differential by any means...as is what you fellas are implying needs to happen before direct access is warranted. However, a PT needs to recognize (and this is what is promoted throughout the DPT curriculum) that "PLACE MEDICAL CONDITION HERE" can look like cervical radiculopathy, and if a patient is not responding to treatment and/or presents with signs and symptoms that cannot be explained by the MSK diagnosis, then the patient needs to be referred out to his GP asap.

What I am trying to say, and I hope is clear in this message, is that you don't need to train PTs to be experts in every system of the body in order to warrant direct access, or else like lawguil added, PT would just be a specialty under medicine. What PT programs are currently doing is molding a healthcare practitioner who is not only an expert in MSK injury and rehabilitation, but also fluent enough in non-MSK issues to understand what is or isn't indicated for PT.

And, Dr. 14220, as far as soccer31's post regarding PTs performing better workups and taking better history's than PAs and Physicians: I believe he was referring to only MSK issues. His statement that many scripts given to PTs in that arena are useless is correct. They are often vague and many times just plain wrong...but again, a GP isn't trained to perform as complete and proper MSK workup as a PT...I hope this makes sense and ties back full circle with my earlier statement that PTs don't need to be experts in every other body system to have direct access...otherwise I could make the ludicrous case that GPs shouldn't have direct access to MSK patients because they don't have the proper training...

...The fact of the matter is that GPs are trained to recognize when PT is indicated without needing to know exactly what the MSK issue is or its course of treatment. As such, PTs are trained to recognize when a referral to a MD is indicated, even if they don't know what exactly the medical issue is.

I apologize if this was a bit rambling...typed up and sent via phone.

I don't appreciate comments regarding being "misinformed", especially from a pre-professional/PT student. If you disagree with my opinion...that's fine. I was really trying to avoid this debate....and I will unless you educate yourself regarding the issues. Below is a link that outlines the real issues regarding direct access for therapy services. If there are points of this comprehensive review of therapy services you would like to debate in an orderly and professional fashion....I'm interested. But you must read and learn about the issues first....both sides of the debate. What is written above by you is frankly making us less informed decision makers by use of old talking points and an overly simplified analysis. It appears to me that you have a great deal of 'un-learning' to do before you accurately understand the issues.

PLEASE READ IF YOU REALLY WANT TO UNDERSTAND. MORE INFORMATION FORTHCOMING!

http://www.medpac.gov/publications/congressional_reports/Dec04_PTaccess.pdf

These issues haven't changed since 2004 and scholars (such as myself) consider this the best analysis I've read!

Best, L.

 

[janky]

that is a nice idea, but completely naive and idealistic. for example, take an obese person who does no exercise--say this person had diabetes and high blood pressure. ...

obviously, the best thing this person could do is eat better and exercise, in order to lose weight, and lower their blood pressure and blood sugar. at their appointment with the MD/DO/PA/NP--THEY ARE TOLD ALL OF THIS!!!! do u think these providers are really force feeding these people meds?? NO!!!

they write them scripts for meds that lower their blood pressure and blood sugar, so that the patient doesnt go blind, have a stroke, suffer from heart or kidney failure, etc....

step into reality my friend

A reality brought on by us. Nobody wants to admit that they caused their own ailments by poor lifestyle choices.

 

[MotionDoc]

I don't appreciate comments regarding being "misinformed", especially from a pre-professional/PT student. If you disagree with my opinion...that's fine. I was really trying to avoid this debate....and I will unless you educate yourself regarding the issues. Below is a link that outlines the real issues regarding direct access for therapy services. If there are points of this comprehensive review of therapy services you would like to debate in an orderly and professional fashion....I'm interested. But you must read and learn about the issues first....both sides of the debate. What is written above by you is frankly making us less informed decision makers by use of old talking points and an overly simplified analysis. It appears to me that you have a great deal of 'un-learning' to do before you accurately understand the issues.

PLEASE READ IF YOU REALLY WANT TO UNDERSTAND. MORE INFORMATION FORTHCOMING!

http://www.medpac.gov/publications/congressional_reports/Dec04_PTaccess.pdf

These issues haven't changed since 2004 and scholars (such as myself) consider this the best analysis I've read!

Best, L.

Lawguil,

Looking forward to debating the issue with you, but first lets be clear about what we are talking about. My post was not about the pros and cons of direct access...it was concerning the changes in the PT curriculum that warrant direct access. As far as I am concerned, those two are very different things.

1) The first deals with whether direct access truly decreases the overall healthcare costs of a patient and allows overall better care.

2) The second assumes that direct access is warranted, and considers the changes in PT curriculum that train the Physical Therapist to function without the need of Physician referrals while not endangering the patient with a "misdiagnosis" of MSK injury when it is in fact an underlying medical condition presenting as MSK.

Also, it is insulting to be dismissed from an argument because I am "just" a student. A seasoned clinician, with no other experience, is not necessarily the best individual to consult in policy creation and interpretation...why then do you believe the oppossite to be true?

 

[lawguil]

Lawguil,

Looking forward to debating the issue with you, but first lets be clear about what we are talking about. My post was not about the pros and cons of direct access...it was concerning the changes in the PT curriculum that warrant direct access. As far as I am concerned, those two are very different things.

Great - we're talking about the same stuff. Tell me about the changes to the curriculum that "warrant direct access". You do realize that the APTA (nor you) decide what warrents direct access. Further, just because direct access is achieved via political victory doesn't mean it's warranted.

1) The first deals with whether direct access truly decreases the overall healthcare costs of a patient and allows overall better care.

Again, if you read the independent studies - it is believed costs will increase with direct access. Direct access for the APTA is about more patients and billing, not patient care (IMHO)

2) The second assumes that direct access is warranted, and considers the changes in PT curriculum that train the Physical Therapist to function without the need of Physician referrals while not endangering the patient with a "misdiagnosis" of MSK injury when it is in fact an underlying medical condition presenting as MSK.

The answer is that it is not warranted based on the minor changes to education. The education really hasn't changed....DDX has always existed in PT education. Adding introductory coursework in medical DDx and pharm doesn't create an independent primary care provider. Lots of clinical training using and seeing DDX under the supervision of an expert really helps. PT's don't train in any settings that would allow this type of clinical education to occur. Recognizing the "red flags" is not a good system for patient care and just isn't cost effective IMHO. Do I believe that lots of people will die...nope. Occationally will somebody get hurt....yes. Is direct access about patient care.....nope. Is it about more money......yes. Direct access paid for by insurance means more money. It's important to eliminate the conflict of interest and let doctors decide who needs and doesn't need PT.

Also, it is insulting to be dismissed from an argument because I am "just" a student. A seasoned clinician, with no other experience, is not necessarily the best individual to consult in policy creation and interpretation...why then do you believe the oppossite to be true?

You weren't dismissed because you are a student! You were dismissed for acting like an authority on these issues. You are called out for accusing others of being "misinformed" about an issue that is more value driven than fact driven. As a student, it's best to ask questions and listen to the answers. Form you're opinion after years of experience....not ignorance.

Have you read the medpac paper regarding this issue yet?

"D"PT education is standard physical therapy education...an attempted name change. The changes that occured could have easily occured in the same educational footprint of the BSPT. Our AT program has had the same Pharm/DDX component in their curriculum for years.....before the PT's added it.

It's so sad to see folks going into PT thinking they're going to be "doctors"....they're chasing the degree rather than the profession. Check out the clinicians forum making fun of the entry level clinical doctorate degrees...

 

[lawguil]

A seasoned clinician, with no other experience, is not necessarily the best individual to consult in policy creation and interpretation...why then do you believe the oppossite to be true?

What are you talking about.....you make a statement as though it is fact and then ask a question referencing the statement.... working under the assumption that everybody must believe the statment is true....it's freaking bizarre.

I've beginning to believe that you think you're an authority on everything PT....just sit back and listen to motion"doc".

The "doctor" is in the house!

DONE FOR NOW

I'll respond when I see an intelligent arguement!

BYE

 

[MotionDoc]

Lawguil,

This is apparently a touchy topic for you, and by the tone of your last message, it does not look like you are interested in a real debate, rather attack when confronted with strong opinion different from yours. If that is the case, let's take this off the boards and to aim, msn, or some other messaging service (or phone if you'd like) as I do not believe this is the venue for emotional statements.

As to your last post, this is a forum with individuals (as should be implied) expressing their opinions on just about every question asked. Do I have to end every one of my messages with IMHO or IMO or FME for you to be satisfied? Tough.

I do not know where you teach or what experiences you have had, but your statements regarding the curriculum change are concerning. I also have teaching experience at the university level, and I have seen the same exact course taught by the same instructor and with the same supplemental materials yield two very different results in what students actually learned. The difference? The teaching philosophy employed by the instructor. It seems to me that you are looking at credit hours and course names and concluding no real change between MSPT and DPT curriculums. Are you failing to recognize that the same course can have a different spin? That a similar curriculum can yield a different quality student when taught with a different philosophy?

On a side note, I personally cannot comment on those programs that have done little to strengthen their faculty to manage the DPT, I am not sure how they manage really. Maybe you have experienced this sort of program? I don't know...

As far as this statement is concerned: "A seasoned clinician, with no other experience, is not necessarily the best individual to consult in policy creation and interpretation...why then do you believe the oppossite to be true?" and your bash that I am creating fact from opinion... My response: can you read? I deliberately chose my words to avoid that. "not necessarily the best..." how can you argue that? Are you trying to make the case that a seasoned clinician is always the best?

Last, do you assume that all individuals who promote the DPT are chasing the infamous "Dr." title? Do you think so little of people that you think that's all that motivates them? Your experiences and readings may have cemented in your mind the belief that this is all value-driven, but do you not accept the possibility that many may actually be in this for the right reasons? That there are actually altruistic individuals in the PT profession that honestly feel that this is the next necessary step needed to be taken?

You obviously have a valuable perspective to add to the debate, but I would suggest you keep emotion out of your posts. If you cannot, I enjoy a good heated debate, but like I said above, IMO this is not the proper arena.

 

[MotionDoc]

You weren't dismissed because you are a student! You were dismissed for acting like an authority on these issues.

As a student, it's best to ask questions and listen to the answers. Form you're opinion after years of experience....not ignorance.

Just to clarify, do I believe I know it all? Heck no...but I most definitely understand the issues enough to form an opinion, aand it is just that, an opinion...

I would hope that the authority on these issues is not spending his/her time lurking around message boards.

And, as much as I disagree with your opinion, I do apologize for what seemed like me saying you are misinformed... just so you are aware, I was not directing that statement at any particular individual, rather the body of truly uninformed parrots out there who merely repeat what others have told them.

 

[lawguil]

Lawguil,

This is apparently a touchy topic for you, and by the tone of your last message, it does not look like you are interested in a real debate, rather attack when confronted with strong opinion different from yours. If that is the case, let's take this off the boards and to aim, msn, or some other messaging service (or phone if you'd like) as I do not believe this is the venue for emotional statements.

As to your last post, this is a forum with individuals (as should be implied) expressing their opinions on just about every question asked. Do I have to end every one of my messages with IMHO or IMO or FME for you to be satisfied? Tough.

I do not know where you teach or what experiences you have had, but your statements regarding the curriculum change are concerning. I also have teaching experience at the university level, and I have seen the same exact course taught by the same instructor and with the same supplemental materials yield two very different results in what students actually learned. The difference? The teaching philosophy employed by the instructor. It seems to me that you are looking at credit hours and course names and concluding no real change between MSPT and DPT curriculums. Are you failing to recognize that the same course can have a different spin? That a similar curriculum can yield a different quality student when taught with a different philosophy?

On a side note, I personally cannot comment on those programs that have done little to strengthen their faculty to manage the DPT, I am not sure how they manage really. Maybe you have experienced this sort of program? I don't know...

As far as this statement is concerned: "A seasoned clinician, with no other experience, is not necessarily the best individual to consult in policy creation and interpretation...why then do you believe the opposite to be true?" and your bash that I am creating fact from opinion... My response: can you read? I deliberately chose my words to avoid that. "not necessarily the best..." how can you argue that? Are you trying to make the case that a seasoned clinician is always the best?

Last, do you assume that all individuals who promote the DPT are chasing the infamous "Dr." title? Do you think so little of people that you think that's all that motivates them? Your experiences and readings may have cemented in your mind the belief that this is all value-driven, but do you not accept the possibility that many may actually be in this for the right reasons? That there are actually altruistic individuals in the PT profession that honestly feel that this is the next necessary step needed to be taken?

You obviously have a valuable perspective to add to the debate, but I would suggest you keep emotion out of your posts. If you cannot, I enjoy a good heated debate, but like I said above, IMO this is not the proper arena.

Still no substance from you to debate!

Reminder: Topic is direct access : Good or bad for healthcare

Why....or why not!

DPT is not improved from previous generations......in any meaningful way.

All curriculums evolve with time....PT has simply experienced degree creep
Name change not required (DPT)

Why do you suppose the atpa would do such a thing?

As a University prof you must understand....

Where is the debate?

Still no substance

 

[lawguil]

Applied Professional Doctorates
Members continued to have concerns that applied professional doctorates, which blend clinical and research
components (such as the Ed.D., DPT, and AuD), are being elevated to entry-level certification for many
professional fields. The key issue is whether degree inflation is a result of an expanding knowledge base in
applied fields or an attempt by professional organizations to increase the status of practitioners. ****
consultants noted that most “degree creep” is being concentrated in the allied health fields such as physical
therapy (by 2010 the DPT will be required for entry into the field), audiology (whose professional association
will require the Doctorate of Audiology by 2007). Criminology was also mentioned as a possible candidate for
doctoral degree creep.

 

[lee9786]

Criminology? huh... learn something new everyday. It's become clear to me that the term "doctorate" has been watered down over the past decade. Not everyone is pursuing the DPT for pursuit of a "doctorate" though. Hopefully the majority are pursuing it because they think they could be be good PTs. Hopefully these students are filtered out during the application process.

 

[jles]

Lawguil,

I actually think MotionDoc is doing a great job representing the DPT degree and making excellent, rational arguments, all while keeping his cool and remaining professional. How scholarly of him! I must hand it to him, way to keep on. Why are you so bitter Lawguil? What did PT do to you? Wow.

As a second year DPT student at a research I university, I strongly disagree with your opinion and think you are poorly representing yourself, "seasoned" clinicians, and PT. I can give you the benefit of doubt and conclude that your school must be subpar and is NOT representative of most other schools. Indeed there are many inconsistencies within professional practice and curricula which need to be standardized. I can only speak for my university, but PA and PT academic stats are comparable, actually PT has higher averages with more rigorous prereqs if anyone cares...So what? Higher numbers of applicants does not mean they are of higher caliber, longer experience in the field does NOT equal a superior clinician, nor does weekend CEU courses where some evidence is out there suggesting isn't all that effective. I'm sorry you made a poor career choice.

The thing is, as my faculty has put it, and in addition to MotionDoc's point about the identity change to a doctoring profession (I apologize if that misrepresents what you said but I don't have the time to go back), the entry level bar has been raised so we are learning more than you did in school in addition to more clinical hours. That's great that you posted someone's opinion regarding degree inflation, but where is the systematic analysis of MPT and DPT curricula that is required to support that claim? I couldn't find a study anywhere.

My program is an 8 semester, 3 year program…Take summers off and you have a 4 year program AFTER a bachelors degree. Not to mention the residency I will probably go into afterwards.

For a course comparison:
Did you take one full year of evidence based practice? (3 semesters)
2 semesters of cadaveric functional anatomy/biomechanics
2 semesters of orthopedics
2 semesters of radiology
2 semesters of differential dx not including 1 sem. ex phys and 1 semester physiology
1 semester cardiopulmonary PT
coverage of lymphedema management
manipulation
burns
wounds
pediatrics (one semester)
2 semesters of neurorehab
Locomotor training experience for SCI
in-depth coverage of vestibular diff dx and management
geriatrics (one semester)
prosthetics and orthotics (one semester)
2 semesters of motor control
serial casting
32 weeks of internships
3 semesters of professional issues dealing with legal, ethical, reflection, professional identity, community service projects, business aspects of PT practice
interdisciplinary course with med, pharm, dental, nursing students working in the community

So why don't you tell me that my program is inflated and filled with fluff. Let me know something you learned in the clinic that I didn't mention. Please.

This is what you said:
"PLEASE READ IF YOU REALLY WANT TO UNDERSTAND. MORE INFORMATION FORTHCOMING!

http://www.medpac.gov/publications/c...4_PTaccess.pdf

These issues haven't changed since 2004 and scholars (such as myself) consider this the best analysis I've read!"

That's great, so because a "scholar" such as yourself says so then it must be since everyone else is an idiot. (even though you didn't mean that you come off that way) With all those caps no less, double wow.

To your document:
"Opponents argue that a physician examination is required to correctly assess and diagnose a patient's medical condition before the initiation of physical therapy. They also state that ongoing medical supervision ensures that a patient's response to treatment is considered within the context of his or her total medical care."

Well that's great…there is already evidence supporting the financial savings, safety, and efficacy of direct access PT, and there is plenty more to come so get ready - the profession is changing with or without you.

Just like every previous generation complains about the next…

Anyway, here's some reading:

1) Direct Access Physical Therapy and Diagnostic Responsibility: The Risk-to-Benefit Ratio - J Orthop Sports Phys Ther. 2006
..."In summary, the risk from either diagnosis or intervention from a physical therapist is extraordinarily low, with the possibility of substantial benefit. This optimal combination of substantial benefit, with little or no risk, is relatively rare in the healthcare field and therefore represents an attractive healthcare investment..."

2) Pursuit and Implementation of Hospital-Based Outpatient Direct Access to Physical Therapy Services: An Administrative Case Report - PTJ 2010
"Reviewed patient care decisions by therapists participating in the pilot program were deemed appropriate 100% of the time by physician chart reviewers. Approximately 10% of the patients seen were referred to a radiologist for plain film imaging, and 4% and 16% of the patients were referred to physicians for pain medications or medical consultation, respectively. The pilot program's success led to institutional adoption of the direct access model in all physical therapy outpatient clinics."

3) Physical Therapists Knowledge of Musculoskeletal Conditions Childs JD, Whitman JM. Sizer PS, Pugia ML, Flynn TW, Delitto A. A description of physical therapists knowledge in managing musculoskeletal conditions. BMC Muscoloskelet Disord. 2005;6:32.
"Experienced physical therapists had higher levels of knowledge in managing musculoskeletal conditions than medical students, physician interns and residents, and all physician specialists except for orthopaedists. Physical therapist students enrolled in doctoral degree educational programs achieved significantly higher scores than their peers enrolled in master's degree programs. Furthermore, experienced physical therapists who were board-certified in orthopaedic or sports physical therapy achieved significantly higher scores and passing rates than their non board-certified colleagues."

Another one in the military:
4) "Risk determination for patients with direct access to physical therapy in military health care facilities." JOSPT, 2005
"...patients seen in military health care facilities are at minimal risk for gross negligent care when evaluated and managed by PTs, with or without physician referral."

http://ssigaaompt.blogspot.com/2009/09/physical-therapists-knowledge-decision.html

 

[lawguil]

Lawguil,

I actually think MotionDoc is doing a great job representing the DPT degree and making excellent, rational arguments, all while keeping his cool and remaining professional. How scholarly of him! I must hand it to him, way to keep on. Why are you so bitter Lawguil? What did PT do to you? Wow.

As a second year DPT student at a research I university, I strongly disagree with your opinion and think you are poorly representing yourself, "seasoned" clinicians, and PT. I can give you the benefit of doubt and conclude that your school must be subpar and is NOT representative of most other schools. Indeed there are many inconsistencies within professional practice and curricula which need to be standardized. I can only speak for my university, but PA and PT academic stats are comparable, actually PT has higher averages with more rigorous prereqs if anyone cares...So what? Higher numbers of applicants does not mean they are of higher caliber, longer experience in the field does NOT equal a superior clinician, nor does weekend CEU courses where some evidence is out there suggesting isn't all that effective. I'm sorry you made a poor career choice.

The thing is, as my faculty has put it, and in addition to MotionDoc's point about the identity change to a doctoring profession (I apologize if that misrepresents what you said but I don't have the time to go back), the entry level bar has been raised so we are learning more than you did in school in addition to more clinical hours. That's great that you posted someone's opinion regarding degree inflation, but where is the systematic analysis of MPT and DPT curricula that is required to support that claim? I couldn't find a study anywhere.

My program is an 8 semester, 3 year program…Take summers off and you have a 4 year program AFTER a bachelors degree. Not to mention the residency I will probably go into afterwards.

For a course comparison:
Did you take one full year of evidence based practice? (3 semesters)
2 semesters of cadaveric functional anatomy/biomechanics
2 semesters of orthopedics
2 semesters of radiology
2 semesters of differential dx not including 1 sem. ex phys and 1 semester physiology
1 semester cardiopulmonary PT
coverage of lymphedema management
manipulation
burns
wounds
pediatrics (one semester)
2 semesters of neurorehab
Locomotor training experience for SCI
in-depth coverage of vestibular diff dx and management
geriatrics (one semester)
prosthetics and orthotics (one semester)
2 semesters of motor control
serial casting
32 weeks of internships
3 semesters of professional issues dealing with legal, ethical, reflection, professional identity, community service projects, business aspects of PT practice
interdisciplinary course with med, pharm, dental, nursing students working in the community

So why don't you tell me that my program is inflated and filled with fluff. Let me know something you learned in the clinic that I didn't mention. Please.

This is what you said:
"PLEASE READ IF YOU REALLY WANT TO UNDERSTAND. MORE INFORMATION FORTHCOMING!

http://www.medpac.gov/publications/c...4_PTaccess.pdf

These issues haven't changed since 2004 and scholars (such as myself) consider this the best analysis I've read!"

That's great, so because a "scholar" such as yourself says so then it must be since everyone else is an idiot. (even though you didn't mean that you come off that way) With all those caps no less, double wow.

To your document:
"Opponents argue that a physician examination is required to correctly assess and diagnose a patient’s medical condition before the initiation of physical therapy. They also state that ongoing medical supervision ensures that a patient’s response to treatment is considered within the context of his or her total medical care."

Well that's great…there is already evidence supporting the financial savings, safety, and efficacy of direct access PT, and there is plenty more to come so get ready - the profession is changing with or without you.

Just like every previous generation complains about the next…

Anyway, here's some reading:

1) Direct Access Physical Therapy and Diagnostic Responsibility: The Risk-to-Benefit Ratio - J Orthop Sports Phys Ther. 2006
..."In summary, the risk from either diagnosis or intervention from a physical therapist is extraordinarily low, with the possibility of substantial benefit. This optimal combination of substantial benefit, with little or no risk, is relatively rare in the healthcare field and therefore represents an attractive healthcare investment..."

2) Pursuit and Implementation of Hospital-Based Outpatient Direct Access to Physical Therapy Services: An Administrative Case Report - PTJ 2010
"Reviewed patient care decisions by therapists participating in the pilot program were deemed appropriate 100% of the time by physician chart reviewers. Approximately 10% of the patients seen were referred to a radiologist for plain film imaging, and 4% and 16% of the patients were referred to physicians for pain medications or medical consultation, respectively. The pilot program's success led to institutional adoption of the direct access model in all physical therapy outpatient clinics."

3) Physical Therapists Knowledge of Musculoskeletal Conditions Childs JD, Whitman JM. Sizer PS, Pugia ML, Flynn TW, Delitto A. A description of physical therapists knowledge in managing musculoskeletal conditions. BMC Muscoloskelet Disord. 2005;6:32.
"Experienced physical therapists had higher levels of knowledge in managing musculoskeletal conditions than medical students, physician interns and residents, and all physician specialists except for orthopaedists. Physical therapist students enrolled in doctoral degree educational programs achieved significantly higher scores than their peers enrolled in master's degree programs. Furthermore, experienced physical therapists who were board-certified in orthopaedic or sports physical therapy achieved significantly higher scores and passing rates than their non board-certified colleagues."

Another one in the military:
4) "Risk determination for patients with direct access to physical therapy in military health care facilities." JOSPT, 2005
"...patients seen in military health care facilities are at minimal risk for gross negligent care when evaluated and managed by PTs, with or without physician referral."

http://ssigaaompt.blogspot.com/2009/09/physical-therapists-knowledge-decision.html

I will respond to your "references" later.....Did you actually read them?


I'm busy with school

In the mean time

Physical Therapy Program Options

This year's student colloquium will attempt to shed some light on the possible career paths open to a student obtaining a bachelor's degree in Kinesiology. One natural option for those interested in the sport sciences is to become a physical therapist.

There are two main program choices for prospective PT students: professional (entry-level) master's and professional (entry-level) doctoral. Currently, there is no required curriculum difference between the masters and doctoral programs; both are accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE) which ensures faculty, facilities and curriculum are adequate to prepare students to become physical therapists. In theory, "Student A" who graduates from a master's program and receives an entry-level master's in PT (MPT or MSPT) could have the same number of credit hours and clinical internship hours as student B who graduates from an entry-level doctoral program and receives a doctoral physical therapy degree (DPT). Both students will take the same licensure exam and have to achieve the same passing score to become a licensed physical therapist. Therefore, the type of degree granted is determined by the university. However, in reality, most universities offering a DPT have added required courses and internship hours so that the length of study is closer to 2 ½ to 3 years rather than the 2 years needed to complete most master's degree programs.

So what advantage does having a DPT degree have over that of a MPT/MSPT? Unfortunately, the DPT degree is too "new" and the number of graduates too few to really know the answer to this important question. Limited data compiled thus far by the American Physical Therapy Association suggests that DPT graduates do not have a higher passing rate on the national licensing exam, nor do they have higher starting salaries and are not more employable than graduates with a MPT/MSPT degree. It is hoped that the DPT program will better prepare future physical therapists to be autonomous practitioners, much like the doctors of Optometry.

Finally, I would like to briefly mention that there are two types of master's program in PT; one in which the student begins PT school after having obtained a bachelor's degree (4yrs + 2 yrs) and one in which the student enters the PT program after their junior year (3 yrs + 3 yrs). The 4 + 2 program is usually more appealing to those who already have a degree but because the PT curriculum is covered in 2 yrs compared with the 3 yrs in the 3 + 3 program, the academic load is considerable. Although most institutions do offer an "allied health degree" for those who complete their senior yr in the 3 + 3 program, you may want to verify this so that in the event that you decide not to continue in the PT program, you will at least have a bachelor's degree.

To find out more about the DPT program, accredited PT schools, current job market and salary, visit the American Physical Therapy Association's web page, www.apta.org.

FROM ACSM

 

[Danae00]

.

 

[lee9786]

Well the DPT is directly associated with direct access so the two go hand in hand. The fact that the licensing exam hasn't changed is a problem in my opinion. Another problem is relative ease of attaining the tDPT. The tDPT is a slap in the face of those that do expend the time and money to get the doctorate. I think both concepts devalue the credibility of the DPT degree. In my opinion the licensing exam should be advanced to better represent the minimum educational requirements of an advanced DPT degree. The education investment could have then be to advance the educational base of PTs across the board as opposed to be utilized for an apparent increase in clinical rotations which seem unnecessary based on a MsPT model that seemed sufficient. The DPT should have also provided an opportunity for advancement in various specialties to help advance the earning potential of the degree. That, in my opinion, was a huge mistake. People act for incentives it is human nature. I wonder sometimes if the APTA has their heads in the clouds.


As for direct access, it is my understanding that it has been shown to be relatively safe. Then again it's not been used in any significant volume. The need for direct access could be more apparent as the baby boomers start crashing through the system. Will there be enough medical support? Obvious problems are the incentive for PTs to overtreat and the possibility for missing underlying pathologies. So if PTs started getting reimbursed for direct referral then these are two huge issues that could potentially adversely affect this profession.

 

[lawguil]

Sorry if I sound ignorant here, but there seems to be two different debates here. One talking about the benefit of the DPT over a MScPT, and the other talking about direct access. I don't see why these arguments are going hand in hand.

I'm in Canada where the DPT does not exist. A master's level (~ 2.5 years) is as high as you can go outside of doing a research based PHD (as far as I know). However, direct access / self-referral to PT is available across the entire country. I have not heard of any ill effects to patients due to this set up.

I tried to do a quick google search on the drawbacks to Canada's system but all I mostly saw was praise, granted mostly from other PT organizations. Still, I had a hard time finding any criticism, and certainly no evidence to suggest that this is dangerous for the patients.

I admit that I could be missing some vital information here (it was a very quick google search and I'm only pre-PT!). But as it stands I'm wondering where all of this fear of direct-access is coming from. Sure there are all sorts of great "what if" statements floating around in some of those articles, but are any of these doom filled predications likely to come true?

I mean, have those predictions come true in places like Canada that do have direct access? If so, do these negative consequences truly outweigh the benefit to the patient of having direct access? Or, if there is a lack of evidence to suggest these fears are valid, is this just a case of certain professions marking one's territory?

I guess having grown up being able to access PT services whenever I needed them just makes the idea of requiring a doctor's referral seem bizarre to me.

Dana,

Great observation....there are two debates

A couple of points....

(I'm away from my desk) I would be interested to learn more about PT in canada and what type of "back end" or "front end" oversight exists to control inappropriate/overtreating in the physical therapy world....how are PT's paid? Does PT approval need to occur within a certain time frame via PCP.

The ultimate goal in the US is PT's working autonomously without physician oversight....I don't agree with this. For instance, many of the patients treated in PT have multiple medical conditions that need followup and management by the MD. Patients may see several specialist at the same time for various conditions....but the total care is overseen by the primary care provider.

For instance, when my mother was sick and in the nursing home...her PCP administrated her healthcare in consultation with specialists, including PT's, but he is the only person with the global snapshot of my mothers health. There are several times he discontinued PT based on treatments she was recieving and bloodwork. This is only one example....and guess what....when PT was ordered again.....the PT never seemed to understand why it was stopped. The PT didn't have to...they just had to follow orders and weren't familiar with contraindications related to these types of issues. They couldn't review, interpret, or react to labs that suggested her immunity was low and continued activity put her at risk.....but the PCP could.

THis is one example......working in PT, these types of patients represent 30-70% of my patients on any given day.

Now i'm not under the illusion that just because PT is successful with direct access that consultation b/t practitioners will cease....but I am concerned with ignorent non medically trained individuals over estimating their abilities. My insurance won't pay for direct access to other MD specialist without referral...why would they somehow decide to allow PT's direct access.

I believe patient care will suffer....folks will fall through the cracks.....patients don't understand the system and are unable to help themselves.....they rely on their PCP's. There an important gate keeper by my standards.

The other major issue is the concern of healthcare dollars being wasted on overtreating in the PT world. It's already assessed as a concern with a lack of EBM to determine the appropriate dose of therapy.....and even when therapy is really indicated.

I look forward to responding to some previous emails.

Unedited, L

 

[MotionDoc]

what type of "back end" or "front end" oversight exists to control inappropriate/overtreating in the physical therapy world...

...The other major issue is the concern of healthcare dollars being wasted on overtreating in the PT world.

Lawguil, I am interested to hear what your thoughts are on physician-owned PT practices. Corruption exists everywhere and in everything. It is my personal opinion that we should not limit the possible good for fear the corrupt few will "take over." I have a problem assuming everyone else is vying for direct access in order to take advantage of a new found opportunity to fraud the system. Anyway, I am assuming to address your valid concern, my DPT program has several professional ethics courses sprinkled throughout the curriculum that directly address these issues.

For instance, many of the patients treated in PT have multiple medical conditions that need followup and management by the MD. Patients may see several specialist at the same time for various conditions....but the total care is overseen by the primary care provider.

I agree, for individuals that are being actively treated for known multiple medical conditions, or have unstable illness, oversight by the PCP is a must.

For instance, when my mother was sick and in the nursing home...her PCP administrated her healthcare in consultation with specialists, including PT's, but he is the only person with the global snapshot of my mothers health.

Again, I agree, a PCP should be overseeing your mother's care (I hope she is doing better btw) as her condition obviously spanned much more than MSK.

There are several times he discontinued PT based on treatments she was recieving and bloodwork. This is only one example....and guess what....when PT was ordered again.....the PT never seemed to understand why it was stopped. The PT didn't have to...they just had to follow orders and weren't familiar with contraindications related to these types of issues. They couldn't review, interpret, or react to labs that suggested her immunity was low and continued activity put her at risk.....but the PCP could.

Our opinions are shaped by experience, and I am truly sorry you had very negative experiences when it comes to PT.
Two things: First, in my DPT program, from the very first semester of acute care/patient care, and again in applied physiology I and applied physiology II, and again in medical science I, we are taught and constantly drilled on labs and their implications on PT (and this is in addition to the many courses that already address specific medical pathologies and the implications that their course of treatments have on PT). With that said, I am very confident in my ability to pick up a chart, review the ordered labs, and then conclude: this patient should not get PT today (notice that I am not saying I can conclude that this patient has "xyz condition" and it is getting worse). My confidence is seconded by MDs and PTs alike who are teaching these courses.
Second, your reaction of "the PT didn't have to...they just had to follow orders" is very concerning. If I was admitted to a hospital for some serious illness, I would EXPECT every single individual - from the nurse to the surgeon operating on me - to at the very least understand that the things they are doing to me can very well negatively affect my health!

I believe patient care will suffer....folks will fall through the cracks.....patients don't understand the system and are unable to help themselves.....they rely on their PCP's. There an important gate keeper by my standards.

In the current system people fall through the cracks all the time. PTs catch things that MDs miss all the time. The shear amount of time spent and talking with patients that PTs have gives them the unique ability to truly understand their patients conditions (notice I am not saying they are able to diagnose or treat these conditions). You know as much as I that sometimes medical pathologies don't even present unless induced by activity, and in these situation, it is the PT who brings it to the attention of the MD.

Again, I agree that a PCP should absolutely be involved in the care of patients who have actively treated medical comorbidities. Even in a direct access scenario, this will never change, and from my understanding is not the hope of the APTA. Am I beginning to understand that you believe this not to be the case?

 

[lawguil]

Lawguil, I am interested to hear what your thoughts are on physician-owned PT practices. Corruption exists everywhere and in everything. It is my personal opinion that we should not limit the possible good for fear the corrupt few will "take over." I have a problem assuming everyone else is vying for direct access in order to take advantage of a new found opportunity to fraud the system. Anyway, I am assuming to address your valid concern, my DPT program has several professional ethics courses sprinkled throughout the curriculum that directly address these issues.



I agree, for individuals that are being actively treated for known multiple medical conditions, or have unstable illness, oversight by the PCP is a must.



Again, I agree, a PCP should be overseeing your mother's care (I hope she is doing better btw) as her condition obviously spanned much more than MSK.



Our opinions are shaped by experience, and I am truly sorry you had very negative experiences when it comes to PT.
Two things: First, in my DPT program, from the very first semester of acute care/patient care, and again in applied physiology I and applied physiology II, and again in medical science I, we are taught and constantly drilled on labs and their implications on PT (and this is in addition to the many courses that already address specific medical pathologies and the implications that their course of treatments have on PT). With that said, I am very confident in my ability to pick up a chart, review the ordered labs, and then conclude: this patient should not get PT today (notice that I am not saying I can conclude that this patient has "xyz condition" and it is getting worse). My confidence is seconded by MDs and PTs alike who are teaching these courses.
Second, your reaction of "the PT didn't have to...they just had to follow orders" is very concerning. If I was admitted to a hospital for some serious illness, I would EXPECT every single individual - from the nurse to the surgeon operating on me - to at the very least understand that the things they are doing to me can very well negatively affect my health!



In the current system people fall through the cracks all the time. PTs catch things that MDs miss all the time. The shear amount of time spent and talking with patients that PTs have gives them the unique ability to truly understand their patients conditions (notice I am not saying they are able to diagnose or treat these conditions). You know as much as I that sometimes medical pathologies don't even present unless induced by activity, and in these situation, it is the PT who brings it to the attention of the MD.

Again, I agree that a PCP should absolutely be involved in the care of patients who have actively treated medical comorbidities. Even in a direct access scenario, this will never change, and from my understanding is not the hope of the APTA. Am I beginning to understand that you believe this not to be the case?

Why did a research performed by independent consultants (see MEDPAC document - already provided a link) dissagree with your opinion. They used evidence....not research sponsered by the APTA .......

Independent research agrees with my philosophy

Have you read the MEDPAC document yet? Anybody?

I only have so much time during the day....again, I hope to respond in more depth when I have a chance...

l.

 

[lawguil]

Lawguil,

I actually think MotionDoc is doing a great job representing the DPT degree and making excellent, rational arguments, all while keeping his cool and remaining professional. How scholarly of him! I must hand it to him, way to keep on. Why are you so bitter Lawguil? What did PT do to you? Wow.



As a second year DPT student at a research I university, I strongly disagree with your opinion and think you are poorly representing yourself, "seasoned" clinicians, and PT. I can give you the benefit of doubt and conclude that your school must be subpar and is NOT representative of most other schools. Indeed there are many inconsistencies within professional practice and curricula which need to be standardized. I can only speak for my university, but PA and PT academic stats are comparable, actually PT has higher averages with more rigorous prereqs if anyone cares...So what?

thumbdown - more rigorious pre-reqs...how do you figure?

Higher numbers of applicants does not mean they are of higher caliber, longer experience in the field does NOT equal a superior clinician, nor does weekend CEU courses where some evidence is out there suggesting isn't all that effective. I'm sorry you made a poor career choice.

Nope...just sick of it.....12 years of education in PMR....boring.....

The thing is, as my faculty has put it, and in addition to MotionDoc's point about the identity change to a doctoring profession (I apologize if that misrepresents what you said but I don't have the time to go back), the entry level bar has been raised so we are learning more than you did in school in addition to more clinical hours. That's great that you posted someone's opinion regarding degree inflation, but where is the systematic analysis of MPT and DPT curricula that is required to support that claim? I couldn't find a study anywhere.

That's because the difference mandated by the APTA is - nothing!
Some schools added additional clinical, radiology, pharm, and DDX...a total facade...will the added experience help....sure....the other courses are show and tell...

My program is an 8 semester, 3 year program…Take summers off and you have a 4 year program AFTER a bachelors degree. Not to mention the residency I will probably go into afterwards.

Please post number of weeks that you program is?....or credits. The program I'm most familiar with is 112 credits.... I will have to figure but i believe it's about 90-ish weeks over 3 years.....and the class days are pretty fluffy



For a course comparison:
Did you take one full year of evidence based practice? (3 semesters)
2 semesters of cadaveric functional anatomy/biomechanics
2 semesters of orthopedics
2 semesters of radiology
2 semesters of differential dx not including 1 sem. ex phys and 1 semester physiology
1 semester cardiopulmonary PT
coverage of lymphedema management
manipulation
burns
wounds
pediatrics (one semester)
2 semesters of neurorehab
Locomotor training experience for SCI
in-depth coverage of vestibular diff dx and management
geriatrics (one semester)
prosthetics and orthotics (one semester)
2 semesters of motor control
serial casting
32 weeks of internships
3 semesters of professional issues dealing with legal, ethical, reflection, professional identity, community service projects, business aspects of PT practice
interdisciplinary course with med, pharm, dental, nursing students working in the community

This means nothing to me

So why don't you tell me that my program is inflated and filled with fluff. Let me know something you learned in the clinic that I didn't mention. Please.

You'll someday become a practicing PT...you'll get it someday

This is what you said:
"PLEASE READ IF YOU REALLY WANT TO UNDERSTAND. MORE INFORMATION FORTHCOMING!

http://www.medpac.gov/publications/c...4_PTaccess.pdf

These issues haven't changed since 2004 and scholars (such as myself) consider this the best analysis I've read!"

That's great, so because a "scholar" such as yourself says so then it must be since everyone else is an idiot. (even though you didn't mean that you come off that way) With all those caps no less, double wow.

To your document:
"Opponents argue that a physician examination is required to correctly assess and diagnose a patient's medical condition before the initiation of physical therapy. They also state that ongoing medical supervision ensures that a patient's response to treatment is considered within the context of his or her total medical care."

Well that's great…there is already evidence supporting the financial savings, safety, and efficacy of direct access PT, and there is plenty more to come so get ready - the profession is changing with or without you.

Just like every previous generation complains about the next…

It's not changing.....PT will be always be ancillary staff

 

[lawguil]

1) Direct Access Physical Therapy and Diagnostic Responsibility: The Risk-to-Benefit Ratio - J Orthop Sports Phys Ther. 2006
..."In summary, the risk from either diagnosis or intervention from a physical therapist is extraordinarily low, with the possibility of substantial benefit. This optimal combination of substantial benefit, with little or no risk, is relatively rare in the healthcare field and therefore represents an attractive healthcare investment..."


Ok...you referenced an editorial from OSPT....are you serious

I'm not sure I'm even going to review the rest...

I probably will anyway.

WOW!

 

[soccer31]

Lawguil,


My program is an 8 semester, 3 year program…Take summers off and you have a 4 year program AFTER a bachelors degree. Not to mention the residency I will probably go into afterwards.

Please post number of weeks that you program is?....or credits. The program I'm most familiar with is 112 credits.... I will have to figure but i believe it's about 90-ish weeks over 3 years.....and the class days are pretty fluffy

Do you mind sharing what program you most familiar with? Because 90-ish weeks over 3 years is a joke, I would have to agree with you on that one. The one that I attend, and therefore am familiar with, offers 92 weeks of just clinical internship (http://www.shrs.pitt.edu/PT.aspx?id=172) . And the days that we are in class we are there from pretty much 8-5, so not fluffy at all! And I believe the discrepancy between different programs is a major influence and greatly influences this whole direct access debate.

 

[DancerFutureDPT]

So without going too far into the debate, because I'm really too lazy to read through all the arguments (I worked a 12 hour day today and had 5 hours of classes so my eyes hurt ) and I haven't kept up with this thread since the original topic of PA vs. PT, I'm going to give my thoughts on the issue...

- Re: direct access...I feel like the debate here is stemming from two different areas of PT...PTs that are perhaps more involved/longer-term (like in the nursing home) versus outpatient ortho. I personally have never been gung-ho in favor of direct access, but I'm not opposed to it either. Having direct access would not prevent other medical professionals (MDs, PCPs, etc) from being involved or informed - it just wouldn't require it. Personally, my PCP is pretty much useless when it comes to MSK issues or PT - when I went to him to get a script for PT (I thought it'd be an easy request) he told me my ankle cracking was normal ("everyone's ankle cracks") and wouldn't give me a script...my PT who screened me and told me to get a script said it was my FHL popping...6 months later after it not getting better I went to an ortho and got my script, and my PT was right - my FHL was snapping over scar tissue within the sheath. Score one for the PT, minus one for the PCP. But for other people, the PCP should definitely be involved. We have a lot of women's health patients at our outpatient clinic, and they all CC the progress notes and updates to the PCPs. It's not always necessary, though. It's just like when a patient sees a specialist - they don't have to tell their PCP they went, or send them info, if they don't want to. I always do just so they have a copy of all my medical records since I've had the same PCP since I was born, but aside from having it for record keeping there's no reason to send my PCP a copy of my ortho's assessment of my snapping hip syndrome from last week - I honestly don't think my PCP cares about that since he has more important things to worry about.

- Re: the insurance requiring a referral to see a specialist - very few insurances actually require that. From my experience working with insurance companies, it's really only the HMO's that require a referral. I think it's dumb that they require that, since it's extra money (paying to go see your PCP just to get a referral, and then having to go see the specialist which costs more money, etc., unless your PCP will give you one without seeing you first). I like to be able to see who I want, when I want, no questions asked Many insurance companies bill for PT (copays, etc.) as a specialist, and it's considered a medical service, so I can see why some people say it should be accessible without a referral.

- In some settings, it is impossible to get rid of the medical connection, even if everyone wanted to (i.e. inpatient). In these settings, the patients are at a higher risk for complications, changes in their conditions, etc., so they are supervised by many medical personnel...not just one MD, one PT, or one nurse - it takes a village. Direct access state or not, I don't see inpatient policies being impacted by the access laws of the state (correct me if I'm wrong - like I said I haven't thoroughly researched all this since I live and will go to school in a non-direct access state. I've worked in a clinic for 2 years and I know it's a pain to keep up with MD referrals, so getting direct access would save me a lot of headaches!)

- As for the MPT versus DPT curriculum, I don't know much about it. I do know that some MDs in our area will not refer patients (esp. spine patients) to MPTs anymore - only DPTs (or MPTs with at least 10 years experience). I know this is unfounded, but that's just what they do. I also know that NIU (Northern IL Univ) is finally switching from the MPT to the DPT...and it's taken them a long time to get the accreditation to do so, so it must not be a super easy transition to make, curriculum-wise. From what I understand (from what I've heard from PTs I work with, so idk how accurate it is), NIU didn't have enough PhDs in their faculty which was part of the hang up...which suggests the importance on the research component of the DPT. Like I said though, I'm not totally sure if this is true (re: the PhDs), but it has been at least 2 yrs since NIU started the transition to the DPT degree and only now for entering fall 2010 is it happening (at least it's supposed to be accredited by then).

- Mainly, I think we need to give credit to PTs....they've gone through at least 6 years of post-high school education, and they're not idiots. I'm sure there are a few, but for the most part, if direct access is available and a PT is treating a patient who is not getting better, or the PT can't figure out what is wrong, they're going to refer the patient to a physician. I don't think PTs have an inherit ego that will prevent them from telling their patients to get a second opinion from an MD/DO. Sometimes though requiring an MD is completely pointless, like when a 10 year old dancer sprains her ankle in ballet class...sometimes there are times when going to a doctor is a waste of time. But if a football player comes in for PT after getting tackled on the field and hurting his knee, a PT isn't going to treat him if they think he might have an ACL tear - they're going to send him to an MD to get it checked. Some things absolutely require the assistance of an MD, especially because a lot of patients are surgical. And even in direct access states, if an MD does an ACL reconstruction he isn't going to ignore the patient after the surgery - when the patient goes in for PT the MD will follow up with the therapist to check on the progress whether the state is direct access or not. The two professions are intertwined, like it or not, and while PT can definitely become even more autonomous and shouldn't necessarily require a referral by law, MDs will probably always play a role in PT since many of us PTs will share patients with the MDs.

Okay that was longer than I thought it was going to be, and probably isn't very articulate, but like I said it's been a long day. and these are just my two cents so try not to rip me apart too much - I'm just stating my opinions/understandings on the issue, not trying to get in the middle of what seems to be a very intense debate/argument.

 

[lawguil]

Do you mind sharing what program you most familiar with? Because 90-ish weeks over 3 years is a joke, I would have to agree with you on that one. The one that I attend, and therefore am familiar with, offers 92 weeks of just clinical internship (http://www.shrs.pitt.edu/PT.aspx?id=172) . And the days that we are in class we are there from pretty much 8-5, so not fluffy at all! And I believe the discrepancy between different programs is a major influence and greatly influences this whole direct access debate.

I don't care the share the program....Prefer privacy...I would have to double check my calculations....find a calendar with all the breaks...time off...ect. Interested in actual days in class/clinical.

92 weeks of clinical training sounds very excessive.....thats approximately 3,680 clinical hours....that to me would be a waste of the students time and money....at some point you have to get out there and practice to achieve that final phase of clinical maturity.

???major question mark there. I read the link...but couldn't find any course sequence on the site...(but didn't look hard) that would be nearly 2 years of clinical training....there has to be some overlab with the didactic that there counting. By that same measure, our program would have approximately the same because students start clinical training the first week of class in concert with didactic...

unedited.....

l.

 

[lee9786]

I think the NPTE exam not changing from MsPT to DPT speaks for itself. I don't disagree with the transition but how the transition was brought about. I think the PT profession has bigger issues going on right now then direct access.

One big concern is lack of evidence. A recent article in the NY times exploits the lack of evidence backing up hot, cold, estim, usound modalities. How it has taken until 2010 to figure this out is beyond me. The research is out and is saying these modalites are overrated. Yet some PTs are still very heavily modality reliant for pretty much buying time as well as billing purposes. Yes the research is advancing, but how much, when, and how much of an impact will it make? lots of what ifs.

Another big concern is overtreatment. There are concerns if PTs get direct access there will be even more overtreatment. How is that going to reduce costs? Add in the concept of the caps and why people feel there needs to be caps. For some things there does require more treatment than the caps allow. For some the ailment can be taken care of in far less visits. This profession needs to find out how to deal with this problem of overtreatment and provide efficient and effective care.

Another big concern is practice. Like other areas of healthcare there is a financial incentive to do more. PTs selling point though, is that they are cost effective care. Can they change their practice methodologies to a concept that rewards cost-effective patient results over revenue generated from third party payers? Hate to say it but I see it way too often already.

The big HUGE concern is Medicare! This is the big one. It's not all that too far away from complete financial collapse. I think the projected year is 2017. The baby boomers are going to start exhausting the medicare dollars while there are not enough of generation x, y, and dare I say z paying into the system. Who will get priority? Medicine. Can PTs show that they are a necessary component to healthcare to help reduce costs? Why has it taken until now to start really questioning practice and evidence? I am concerned. I wonder what 2020 really looks like. Is it a time where PT practice is flourishing with cost-effective practice or is it a bunch of DPTs that can't pay back their loans applying to MD/PA school etc...?

 

[lawguil]

So without going too far into the debate, because I'm really too lazy to read through all the arguments (I worked a 12 hour day today and had 5 hours of classes so my eyes hurt ) and I haven't kept up with this thread since the original topic of PA vs. PT, I'm going to give my thoughts on the issue...

- Re: direct access...I feel like the debate here is stemming from two different areas of PT...PTs that are perhaps more involved/longer-term (like in the nursing home) versus outpatient ortho. I personally have never been gung-ho in favor of direct access, but I'm not opposed to it either. Having direct access would not prevent other medical professionals (MDs, PCPs, etc) from being involved or informed - it just wouldn't require it. Personally, my PCP is pretty much useless when it comes to MSK issues or PT - when I went to him to get a script for PT (I thought it'd be an easy request) he told me my ankle cracking was normal ("everyone's ankle cracks") and wouldn't give me a script...my PT who screened me and told me to get a script said it was my FHL popping...6 months later after it not getting better I went to an ortho and got my script, and my PT was right - my FHL was snapping over scar tissue within the sheath. Score one for the PT, minus one for the PCP. But for other people, the PCP should definitely be involved. We have a lot of women's health patients at our outpatient clinic, and they all CC the progress notes and updates to the PCPs. It's not always necessary, though. It's just like when a patient sees a specialist - they don't have to tell their PCP they went, or send them info, if they don't want to. I always do just so they have a copy of all my medical records since I've had the same PCP since I was born, but aside from having it for record keeping there's no reason to send my PCP a copy of my ortho's assessment of my snapping hip syndrome from last week - I honestly don't think my PCP cares about that since he has more important things to worry about.

- Re: the insurance requiring a referral to see a specialist - very few insurances actually require that. From my experience working with insurance companies, it's really only the HMO's that require a referral. I think it's dumb that they require that, since it's extra money (paying to go see your PCP just to get a referral, and then having to go see the specialist which costs more money, etc., unless your PCP will give you one without seeing you first). I like to be able to see who I want, when I want, no questions asked Many insurance companies bill for PT (copays, etc.) as a specialist, and it's considered a medical service, so I can see why some people say it should be accessible without a referral.

- In some settings, it is impossible to get rid of the medical connection, even if everyone wanted to (i.e. inpatient). In these settings, the patients are at a higher risk for complications, changes in their conditions, etc., so they are supervised by many medical personnel...not just one MD, one PT, or one nurse - it takes a village. Direct access state or not, I don't see inpatient policies being impacted by the access laws of the state (correct me if I'm wrong - like I said I haven't thoroughly researched all this since I live and will go to school in a non-direct access state. I've worked in a clinic for 2 years and I know it's a pain to keep up with MD referrals, so getting direct access would save me a lot of headaches!)

- As for the MPT versus DPT curriculum, I don't know much about it. I do know that some MDs in our area will not refer patients (esp. spine patients) to MPTs anymore - only DPTs (or MPTs with at least 10 years experience). I know this is unfounded, but that's just what they do. I also know that NIU (Northern IL Univ) is finally switching from the MPT to the DPT...and it's taken them a long time to get the accreditation to do so, so it must not be a super easy transition to make, curriculum-wise. From what I understand (from what I've heard from PTs I work with, so idk how accurate it is), NIU didn't have enough PhDs in their faculty which was part of the hang up...which suggests the importance on the research component of the DPT. Like I said though, I'm not totally sure if this is true (re: the PhDs), but it has been at least 2 yrs since NIU started the transition to the DPT degree and only now for entering fall 2010 is it happening (at least it's supposed to be accredited by then).

- Mainly, I think we need to give credit to PTs....they've gone through at least 6 years of post-high school education, and they're not idiots. I'm sure there are a few, but for the most part, if direct access is available and a PT is treating a patient who is not getting better, or the PT can't figure out what is wrong, they're going to refer the patient to a physician. I don't think PTs have an inherit ego that will prevent them from telling their patients to get a second opinion from an MD/DO. Sometimes though requiring an MD is completely pointless, like when a 10 year old dancer sprains her ankle in ballet class...sometimes there are times when going to a doctor is a waste of time. But if a football player comes in for PT after getting tackled on the field and hurting his knee, a PT isn't going to treat him if they think he might have an ACL tear - they're going to send him to an MD to get it checked. Some things absolutely require the assistance of an MD, especially because a lot of patients are surgical. And even in direct access states, if an MD does an ACL reconstruction he isn't going to ignore the patient after the surgery - when the patient goes in for PT the MD will follow up with the therapist to check on the progress whether the state is direct access or not. The two professions are intertwined, like it or not, and while PT can definitely become even more autonomous and shouldn't necessarily require a referral by law, MDs will probably always play a role in PT since many of us PTs will share patients with the MDs.

Okay that was longer than I thought it was going to be, and probably isn't very articulate, but like I said it's been a long day. and these are just my two cents so try not to rip me apart too much - I'm just stating my opinions/understandings on the issue, not trying to get in the middle of what seems to be a very intense debate/argument.

Hard to follow some of your logic

and the dancer who sprained their ankles should see the MD first if (+) OTOWA rules are identified to rule out fracture. The trip to the PT first would be a wasted appointment….

Agree, PT's are poorly qualified for pre-hospital care!

A mild ankle sprain doesn't necessarily need therapy....that's the problem with direct access to PT...they'll justify treating everything when the MD will screen these folks out…preventing 4 weeks of over treating

Regarding this being an "intense arguement" ....I hope it's considered to be a productive arguement....because with valid or reasonable arguements, my mind about this issue can be changed!!!

L.

 

[DancerFutureDPT]

Hard to follow some of your logic

and the dancer who sprained their ankles should see the MD first if (+) OTOWA rules are identified to rule out fracture. The trip to the PT first would be a wasted appointment….

Again, I'm not a PT yet, but isn't there a way to check for a fx with ultrasound or a tuning fork?

Maybe that was a bad example...but like I know when I was younger an in PT after I had a bone infection in my foot, I was in PT because my calf muscle was substantially smaller on the left than on the right from limping for 2.5 years...after my infection was cleared, I needed PT to restrengthen my leg. At that point in the medical care an MD wasn't required. In some cases with things like tendonitis, overuse injuries, etc., sometimes an MD visit is just a box they have to check before they can get treatment. I'm definitely not saying MDs should be taken out of outpatient ortho treatment, because there are absolutely times when a pt needs to see an MD - if someone falls on the ice and needs to check to make sure they didn't break anything, an ACL tear, etc., but I don't think it's always necessary.

And like you said, there is an issue of overtreating - and direct access may contribute to that. I sprained my ankle last year falling down 3 stairs in my apt building, and while my ankle was in a lot of pain for a few days, I was able to rehab it myself (fortunately working in a clinic I had access to therabands, balance boards, etc), but it would have fixed itself with RICE treatment, I assume. I think it's up to the PTs though to decide after that first consultation/eval if PT is really necessary...it's my understanding that with the exception of Multiple Sclerosis, insurance won't pay for maintenance therapy or non-medically necessary PT. It's up to the PT to be responsible and say: "Look, your sprain isn't that bad. Here's some exercises you can do at home, and if it doesn't get better in two weeks then come back or see an MD to rule out other issues." That's basically what our PTs do - we have a "free screen" option where a pt can come in and basically get a mini eval from a PT...if the PT thinks therapy would be beneficial, then they tell the pt to see an MD to get a script. Many times though those screens are the only time the PT ever sees that patient because PT isn't required. And since our PTs are close friends with many MDs (lots of the PTs will even call the MD to get the patient an appt that day and then have them fax over a script), many times the MD literally just takes 2 seconds to look at the patient and then hands them an Rx for therapy. In those cases the MD appt is unnecessary, in my opinion. I've also seen many orthos who really are only there to write a prescription - my ortho never saw me after the initial visit where I got my script, and she just signed off on my progress note every 6 weeks to give me more therapy. Not all of them are that hands-off, but many of them are. On those prescriptions especially all the boxes are checked "per therapist discretion" for frequency, modalities used, exercises, etc.

But you are definitely right that many times an MD is required - PT alone will not cure someone who needs a joint replacement, or a surgical fix. PT comes afterward, and the MD should be involved in the patient's care, even if only getting updated on the condition and offering suggestions in the plan of care.

 

[atstudent]

Again, I'm not a PT yet, but isn't there a way to check for a fx with ultrasound or a tuning fork?

Only have time to answer this one. Yes, both of those are ways to check, BUT I don't know if they have been validated as being as accurate as x-ray.

 

[lawguil]

Only have time to answer this one. Yes, both of those are ways to check, BUT I don't know if they have been validated as being as accurate as x-ray.

If your history, mechanism of injury, and physical evaluation lead you to believe there might be a fracture....I refer for radiographs

IMO, using a tuning fork/US to r/o fx is poor patient care!

 

[soccer31]

I don't care the share the program....Prefer privacy...I would have to double check my calculations....find a calendar with all the breaks...time off...ect. Interested in actual days in class/clinical.

Fair enough...

92 weeks of clinical training sounds very excessive.....thats approximately 3,680 clinical hours....that to me would be a waste of the students time and money....at some point you have to get out there and practice to achieve that final phase of clinical maturity.

thats what our 3rd year year-long clinicals are for... I have never heard of too many practice NOT leading to perfection, first time...

???major question mark there. I read the link...but couldn't find any course sequence on the site...(but didn't look hard) that would be nearly 2 years of clinical training....there has to be some overlab with the didactic that there counting. By that same measure, our program would have approximately the same because students start clinical training the first week of class in concert with didactic...
its there, under curriculum if you are curious. Same thing happen here, we start clinical on our 2nd semester (fall) on a part time basis (12hrs/week). We have that nearly every semester, combined with a full-time summer and year-long as mentioned previously.

I wont going to start a whole new debate on this because it could be a whole new thread, I just wanted to clarify some points. But like I mentioned before the discrepancy among programs are pretty bad and I wish there was consistency to it like in other health degrees.


unedited.....

l.

Peace... I am out of this discussion. It has been taking too much of my time to keep up with it

 

[lawguil]

Curriculum
Click here for link to official *** course descriptions11.

First-Year, Summer Semester Courses (July - August) Course Title Credits
ANNB 201 Anatomy 5
PT 203 Professional Issues Seminar 1 2
Total
7

First-Year, Fall Semester Courses Course Title Credits
GRNU 303 Pharmacology 3
GRNU 305 Pathophysiology 3
PT 204 Professional Seminar 2 0
PT 241 Patient Management - Fundamental Skills 6
RMS 213 Movement Science 1 3
RMS 244 Patient Management - Therapeutic Modalities 2
Total
17


First-Year, Spring Semester Courses Course Title Credits
ANNB 302 Neuroanatomy 4
PT 205 Professional Seminar 3 0
PT 242 Patient Management - Musculoskeletal 1 8
RMS 220 Research 1 3
RMS 251 Exercise in health and Disease 3
Total
18


Second-Year, Summer Semester Courses (July - August) Course Title Credits
PT 215 Movement Science 2 3
PT 254 Clinical Internship 1 (May - July) 6 weeks 2
PT 321 Research 2 1
Total
6


Second-Year, Fall Semester Courses Course Title Credits
NH 301 Ethics 3
NH 302 Quality in Health Care 3
PT 206 Professional Seminar 4 0
PT 345 Patient Management - Neuromuscular 1 6
PT 347 Patient Management - Cardiovascular and Pulmonary 5
Total
17


Second-Year, Spring Semester Courses Course Title Credits
GRNU 315 Health Care Policy 3
NH 303 Health promotion/public health 3
PT 207 Professional Seminar 0
PT 322 Research 3 3
PT 346 Patient Management - Neuromuscular 2 5
PT 348 Patient Management - Medical/Surgical 2
Total
16


Third-Year, Summer Semester Courses (May - July) Course Title Credits
PT 331 Practice Management 2
PT 349 Patient Management - Musculoskeletal 2 4
GRAD 497 Comprehensive Exam 0
Total
6
Third-Year, Fall Semester Courses Course Title Credits
PT 353 Clinical Internship 2 (August - October) 8 weeks 3
PT 355 Clinical Internship 3 (October - December) 8 weeks 3
Total
6
Third-Year, Spring Semester Courses Course Title Credits
PT 356 Clinical Internship 4 (January - April) 14 weeks 6
Total
6

Clinical Experience
The curriculum includes four internship courses that comprise 36 weeks of full-time clinical education experience. Students practice in a variety of settings under the supervision of clinical instructors who are licensed physical therapists.

The ************contracts with over 270 clinical sites for student internships. These experiences are scheduled throughout northeastern United States with some experiences offered in other parts of the country. Students should expect to have to travel and are responsible for travel and living expenses during the internship courses. Students are required to demonstrate adequate immunization against certain specified diseases and must obtain professional liability insurance, health clearance and CPR certification prior to enrolling in the clinical experience.

Graduation Requirements
A minimum of 99 semester credit hours, a grade point average of 3.0, and successful completion of all internship experiences and a comprehensive examination are required for graduation.

This is more like the average DPT program....36 weeks of clinical education (some of the weeks are rather weak = approximately 1200 actual hours) or approximately 100 credits of total coursework....


In the spirit of PA versus PT: PA education jams approximately 135 credits and over 2000 hours of clinical training into 2 years....

 

[MotionDoc]

I think the NPTE exam not changing from MsPT to DPT speaks for itself. I don't disagree with the transition but how the transition was brought about. I think the PT profession has bigger issues going on right now then direct access.

I agree, this is a glaring fact...but this does not necessarily imply that there was no change in the programs themselves.

One big concern is lack of evidence. A recent article in the NY times exploits the lack of evidence backing up hot, cold, estim, usound modalities. How it has taken until 2010 to figure this out is beyond me. The research is out and is saying these modalites are overrated. Yet some PTs are still very heavily modality reliant for pretty much buying time as well as billing purposes. Yes the research is advancing, but how much, when, and how much of an impact will it make? lots of what ifs.

I don't have time to find a better link, but a majority of medical interventions do not even have much strong evidence behind them: http://www.shef.ac.uk/scharr/ir/percent.html

With that said, PTs that rely heavily on those modalities are not the type of PTs you will see graduating from many DPT programs who, nowadays, frown on non-evidence based interventions except as a last resort.

This profession needs to find out how to deal with this problem of overtreatment and provide efficient and effective care.

Trust me, compared with how much fraud is out there in surgery and medical practice, with how relatively little PTs get paid for the interventions they provide, unethical overtreatment is not a huge issue (but to address your statement, ethical practice is addressed ad nauseum in DPT curriculum...but you can't change a rotten apple.)

http://www.aboutlawsuits.com/st-joseph-hospital-implanted-heart-stents-not-needed-7669/

Are the overtreatment police more concerned with hundreds of $20,000 fraudulent surgeries that put hundreds of honest people on anti-coagulants the rest of their lives, or the hundreds of people getting $50 ice and stim.

Another big concern is practice. Like other areas of healthcare there is a financial incentive to do more. PTs selling point though, is that they are cost effective care. Can they change their practice methodologies to a concept that rewards cost-effective patient results over revenue generated from third party payers? Hate to say it but I see it way too often already.

Are you ready to make the general assumption that a vast majority of PTs are unethical? If not, then do you think the fraudulent actions of a few should be enough to keep the profession from advancing?

The big HUGE concern is Medicare! This is the big one. It's not all that too far away from complete financial collapse. I think the projected year is 2017. The baby boomers are going to start exhausting the medicare dollars while there are not enough of generation x, y, and dare I say z paying into the system. Who will get priority? Medicine.

It is easy to make this an either/or decision, but think about it a little more...I don't believe it will ever be that simple. In the acute care setting for example: "Patient X" has necessary surgery for "Lower-Extremity Condition Y," but since there is no money to pay for proper rehabilitation post-op in this new medicare-less society, "Patient X" lives with lifelong pain from a debilitating fall after trying to walk up the stairs of his home on an atrophied and osteoporetic leg that has been unweighted and in a cast for 4 months. Surgical medicine has progressed to the point that incredibly invasive orthopedic surgeries, that they themselves would have put people out of commission for life, are made feasible only because advances in rehabilitation science allow for post-op care that will restore whatever was lost. Or, consider stroke, SCI, TBI or any other post-neurological disorder...what do we do with these people if no one can afford to enter rehabilitation anymore...etc, etc, etc. I believe PT has already proven itself to be a critical player on the healthcare team.

Can PTs show that they are a necessary component to healthcare to help reduce costs? Why has it taken until now to start really questioning practice and evidence? I am concerned. I wonder what 2020 really looks like. Is it a time where PT practice is flourishing with cost-effective practice or is it a bunch of DPTs that can't pay back their loans applying to MD/PA school etc...?

http://www.donohoe-wellmon.com/pt/evidence_based_pracitice.htm

If you are not familiar with the early '90s article: "One bum knee meets five physical therapists," check out the link above. This was the catalyst needed to get the profession on the "evidence-based practice" bandwagon. The profession has made huge strides since...I think the question really is: "Is it working?"

My thoughts: the "new and improved" profession is still incredibly young and it is therefore difficult to truly assess. Still, considering the incredible vision set by the APTA, the many devoted individuals across the nation committed to it, the growing number of new applicants and DPT graduates, and the retirement of those in the profession who just refuse to accept evidence-based intervention and would prefer sticking to the good ole' heat pack, ultrasound, stretch, ice + stim routine, I believe that: YES, it is working.

 

[MotionDoc]

In the spirit of PA versus PT: PA education jams approximately 135 credits and over 2000 hours of clinical training into 2 years....

Both PA and DPT programs vary (which is both flaw and not).

My DPT Program is: ~2000 Clinical Hours and 114 credits, 2.5 years

My friend's PA program is: ~2000 Clinical Hours and 118 credits, 2 years

Similar, but the main difference (aside from material), is he has 1 year of didactic instruction with no clinical hours, and 1 year of just rotations. I have 2 years of combined clinical hours and didactic instruction, and 1/2 year of just clinical rotations. Can't tell you which is a better model...