From BS to DPT - WHY?

lawguil · Oct 6, 2004

I'm just wondering what others in the allied health profession feel about physical therapy programs moving to a "clinical doctorate." I read some posts and heard from some PT's that it is partly about leveling the playing field with Chiropractors. Others say it more accurately reflects the level of detail, educational rigor, skills, and autonomy of the physical therapy profession. I'm not completely buying it at this point simply because just a few years ago, entry level PT only required a baccalaureate degree. I've also consulted a couple of schools who have recently moved to this clinical doctorate, and they're selling the doctor part, but don't deny that the physical therapy part of the training hasn't changed from the bachelors to the masters to the doctorate with the exception of a course or simple structuring of the program. What have changed are the pre-requisites for the actual PT program. An entry level program is still 3 years and instead of calling it masters, they call it a clinical doctorate? They don't do a thesis or a dissertation, but a research project that can take several forms (research paper, mock thesis, ect, ect,ect. = garbage) I did this same project in my undergraduate career. One of the explanations was that they didn't think that freshman had the emotional stability to deal with gross anatomy (maybe true?, but the program was done that way for years, why not simply wait until second year and simply select students with an aptitude for the profession. I'm not questioning the quality of the education that a physical therapist completes, but I am concerned about letting "doctorate-Dr" become a blanket term to describe everyone who has a degree in a medical profession. I'm also concerned about the cost of education. If you can develop the skills of a physical therapist in a four year education like they have done for years (It's clearly proven) and the pre-requisite courses that are now in place for PT education never really materialize into anything tangible as a practicing PT, and the program doesn't reflect the quality or depth of academia that those who have truly earned a doctorate, why would anybody support it (unless you are an institution of higher education who has clearly identified an opportunity to tack on an additional 40k+ to a students educational expenses and the best way to sell it is to give them a doctorate) - now that makes sense if your a business person. I can't believe that an academic institution would buy into this for any other reason other than something fiscal. This sounds like an editorial, but I am just wondering if I'm seeing this at face value.

PS. I'm trying to avoid the whole Chiropractic thing simply because I personally don't consider there schools academic institutions. Thanks, Lawguil

chicoborja · Oct 6, 2004

I completely agree with you Lawguil. I'm not a physical therapy student but rather an audiology student but my field is doing the exact same thing. Our entry level degree for decades was the masters with a required 9 month fellowship with provisional licensure following graduation. Now my field has adopted the AuD only several years prior to the DPT and several years after the transition from the BS to the PharmD. In my particular program, they added a few classes and combined renamed the fellowship as the 4th year externship and require us to take several interdisciplinary electives. I believe this is not unlike what physical therapy is doing. At least many of your programs (although going against the grain) realize that the 3 yr. DPT model is sufficient, although I realize some of your programs have adopted a 4 year model. In audiology, the majority of programs have adopted the 4 year model with only a few black sheep having the 3 year model. My only contention with the 3 year model is that it is not necessarily a doctorate but more similar to maybe the specialist degree (i.e., SpEd or EdSp) found in the field of education. In regards to lack of a dissertation or thesis, I do not disagree with this. The thesis usually is optional for master's degree students and the disseration is required for research doctoral students (PhD, ScD, EdD) but no professional doctoral (MD, DO, OD, DPM, PharmD) degrees that I know of even require a doctoral project. Similarly to the DPT programs, many AuD programs (and PsyD programs for that matter) require either a doctoral essay or some type of capstone project. My belief as to why this is has to do with the location of these programs. Most AuD and DPT programs are housed in colleges of allied health/health professions or similar academic rather than professional schools. These projects may be the requirement of the college/university or maybe the department has elected have the project to add reputability to the degree or possibly other reasons. I feel the doctoral essay/capstone project is an excellent idea because it gives the clinician greater exposure to research design and methodology.

uhapt · Oct 6, 2004

In my opinion the APTA need leverage in congress, thus the DPT. I'm actually studing under a fellow of the APTA and she has expressed her overwhelming support for the DPT program, I believe it has a lot to do with the bill that was passed about pts, ot and speech therapist and how they/we were only aloted 1500 by medicare for the duration of treatment. The way the bill was worded, OT and Speech received more money than PT's. That made important people mad---important people want to do something---important people lobby congress on behalf of PT's---PT education standards rise.

My gross anat. lab instructor ran one of many clinics in CT, he was involved in hiring/firing of many PT in the CT area. The clinics he worked for were affiliated with a T1 Hosp. (Hartford) He only has his BS, and he stated that no mater what happens DPT will be at a disadvantage. He went on to say that we all have to pass the same boards regardless. Except that DPT having spend more money on a longer education are going to expect to get paid more, so why should he hire an entry-level DPT and pay 45K when he can hire a MSPT and pay them 40K. Thats his opinion and thats fine;

Pardon the spelling

lawguil · Oct 6, 2004

The Doctor of Science degree (and the Doctor of Health Science - DHSc) is a well-recognized degree in Europe and to a lesser degree on the East Coast (Boston University was one of the first institutions to award the DSc). The DSc is designed for professional specialty areas such as Dentistry, Pharmacology, and Physical Therapy. The DSc degree?s primary focus is on the practice of the profession. It tends to have depth and focus in the professional area, but not the breath one might see in a PhD. It is distinctive from an EdD or PsyD in that it builds on the entry level education of a profession and the subsequent post entry level clinical experience. Most DSc degrees are over 60 credits in length. Most have some significant terminal project such as a doctoral project or dissertation but less research (inquiry) credits than a PhD or EdD.
Depending on the focus of the institution (research vs. teaching), the DSc degree is accepted in most academic institutions, but may not qualify an individual for a tenure tract position. It is generally regarded as an academic degree rather than a clinical degree.
Issues to consider: The DSc degree may prepare an individual to teach in their content area, to provide expert mentoring and vision for their clinical field, and to conduct and participate in clinical research. If a state determines that only individuals with clinical doctorates can be addressed as ?Dr.? in the clinic, the DSc may not qualify. This issue may require legal opinion.

A Doctorate in Education is regarded similarly to a PhD in many institutions. Many academic institutions make a distinction between the EdD and PhD when offering both in the same program. They may regard the EdD as the ?practitioner?s? degree and the PhD as the research degree. Generally, the distinction is in the number of required research (inquiry) credits units required. Often the PhD has a greater requirement for research credit units. However, Harvard, as an example, only offers an EdD for a doctorate in Education. The EdD is generally over 60 credit units, requires a qualifying exam (which may less rigorous than a PhD), and a dissertation.
The EdD is regarded by most academic institutions as an academic doctorate, qualifying the individual for a tenure tract position and by credential, positioning the individual for access to grant money. The EdD, when distinguished from the PhD is designed to create ?users of knowledge? in specific practice areas.
Issues to Consider: Most institutions view the EdD and PhD as synonymous with regards to salary, promotion, tenure, etc. It is not regarded as a strong research based degree when compared with the PhD. The EdD requires a significant time commitment and may include a residency requirement.

The Doctor of Philosophy degree is the ?gold standard? of academic degrees. The purpose of the PhD is to educate students to ?create new knowledge? that is, to become scholars.1 The PhD often has a residency requirement that requires a student to engage in full-time studies on campus for a portion of their program. Non-traditional institutions (such as technology based programs) often do not require this residency requirement.
The emphasis of the PhD is on designing, performing, analyzing, and writing of original research. The PhD is typically broad and may require courses not in the student?s content area. Generally, a PhD requires upwards of 72 credit units.
The PhD is accepted at all academic institutions as the quintessential academic degree. The expectation is the individual will generate research.
Issues to consider: The PhD generally requires the most time and is the most rigorous. Some may feel the PhD does not prepare an individual to work in any particular sector, but rather prepares them for academia. If the PhD (or minor) is not in Education, the degree may not include any education courses. The PhD may be considered not as useful in the clinical area.

The DO,MD, DDS become worthy of the mighty ?D? because of the extensive clinical training, intensity, and invasive autonomy of a physician. Viewing medical schools globally, they are probably more selective than any other educational program. The pre-requisites for medical school make sense and provide a foundation to construct a medical student. Further, referring to a physician as Dr is reflected in hundred and hundreds of years of history and by definition describes what it is they do.
Issues to consider: The MD,DO, DDS is not accepted by most academic institution for tenure tract position, but may be qualified to teach in a specific content area (such as a medical school). As a general rule physicians aren?t known for generating quality research outside of specific clinical subjects.

Now for the DPT, I?m not quite sure what to say. Cap-Stone project? I?ve heard of them. I?m sure that the DPT is an intense program, but physical therapy should be an intense entry level undergraduate program much like engineering. This would give students an opportunity to then do real graduate work and really allow the profession to diversity. Imagine an undergraduate degree in physical therapy and a masters in kinesiology, exercise physiology, or education. This is the way that athletic training works. Entry level athletic training is still an 4 year undergraduate program, but 70% of all athletic trainers have a masters degree or PhD/EdD. This is going to have a dramatic effect on who?s doing the research related to clinical therapy. At this point, a DPT who has 7 or more years invested in a DPT program (3 of them questionable) with very, very little research background or knowledge. These same people simply aren?t going to pursue academic degrees due to the time/money they have already invested and I'm not sure there is a big demand for graduate assistant DPT's. Perhaps I?m just an odd and daffy duck waddling to my own quack. I?ll let others decide!
Regards, lawguil

Freeeedom! · Oct 6, 2004

As a former BSPT that was in a DPT program... and now a DO...I can tell you the DPT was absolutely a political move and had ZERO to do with increasing the education of physical therapists. THis was purely a positioning move by the APTA to grab a portion of the DC pie as well as the ever shrinking medical reimbursement pie...in other words they needed justification for direct access. If massage therapists have it, then why not a "doctor" (of PT).
How else can a BSPT program (and well known) change to a clinical doctorate program in a single year and virtually change ZERO faculty and academic curricula? Political pressure.
I find the actions of the APTA as a money hungry (now essentially forcing all BSPT's to convert to DPT's... WITHOUT CREATING CONTINUING EDUCATION STANDARDS). Yep, the APTA worked for the DPT BEFORE making continuing education standards nationwide OR creating RECERTIFYING standards for licensure (ie every 5-10 years in medicine).
It is all about the $$$

I am certainly glad I got out because I would certainly NOT have been in medicine if I had the HEFTY loans and the small salaries that the current grads have. It sucks to be in that position...

MSHARO · Oct 7, 2004

To say that the DPT has nothing to do with increasing the quality of education is a bunch of crap. True, a majority of it has to do with reimbursment issues, but it also is being designed to help future physical therapist prepare for the responsibilty that direct access would require and to help increase in the body of knowledge that is required of PT's these days. This means better medical screening and in many cases further specialization.

I am not sure why the DPT is being compared to a PhD? Just like chicoborja stated, it is not a research degree, it is a professional degree. People who are going to pursue a DPT are not always interested in pursuing a career in research, just as many physicans aren't going to be performing research. It is apples and oranges. If someone is die hard on performing research, they will get a PhD. And as far as I know....nobody has said that the DPT is intended to be a tenured track degree? So what? If people want to do that, once again...they'll get a PhD.

The reason I got an MS vs a DPT was because of cost and the thought that I may want to go to med school was in the back of my mind. And as of right now...I will agree that the cost vs reimbursement is a huge issue. Right now there is not a huge advantage to having a DPT, but you have to start somewhere don't you?

And to say that it should be as intense as an undergraduate program? Well....I don't know about that... Try cramming that undergraduate degree into 2 years and then maybe... I think we averaged ~22 credit hours per semester, so it was definately more intense.

deleted6669 · Oct 7, 2004

it is also possible to get a DHSc as a p.a.
there is a program at nova southeastern university in FL.
this is essentially an academic research degree and only entitles one to the title of DOCTOR outside of the clinical setting....for instance when lecturing a pa/dhsc would be refered to as dr smith.

Dr.Millisevert · Oct 7, 2004

I find it interesting that the US feels the need to change what has historically been a bachelors degree to a "doctorate diploma". Is this done to further separate yourselves from the british educational system and/or to just be different than the rest of the world? Here is a link to a similar thread concerning the difference in the british medical and dental degrees and how they are bachelor degrees (Bachelor of Medicine and/ Dentistry) but in the US they are clincical doctorate of medicine and dentistry. But they are equal degrees because when a doctor from the UK or Australia comes to the US they are allowed to call themselves MD even though the degree they receieved is a bachelors of medicine, etc. ? Can someone explain why the change in name of the degree if it is still really the same thing?

http://forums.studentdoctor.net/showthread.php?t=149643

lawguil · Oct 7, 2004

I think DrMillisevert poses a great question - "Can anyone explain the change in name of the degree if it is still really the same thing?" MSHARO says 'DPT means', "better medical screening and in many cases further specialization."

Let?s compare two realistic scenarios.

PT#1 - Has an entry level undergraduate degree as a PT and has just completed three years of clinical experience in outpatient orthopedics. Let?s also say that his education cost a modest 15k a year. We'll also say that his/her family was fairly well off and he didn't get any financial aid in the forms of grants ect. So PT#1 has total dept of 60k. He worked for 3 years and earned an average of 45k/year = 135k income.

PT#2 has a clinical doctorate that took 7 years to complete and has just passed his license exam and started working in an outpatient orthopedic clinic. He also came from a well to do family and didn't receive any financial aid (grants ect.) in his undergraduate career (and of course is not eligible to receive anything but loans once his/her undergraduate degree is complete anyway.) His/her schooling also cost a modest 15k/year totaling 105k for the entry level degree. PT#2 has earned 0$, however, s/he goes by the name doctor PT#2.

If you are an uninformed patient with a fairly complicated problem who really doesn't understand the system and you are given the choice of which PT you would like to see, PT#1 or Dr. PT#2. You might choose the physical therapist with the glossy Dr. title not fully understanding that it really doesn't define the ability of the PT. Who would you choose? I would pick the PT with 3 years of clinical experience because I understand that a substantial component to an education once you have a solid foundation comes from experience. Let?s take it a step further, 3 more years pass for PT#1 (now 6 years of experience, and Dr.PT#2 (now 3 years of experience). At this point, knowledge and skill is going to be reflected more on an individual?s aptitude, ability and intellectual curiosity within physical therapy than the degree that they bought. Despite the degree, there training is nearly identical. The only thing being, PT#1 might consider going into a graduate program because s/he can afford it and will then have options to enroll in a program that will affect there medical screening and specialty training exponentially. Simply food for thought. lawguil

Freeeedom! · Oct 7, 2004

I will REPEAT...
The APTA put ZERO effort into making CEU standard across the board for all states...the APTA put ZERO effort into making continuous certification a priority.

So tell me, if it was about education, then why not do the basics first???
Now the APTA has turned its back on all the MS and BS graduates in less than 10 years! Essentially creating a market place that is percieved to the disadvantage of the BS graduate...creating a mentality of "well I better go back to school" and CONSTANTLY feeding into the PT's schools with even HIGHER tuition.
What a scam.
All for the same salary (I started at 45k 10 years ago), a worse job outlook, and many times working in an ECF.

YOU DON"T NEED A DPT TO DO TKE or GAIT TRAINING! That is what the job outlook is. Yeah there are outpatient ortho jobs, but who is giving those up??
And to think an employer even cares about the DPT, they would prefer the MPT with a lower wage and EXACTLY the same practice capibilities.

The jobs are the same...yeah it is a great profession, but now people can't even afford to work part time! The debt load is SOOO high, many need 2 jobs.
Why go to school for so long, to be in debt over your head for 50k/year with a ceiling at 65k in 10 years?
At least a 1/4th of my graduating class in PT left the field with the same realizations of an over saturated market, low wages, and the changing degree.

truthseeker · Oct 8, 2004

Freeeedom! said:
I will REPEAT...
The APTA put ZERO effort into making CEU standard across the board for all states...the APTA put ZERO effort into making continuous certification a priority.

So tell me, if it was about education, then why not do the basics first???
Now the APTA has turned its back on all the MS and BS graduates in less than 10 years! Essentially creating a market place that is percieved to the disadvantage of the BS graduate...creating a mentality of "well I better go back to school" and CONSTANTLY feeding into the PT's schools with even HIGHER tuition.
What a scam.
All for the same salary (I started at 45k 10 years ago), a worse job outlook, and many times working in an ECF.

YOU DON"T NEED A DPT TO DO TKE or GAIT TRAINING! That is what the job outlook is. Yeah there are outpatient ortho jobs, but who is giving those up??
And to think an employer even cares about the DPT, they would prefer the MPT with a lower wage and EXACTLY the same practice capibilities.

The jobs are the same...yeah it is a great profession, but now people can't even afford to work part time! The debt load is SOOO high, many need 2 jobs.
Why go to school for so long, to be in debt over your head for 50k/year with a ceiling at 65k in 10 years?
At least a 1/4th of my graduating class in PT left the field with the same realizations of an over saturated market, low wages, and the changing degree.

Are there national MD or DO CEU standards, or are the standards set by the states?

MSHARO · Oct 8, 2004

You really think it is a scam?? All of these prestigious universities are complicit in pulling a scam across the country? It is only the APTA that made the degree switches? The schools didn't have anything to do with the approval of the doctorate degees? I'm sure they just said "go ahead and change your degree to a doctorate....what do we care? We at least get to charge more!" That is a bunch of crap and you know it.

And no offense, but if you were just running people through gait training and performing a TKE protocol, I am glad you got out. There is a little more to being a good PT than that. If you were just walking people and running them through protocols, you were not benefiting the profession anyways.

While there is not a huge difference in the training level...there is a difference. Again...I didn't go and get a DPT for many of the cost issues that you bring up, but to say it is a scam is a bunch of BS. I know for a fact that my grad school put off the switch for several years in order to adequately prepare for the switch in the curriculum and to build up the faculty. It wasn't just on a whim in order to appease the APTA.

I will agree that there needs to be a more uniform standard for continuing ed. As an athletic trainer, I have more strict CEU requirements.

Gotta go to class....later

Skialta · Oct 8, 2004

MSHARO

So, what made you go back to medical school after being an ATC and a MS PT. I know at least for me it was the fact that I didn't have the autonomy that I wanted, basically I wanted to call the shots so I went back to med school.

I think 99% of the DPT is the APTA trying to gain credibility with medicare and insurance. Don't be naive about the role of the academic institutions in this, they have considerable stake in this process. I know there was a decline in the quality of candidates in the recent past due to the outlook for PT at the time. I really think the downturn in the market in the late 90s and early 2000s was the real reason for this change.

The secret is as early as 1996 when I graduated (last BSPT from my school) the real push was for everyone to have an MS for the purpose of professional clout in the eyes of insurers. Why the APTA would go from a push for everyone to be Masters degrees to DPT in a short 6 or 7 years can only come down to the dollars. The truth is the degree of skill that the DPTs come out with is really not worth the extra cost in my opinion. You can make up for the difference in knowledge much more cheaply through your interaction with collegues and CME at a much more reasonable cost.

What would be helpful for the profession of PT would be a greater emphasis on research. What Physical Therapy really lacks is good hard evidence to back up many of the practices they perform. If you can show proof that your intervention is cost effective then maybe PT might get an increase in reimbursement. I don't think the DPT is really doing that for the profession.

Direct access is pretty much a crock of s..t in my opinion because PTs cant prescribe meds order films or any other diagnostic procedure. I really doubt that the cost of treating most patients would decrease if there was direct access, and most likely it would increase. Just my 2 cents.

Skialta MS2

MSHARO · Oct 9, 2004

Skialta,

Going back to medical school was a very tough decision for me. I never really felt any significant issues about autonomy while practicing and that had no part in my decision to go back. I think that the physican's that I worked with had enough trust in me to just write scripts for eval and treat. I pretty much got to do what I wanted. If I needed more visits they trusted me. For me it was that I changed what I really wanted to do .

Throughout undergrad I had planned on going to PT school and had never really given much thought to med school. However, just as I was applying I had been spending a great deal of time with several physican's and surgeons that I knew and I loved it. I seriously could see myself spending everyday in the operating room for the rest of my life. So I had to make a decision to abandon plans to go to PT school (which I had already gotten into my top choice) or spend another year to take O-Chem and the MCAT just to apply.

So I decided to go on to PT school and told myself that if I really wanted to do it when I was done, that I would. I would only be 2-3 years behind and I would have gained a ton of knowledge and experience. I knew money would be an issue, especially since I would be going to a private PT school, but I also knew that as a physician I would probably be able to pay it back when the time came. I have never been this for the money. I would have made a fine living working as a PT. (Much more than the 46k.)

However, as I went through PT school, I almost dropped out after the first semester because I really knew at that time that I wanted to go to medical school. Even though I loved what I was learning, I found myself more interested in the medical (primarily surgical) aspects of patients rather than just their functional aspects. That was something I couldn't do as a PT!! But I stuck it out because I thought it what I learned would be valuable to me in the future. So it was just a change in the direction of my interests.

I just don't buy the fact that the switch that schools such as Duke, USC, WashU, etc would just change a BS to a DPT just for the heck of it. You don't think that these schools would require just a little bit more? That is kind of an insult to some of these school. And I know exactly what you are talking about when you refer to 1996 etc. There was a pretty quick push from MS to DPT. I do believe that some of that had to do with money and leveling the playing field with chiropractors, but I don't think that was the only reason. I think, at least from my perspective, that some of it had to do with the push for PT's to have diagnostic skills. Uh oh....I said the D work.

And as to your statement about a decline in quality canidates, I don't necessarily think that there was an overal decline in the quality of canidates, it just became such a hot profession in the early 90's and with a predicted shortage that a ton of schools popped up. The canidate's just became more spread out. I don't have any numbers to back that up, but I would be interested to see if there was a decline in applicants and people whou matriculated into PT school during this time. I know for a fact that at WashU, they made a point to keep the standards of canidates up. If they didn't get as many qualified canidates, they just didn't accept as many. I also kinda thought that most of the CEU courses were kinda gimicky and trendy versus scientifically based. I thought that my school did a MUCH better job of specifically looking at the facts. They used not only clinical experience but also scientific evidence to guide practice. I did not anything out of them near to what I did out of the classes that I took at WashU. I thought most were a waste of my time.

I do think that having direct access as a PT would make it cheaper to treat some people just because it would take a step out of the process. But the effect would probably be minimal. I seriously think that most PT's coming out these days have, or will have in the near future decent enough screening ability to know if they are out of their league (especially since DPT programs have been emphasising it). At least I feel that the PT's that I know do. We spent a great deal of time in school on medical screening issues. If it is something that doesn't fit a diagnostic category or doesn't look right, refer them out. Better to be safe than sorry. But if somebody comes in with a sprained ankle or a pulled hamstring, how valuable is it to go see a physician just to be handed a script for PT without even laying a hand on a patient? I saw that a TON! Maybe I am a little biased or have a skewed perspective since as an athletic trainer I usually was the first person to see these injuries and I feel that I can handle them. However seriously I think that for most musculoskeletal injuries I have the ability to determine a sprained ankle from a broken one at least as well as most primary care physicians. If I thought it needed an x-ray, I just refer them to their physician. I know people are going to jump all over this and say no way a PT or an ATC can have the skills of a GP. But from my experience, musculoskeletal wise, it is true. I had several physicians that would directly refer individuals to me just for a consult and input for treatment suggestions when weren't sure as to what was going on.

However, could I diagnose gallstones versus back pain? No...I could not directly diagnose gallstones, and I never pretended that I could. But I could sure tell it wasn't just simple back pain. I knew enough that to be able to tell that they may have symptoms of gallstones and that I should refer them out. Worst case scenario we'd be back where we started. And saying that PT's could not possibly have the medical screening skills needed to pick up on these things, is not really all that vaild, and this is only going to improve with the DPT programs. I definately had numerous occassions where I picked things up that physicians missed. Not saying they are bad physicians or anything, small things get overlooked all the time, but that is why they teach those things. I had more problems when I had patients that I thought did not have a PT problem and really thought that should be seen by their physician again. After trying to call some physicians and explain I would constantly get the "more PT" or "continue PT" response. That what was frustrating to me.

That is just my 2 cents.

Freeeedom! · Oct 11, 2004

MSHARO, where did you practice or did you practice?

I worked as an orthopedic PT for 3 years prior to medical school...in the same medical center you currently attend!

Sure there is more to PT, but often times and most job offerings ask for very little more than functional training. I had a fantastic orthopedic job, but greater than half of my class went into acute care or ECF care...and most of that type of PT is not in need of Doctoral students...no way no how. The field in the Indianapolis area is dominated by LARGE groups that during the mid 90's began to change as reimbursement changed, creating a type of rehab that was absolutely numbers based. Private groups are slightly different, but because of the current environment, large groups are buying the smaller groups to gain market dominence. PT groups are not "partnerships" like medicine and it is difficult to foster "brand loyalty" when exclusive contracts are sometimes created by hospitals or in-house PT groups. In this effort to survive, undercutting competetors prices are commonplace. It is a rough environment for young PT's to come out and expect certain jobs and salaries because they have the DPT. It is like the harsh realization of the PharmD that now hands out Prevacid at CVS.

Furthermore my use of the term "scam" was to emphasize the travisty not to literally infer Indiana University is recieving a "cut of the action".

From BS to DPT - WHY?

lawguil

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chicoborja

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uhapt

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lawguil

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Freeeedom!

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MSHARO

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deleted6669

Dr.Millisevert

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lawguil

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Freeeedom!

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truthseeker

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Freeeedom!

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