PT vs. MD

PhD PT's still don't diagnose diseases or plan treatment. They deliver therapy to patients. A PhD PT would probably be more of a research degree. Physiatrists diagnose diseases and injuries, plan, and monitor therapy. They do injections, EMG's, and other procedures. They fully evaluate patients and determine their level of disability. PT's (master or doctoral level) do not do this.

Originally posted by drusso
PhD PT's still don't diagnose diseases or plan treatment. They deliver therapy to patients. A PhD PT would probably be more of a research degree. Physiatrists diagnose diseases and injuries, plan, and monitor therapy. They do injections, EMG's, and other procedures. They fully evaluate patients and determine their level of disability. PT's (master or doctoral level) do not do this.

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Correction, PT's do plan treatment and carry out their treatment independantly. PT's do not have the "legal" responsiblility to diagnose but must formulate a physical dignosis (as far as treatment is concerned, no different from a "legal" diagnosis). Physical exam skills of PT's are equal to any MD. I am a PT and OFTEN consulted by MD's who have had difficulty with a differential diagosis. Many times I receive referrals from MD's that are WAY off. PT's "fully evaluate patients and determine their level of disability" and perform EMG studeis as well. That being said, there many advantages to the MD title that PT's do not have (i.e. x-rays (although likely to change in the near future), referal to specialists, prescribe meds, etc.

PhD is a research degree, DPT is the a clinical doctrate degree

First I want to make it clear that PTs are excellent and an integral part of the rehab team. You guys are awsome and I have been learning lots from you during my residency....

So much confusion out there... Yup, I do get asked if I am a "PT" occasionally... And to all of you cruising this website and not sure about the difference, here goes my explanation!!!!!

DPT: A clinical doctorate. From speaking to other PTs, these guys basically do more administrative things.... Their role in the future is still up in the air from my understanding.

PhD PT: Researcher. I am not sure if there is actually a PhD in Physical Therapy??? Rather these people are PT's and get a PhD in neuroscience, anatomy or physiology...

MSPT: Masters trained. Duties still the same as a DPT, and from my understanding still can take on admin roles.

BSPT: Phasing this degree out as now there are masters and doctoral trained PTs.

MD-Physiatrist: Went to medical school and completed a residency in Physical med and rehab.

Similarities: Both professions are integral members of the Rehab team and work hand in hand. Both deal with improving the function of the patient. Both can evaluate disablitity, evaluate need for equipment and provide a rehabilitation treatment plan. Both are experts in physical modalities. Both "diagnose" disablitity and both can prognosticate functional outcome of any rehab patient... However, PT diagnosis and an MD diagnosis differ due to the approach/role in patient care/management:

MD-Physiatrists deal with medical issues that arise in the rehab patient, experts in MEDICAL diagnosis of DISABILITIES of ALL KINDS due to both MEDICAL and PHYSICAL etiologies. Can prescribe medications that will optimize a patient's function and/or participation in therapy (antispacticity, pain management, insomnia, bladder/bowel dysfunction, wound care to name a few). Expert in physical modalities for optimizing rehab therapies (heat, cold, electricity, and some in acupuncture). Expert in DIAGNOSIS using EMGs, NERVE CONDUCTION STUDIES, diagnostic/therapeutic injections of the spine and peripheral joints and like all other MDs/DOs can use MRIs, Xrays, CT scans, lab exams to diagnose medical problems. Remember, a physiatry diagnosis will always take into account the medical status' effect on the patient's disability. MD's can clear a patient medically for rehab therapies taking into account the MD's understanding of MEDICAL pathophysiology, medications and DISABILITY.

PT: (DPT, MSPT, BSPT)- HANDS ON treatment of the rehab patient. An educator of MOVEMENT (Kinesiology) for both the patient and family. Teaches the patient therapeutic exercise and makes sure they are done properly. Experts in determining functional status and need for modifications at home. Experts in medical equipment needs for function. Experts in teaching a patient how to walk safely and experts in the gait cycle and its analysis. Expert in physical modalities and their uses. Mostly limited to GROSS MOTOR dysfuntion, where an OT does FINE MOTOR. Can evaluate and treat patients who are MEDICALLY CLEARED to participate in rehab therapies and are competent to do so for those patients with a non-complicated medical history. DOES NOT PRESCRIBE MEDS OR ORDER/INTERPRET IMAGING AND LABS.

I have never heard of PTs doing EMGs for diagnostic purposes, but they do do them for research. I am not aware of PTs being trained in them, unless times have changed. ONLY NEUROLOGISTS AND PHYSIATRISTS CAN USE EMGS FOR DIAGNOSIS.

I hope that clears things up??? Its actually really simple.... an MD is an MD is an MD, and a physiatrist is an MD well versed in ALL ASPECTS OF FUNCTION and the medical needs of the patient receiving all rehab therapies (PT, OT, Speech, Neuropsych)... a PT is a PT is a PT no matter if you are a DPT, MSPT or BSPT... a PT does the hands on work to achieve optimal GROSS MOTOR FUNCTION.

bbbmd,
be careful talking about a profession you don't have much experience with. Although I agree with much of what you said, there are also several things that were just plain wrong. I am lucky to be able to write on both the rehab and medical aspects of this topic as I am a medical student who is also PT. I am short on time right now but I felt I had to speak on the subject. Please PM me if anyone has specific questions

Buster Douglas...

I sent you a PM. Please post comments on the forum so others can contribute to the discussion. I do have significant experience with PT and rehab in general prior to med school... Please shed some light if I seem CONFUSED as well...

Thanks
b

OOPS...

Not Buster Douglas, above reply is for PT to DO/MD... SORRY BUSTER!!!

b

Originally posted by PT to D.O./M.D.
bbbmd,
be careful talking about a profession you don't have much experience with. Although I agree with much of what you said, there are also several things that were just plain wrong.

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What was wrong? I don't have a lot of experience in PM&R (read: none), but I'm a 3rd-year who's considering this field and have therefore done a considerable amount of research on the profession and what it entails.

With that said, I think bbbmd's explanation of the different roles was right on the money - he confirmed everything I had read. I asked a friend of mine, who was a PT before med school, and she confirmed everything he said.

???

To start off - I did not intend to come off confrontational. I just get frustrated when MD's or DO's think that they have experienced all there is to know about PT or rehab in general because they spent 6 weeks in ONE or TWO facility during a rotation.

The DPT is a CLINICAL degree. It is fairly new and there is much controversy about it in the medical community. It is NOT an administrative degree nor was it designed to be. There are far more BS PT's who are administrators (because they have been in the field longer). For the record - I am a DPT. The masters level degree was not mandatory until 2002. Second - there are PhD. PT's - not PhD of anatomy or phys. but PhD.'s of PT. You are correct in assuming that these PT's are primarily research based and are faculty but most universities require that these guys continue to have some clinical exposure. MS PT, BS PT, DPT - all have the same roles and duties and can all perform the same tasks.

"Can evaluate and treat patients who are MEDICALLY CLEARED to participate in rehab therapies and are competent to do so for those patients with a non-complicated medical history."

Is this what you actually think of PT's?? I have seen patients with as complicated a medical history as they come!! By the way - they don't have to be medically cleared by a physician to utilize PT. In my home state - MD's and DO's have spent the last year speaking to Congress about why PT's should not have direct access (although in 48 of the 50 states we already do). There reasoning is because it puts the patients at risk(we won by a vote of 30-2). I have seen numerous patients who's physician missed an obvious problem that was caught by a therapist. I agree that the physician is the primary gate keeper - but tone down the ego guys and recognize that there are other HIGHLY SKILLED professionals that can do things as good or better than you!!

We do use EMG, but its use if in biofeedback. I am not aware of any situation where we would use this modality to diagnose either. As you can tell - I am very passionate about this topic - so much so that I don't always get my point across effectively. Hope I did an OK job here. If not please post / PM questions

LATER

P.S. If you are going to call me a fighter - at least give me a gopod name like Roy Jones or Ali or something

PT to MD/DO:
i'm guessing this from your ID...just out of curiosity, are you going to or about to go to med school..if so, why are you choosing to leave physical therapy? seriously, just curious...not attacking you or anything.

I have been teaching at a medical school for approximately 4 years now and I recently decided to attend medical school after seen some of the students come through the school who have no business being doctors - good MCAT and GPA does not equal good doctor! Anyway, the best way to change a system is from within so I decided to stop bitching and do something about it - for patients - for PT's - and for medicine in general. I love physical therapy but my scope of practice is limited (as described adequately earlier) and I want to do more - I also feel an obligation to help physican see the value of the other paraprofessionals they work with - RN's, PT's, OT's, tech's....the list goes on and on. Hope I am making the right decision!!!

PT to DO/MD:
i'm sorry you've had bad experiences with incompetent medical students and pompous physicians. i assure you not everyone in the medical field is that way. i don't know about others on this forum, but i have always been taught to respect RNs, PTs and other ancillary personnel. perhaps the pompous physiatrists you have worked with are insecure about their positions or decisions (of going into PMR) and are trying to feel better about themselves by putting down their co-workers. but at the same time, i will point out that there are some PTs who feel threatened or have an inferiority complex because they are not MDs (don't ask why) and become defensive. it goes both ways.

i try to think of physiatrists and physical therapists as a mother and father team. you can't be born without each one present (ie. hard to treat pt without each one being involved to some degree). and each one brings nurturing in their own special way. like any family, there will always be control issues and tiffs here and there, but in the end, it really should be about HOW to get the patient better (not whose degree is better). so let's try not to get a divorce here, eh?

PT to M.D./D.O.

Are you going to be attending OUCOM? Let me know - I'm an MS-III there - I'd be happy to give you any info.

Gwen
WORDS OF WISDOM! I would agree wit everything you said!! I think that most of us (both MD/DO and PT) feel this way but lose our minds from time to time. Thanks for reeling me back in Temporary insanity

Teufelhunden
P.S. It is down to OUCOM and one other school at this point - leaning toward OU right now!! One is DO (thinks it fits best with PT degree) and one is MD. I am slightly nervous about the DO because I am considering PM&R or Ortho / sports Med.

Originally posted by PT to D.O./M.D.
I have been teaching at a medical school for approximately 4 years now and I recently decided to attend medical school after seen some of the students come through the school who have no business being doctors - good MCAT and GPA does not equal good doctor!


I also feel an obligation to help physican see the value of the other paraprofessionals they work with - RN's, PT's, OT's, tech's....the list goes on and on.

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I seriously feel that one of the first ways you can start having people respect your role as a paraprofessional is by first not being as condescending in your attitude towards professionals.


I hope you didn't use that reasoning on your med school application for why you should've gotten in.

Many PT's have lobbied, successfully in some states, to be able to perform full EMG/NCS. At our annual course taught by Dr. Dumitru(guru of Electrodiagnostic Medicine), we have a mix of both doctors as well as other ancillary staff who learn the basics of nerve conduction studies, which do not require the insertion of a needle. Although, how someone can r/o the fact that someone doesn't have a concommitant cervical radiculopathy in addition to a carpal tunnel without doing an needle EMG exam is beyond me.

That seems to be the biggest debate in many states. Can a non-physician be allowed to insert a needle(without the direct supervision of a MD/DO). As many of us probably remember, there were many PA's that I knew of in med school that worked with CT surgeons and did graft harvesting, so it's not unheard of.
Any PT who would like the responsibility of an MD/DO should also want the malpractice coverage of such a professional. The complications from needle insertion resulting in a serious hematoma or pneumothorax is although rare, a definite possibility.


This is an old article from a couple of years ago(you can tell because they still use the name HCFA...now called the Centers for Medicare and Medicaid Services in this article. )


Performance of Needle EMG by Physical Therapists Becoming an Issue in Several States

Seems as though many health care professionals will always want to do more, if it means they can get more money for it.

PA/NP doing ER work and simple surgeries
Nurse Anes doing Anes
PTs doing PM&R
Psychologists writing prescriptions...

You often wonder why there are distinctions at all if eventually we're gonna be one big melting pot.

Originally posted by DigableCat
Seems as though many health care professionals will always want to do more, if it means they can get more money for it.

PA/NP doing ER work and simple surgeries
Nurse Anes doing Anes
PTs doing PM&R
Psychologists writing prescriptions...

You often wonder why there are distinctions at all if eventually we're gonna be one big melting pot.

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And it won't ever stop. Every time we "fold" and in give physician-like privileges to non-physicians, we're one step closer to that "melting pot." Thing is, evey time we hand over another privilege, they'll immediately begin lobbying for another, and this process will continue ad nauseam until they're functioning as physicians. Some NPs are already doing this now.

A friend of mine a few years ahead of me told me this:

"Everybody wants to be a doctor without going through medical school."

"Everybody" might be a stretch, but there's definitely a lot of para-professionals pining to write scripts, do invasive procedures, order and interpret labs, make diagnoses, etc.

Hell, even DC's lobbied to write scritps!

If the AMA and AOA doesn't start doing a better job protecting its ground, we're headed for a future where we (physicians) are competing with LPNs for patients. You laugh now...but like I said, they'll keep pushing this as far as it will go, and the financial impetus that's driving healthcare policy these days actually supports these efforts (to increase scope of practice for non-physicians), i.e. if someone comes along and says they can do the same job for cheaper, legislatures just might go for it (if that doesn't convinve them, the lobby money supporting their next campaigns might).

having the chance to be on both sides has pointed out just what you stated above. You don't know what you don't know - going through the medical training has pointed that out. I too - always send family members to see an M.D. or D.O. and tell them to avoid other professionals. Thanks for the words of encouragement axm397!!