Direct Access for PT

[mjb2006]

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This is a hot topic right now in physical therapy. What are the pros? What are the cons? Will it pass?

 

[PublicHealth]

This is a hot topic right now in physical therapy. What are the pros? What are the cons? Will it pass?

It will vary state by state. The medical profession, as well as chiropractic, will be lobbying hard against this. It's an economic and political issue.

Read up:

http://www.aaos.org/wordhtml/statesoc/directaccesspt.pdf

http://www.apta.org/AM/Template.cfm?Section=Home&CONTENTID=22449&TEMPLATE=/CM/ContentDisplay.cfm

 

[mjb2006]

It will vary state by state. The medical profession, as well as chiropractic, will be lobbying hard against this. It's an economic and political issue.

Read up:

http://www.aaos.org/wordhtml/statesoc/directaccesspt.pdf

http://www.apta.org/AM/Template.cfm?Section=Home&CONTENTID=22449&TEMPLATE=/CM/ContentDisplay.cfm

It seems like direct access would be accepted better if the DPT program included some diagnostic imaging. But there is the whole issue of PT's not being able to "diagnose" p.t.'s with anything but musculoskeletal conditions. The main question I have then is why are PT's and the APTA pushing for direct access??

 

[PublicHealth]

It seems like direct access would be accepted better if the DPT program included some diagnostic imaging. But there is the whole issue of PT's not being able to "diagnose" p.t.'s with anything but musculoskeletal conditions. The main question I have then is why are PT's and the APTA pushing for direct access??

$ and status.

 

[guetzow]

PTs have been beating this drum for Yearrrrrrrrrrs. It is about money and status, but makes about as much sense as Respiratory Therapists supplanting Pulmonologists. A therapist is a therapist, just like a nurse is a nurse (Where have we heard that before?...). The 'Fact' of the matter is, that even if the majority of PTs do get direct access, it will take a very long time for the medical culture to change (re: probably 'at least' ten years). i.e.- Initial referrals come from whoooo? Docs!! Patients go to whoooo when they have a problem? Docs!! And lastly, if PTs start ordering Imaging, what next? Where does it end? Writing Scrips? Ordering Labs? That's practicing medicine, not being a therapist. Having a cursory knowledge of meds, imaging, and labs does not a Doc make. We've seen this before (With RNs). A therapist is a therapist. Disgruntled therapists should go back to (MD/Mid-level) school or play the stock market, not attempt and end run around orthopedists and sports medicine "Doctors".

 

[PublicHealth]

PTs have been beating this drum for Yearrrrrrrrrrs. It is about money and status, but makes about as much sense as Respiratory Therapists supplanting Pulmonologists. A therapist is a therapist, just like a nurse is a nurse (Where have we heard that before?...). The 'Fact' of the matter is, that even if the majority of PTs do get direct access, it will take a very long time for the medical culture to change (re: probably 'at least' ten years). i.e.- Initial referrals come from whoooo? Docs!! Patients go to whoooo when they have a problem? Docs!! And lastly, if PTs start ordering Imaging, what next? Where does it end? Writing Scrips? Ordering Labs? That's practicing medicine, not being a therapist. Having a cursory knowledge of meds, imaging, and labs does not a Doc make. We've seen this before (With RNs). A therapist is a therapist. Disgruntled therapists should go back to (MD/Mid-level) school or play the stock market, not attempt and end run around orthopedists and sports medicine "Doctors".

Times are changing. Nonphysicians are lobbying hard.

 

[truthseeker]

PTs have been beating this drum for Yearrrrrrrrrrs. It is about money and status, but makes about as much sense as Respiratory Therapists supplanting Pulmonologists. A therapist is a therapist, just like a nurse is a nurse (Where have we heard that before?...). The 'Fact' of the matter is, that even if the majority of PTs do get direct access, it will take a very long time for the medical culture to change (re: probably 'at least' ten years). i.e.- Initial referrals come from whoooo? Docs!! Patients go to whoooo when they have a problem? Docs!! And lastly, if PTs start ordering Imaging, what next? Where does it end? Writing Scrips? Ordering Labs? That's practicing medicine, not being a therapist. Having a cursory knowledge of meds, imaging, and labs does not a Doc make. We've seen this before (With RNs). A therapist is a therapist. Disgruntled therapists should go back to (MD/Mid-level) school or play the stock market, not attempt and end run around orthopedists and sports medicine "Doctors".

Its not an end run around anyone. I don't understand the threat you seem to feel that PTs are to you and yours. We are not out to usurp anyone's power or $$. The point is when someone rounds second base and pulls a hamstring, they know what they did. There is no reason for them to waste their money and go to their "doctor" to have a hamstring strain diagnosed for them. How many times do you write a diagnosis of "Low Back Pain" on a referral to PT? How much value does that have? or do you do a full body CT/MRI/PET whatever to rule out a dissecting aortic aneurysm on everyone with back pain.

You know, I feel a rant coming on here. All I hear is bitch bitch bitch about how busy the docs are, how much paperwork there is, how horrible it is to have to sign all of the evaluations and discharges and recertifications for Medicare patients, how everything from an ice bag or a freekin band-aid has to be initialed or run by the doctor. Well let me say that you did it to yourselves. If you want to be in charge of every stinkin thing medical then go ahead, but quit complaining. PTs know more about orthopedic evaluation than most family practice docs do and most of them will agree with that statement. Clinically, I would say that the good PTs are as good as the orthopedists. We have to be because we can't order imaging. I don't want that right (although it would be nice), I can ask the referring doc to do it and if my logic is wrong they can tell me and I learn something. The military PTs have been ordering imaging for years and there was even a study done recently that showed that the imaging they ordered was as appropriate as the orthopods and MORE appropriate than the FPs.

If you are that threatened by someone who is better at their particular specialty than you are at theirs then that is pathetic. If you think that PTs want to take over the world and then we won't need orthopedists anymore or sports med docs anymore then you are wrong. We are a group of very well trained professionals who are very good at what we do. We are not trying to steal anybody's pie.

Ease Up.


End of Rant

 

[MacGyver]

$ and status.

Wait a minute. Are you seriously tellling me that that the reason for PT direct access is because of $$ and status? I thought it was because these heroic PTs wanted to treat people who have no health care access to MDs? Please dont shock my world view like that!!!

😱 🙄

 

[truthseeker]

Wait a minute. Are you seriously tellling me that that the reason for PT direct access is because of $$ and status? I thought it was because these heroic PTs wanted to treat people who have no health care access to MDs? Please dont shock my world view like that!!!

😱 🙄

Its about offering skills that nobody else has. Its not status or $$. Its about getting the respect that we deserve and for using those skills to provide healthcare for certain problems more efficiently and more economically than others. Our training has always been as long and as difficult as some other providers with clinical doctorates (I am in no way comparing the difficulty to med school BTW)

 

[PublicHealth]

Its about offering skills that nobody else has. Its not status or $$. Its about getting the respect that we deserve and for using those skills to provide healthcare for certain problems more efficiently and more economically than others. Our training has always been as long and as difficult as some other providers with clinical doctorates (I am in no way comparing the difficulty to med school BTW)

DPT vs. DC says it all.

 

[lawguil]

Its not an end run around anyone. I don't understand the threat you seem to feel that PTs are to you and yours. We are not out to usurp anyone's power or $$. The point is when someone rounds second base and pulls a hamstring, they know what they did. There is no reason for them to waste their money and go to their "doctor" to have a hamstring strain diagnosed for them. How many times do you write a diagnosis of "Low Back Pain" on a referral to PT? How much value does that have? or do you do a full body CT/MRI/PET whatever to rule out a dissecting aortic aneurysm on everyone with back pain.

You know, I feel a rant coming on here. All I hear is bitch bitch bitch about how busy the docs are, how much paperwork there is, how horrible it is to have to sign all of the evaluations and discharges and recertifications for Medicare patients, how everything from an ice bag or a freekin band-aid has to be initialed or run by the doctor. Well let me say that you did it to yourselves. If you want to be in charge of every stinkin thing medical then go ahead, but quit complaining. PTs know more about orthopedic evaluation than most family practice docs do and most of them will agree with that statement. Clinically, I would say that the good PTs are as good as the orthopedists. We have to be because we can't order imaging. I don't want that right (although it would be nice), I can ask the referring doc to do it and if my logic is wrong they can tell me and I learn something. The military PTs have been ordering imaging for years and there was even a study done recently that showed that the imaging they ordered was as appropriate as the orthopods and MORE appropriate than the FPs.

If you are that threatened by someone who is better at their particular specialty than you are at theirs then that is pathetic. If you think that PTs want to take over the world and then we won't need orthopedists anymore or sports med docs anymore then you are wrong. We are a group of very well trained professionals who are very good at what we do. We are not trying to steal anybody's pie.

Ease Up.


End of Rant

I am troubled by the political ambitions of the ATPA. I think that research is needed with respect to physical therapy and the proper dose and utilization of services. I hypothesize that the physical therapy world provides millions of dollars of unneeded services every year and the APTA has been very successful at alluding research that would expose this hypothesis. Also, the APTA has done a good job of alienating other professions who offer similar skills and services by lobbying for legislation that would eliminate competition in physical medicine and rehabilitation (example: the recently adopted CMS regulations on 'incident to physician therapy services). The APTA has made a number of mandates that have nothing to do with education or competencies like mandating a move from an entry level BSPT to a MSPT to a DPT with minimal changes in the curriculum content, lobbying for direct access despite the fact that they aren't trained to make a diagnosis, can't refer for diagnostic tests such as lab test or radiograph (what good is training in differential diagnostics if you can't order or interpret the results. Further, if you aren't trained as a generalist or have a generalist education clinically, your training in differential diagnosis doesn't exist. you don't learn it in a book or orthopedic rehab clinic), aren’t trained to detect certain conditions outside the field of NMS and movement related disorders and thus would be in a position of delivering inappropriate or contraindicated care, increasing the cost of malpractice claims, and lowering the standard or care while driving up health care costs (meaning even more insurance fraud than currently exists in the PT world).

I would like to hear a few more examples that you would like to have direct access for so that PT's could sick their billing department on them! Perhaps you would like to treat sprained ankles without x-rays first or back pain in which will likely resolve on its own in two weeks, or my favorite, frozen shoulder (oh yea, I forgot that you're so effective in treating strained hamstring myo's). Give us some examples of injuries that shouldn't be seen by the physician first...for real! IT IS ABOUT $ AND STATUS! I'VE BEEN INVOLVED FIRST HAND IN THE LOBBYING EFFORTS!

 

[lawguil]

Its about offering skills that nobody else has. Its not status or $$. Its about getting the respect that we deserve and for using those skills to provide healthcare for certain problems more efficiently and more economically than others. Our training has always been as long and as difficult as some other providers with clinical doctorates (I am in no way comparing the difficulty to med school BTW)

Skills nobody else has? Come on! The APTA is actively lobbying (successfully I might add) to eliminate competition from athletic trainers and chiropractors in the movement related sciences.

 

[truthseeker]

I am troubled by the political ambitions of the ATPA. I think that research is needed with respect to physical therapy and the proper dose and utilization of services. I hypothesize that the physical therapy world provides millions of dollars of unneeded services every year and the APTA has been very successful at alluding research that would expose this hypothesis. Also, the APTA has done a good job of alienating other professions who offer similar skills and services by lobbying for legislation that would eliminate competition in physical medicine and rehabilitation (example: the recently adopted CMS regulations on 'incident to physician therapy services). The APTA has made a number of mandates that have nothing to do with education or competencies like mandating a move from an entry level BSPT to a MSPT to a DPT with minimal changes in the curriculum content, lobbying for direct access despite the fact that they aren't trained to make a diagnosis, can't refer for diagnostic tests such as lab test or radiograph (what good is training in differential diagnostics if you can't order or interpret the results. Further, if you aren't trained as a generalist or have a generalist education clinically, your training in differential diagnosis doesn't exist. you don't learn it in a book or orthopedic rehab clinic), aren’t trained to detect certain conditions outside the field of NMS and movement related disorders and thus would be in a position of delivering inappropriate or contraindicated care, increasing the cost of malpractice claims, and lowering the standard or care while driving up health care costs (meaning even more insurance fraud than currently exists in the PT world).

I would like to hear a few more examples that you would like to have direct access for so that PT's could sick their billing department on them! Perhaps you would like to treat sprained ankles without x-rays first or back pain in which will likely resolve on its own in two weeks, or my favorite, frozen shoulder (oh yea, I forgot that you're so effective in treating strained hamstring myo's). Give us some examples of injuries that shouldn't be seen by the physician first...for real! IT IS ABOUT $ AND STATUS! I'VE BEEN INVOLVED FIRST HAND IN THE LOBBYING EFFORTS!

First, I don't dispute that there are marketing campaigns going on but I wouldn't characterize it as eliminating other professions from doing our job, simply protecting our scope of practice. (see the Arkansas case regarding mobilization vs manipulation and other similar pending cases in other states where DCs are trying to eliminate mobilization/manipulation from the PT practice acts where it exists).

Second, I don't dispute that athletic trainers share a skill set with PTs in the orthopedic patient. I am also an ATC and know first hand what a good ATC can offer for evaluation and management of orthopedic injuries. I also know that I learned nothing about treating un-healthy patients. There was some instruction on dealing with diabetics and seizure disorders but nothing about most of the co-morbidities that are found in the general population. Further, the athletes that the ATCs generally work with when they are in school and learning are well known to them. Thorough histroy taking is limited to the injury. This is a gross generalization, the best ATCs take a thorough history but not all are the best, same goes for chiros and PTs.

The problem is that the ATCs are moving out of the traditional role that they had before, that is taking care of an athletic team and its members. While I don't see that as a problem for an ATC working with healthy orthopedic patients, I think if they work in an orthopedist's office, it is no different than referral for profit if the doc is having them do procedures and billing for physical medicine codes and getting reimbursed for that recommendation. Similar to owning an MRI clinic and referring everyone to have an MRI.

Other examples - most back pain patients will improve on their own within two weeks. What we (I should say "I do") is identify what they did wrong to cause the injury and try to teach them ways to make it less likely to happen in the future e.g. bad lifting technique, ergonomics at a desk, posture, abnormal hip muscle flexibility, weak abdominals after multiple abdominal surgeries, leg length discrepancies) Sometimes the two weeks is too long for someone to be debilitated and in pain and so treatments often are used to help someone return to work sooner than the two weeks.

Rotator cuff tendinitis vs adhesive capsulitis - they are treated differently. both may have similar etiologies, in fact rct often comes before ac and is the underlying cause of ac. I get diagnoses all the time of ac from orthopedists that are not that. No capsular pattern, ROM limited by pain, not by structure.

plantar fasciitis - steriods, anti-inflammatories, night splints, limited weight bearing are all typical treatments given by MDs, and DPMs. None of which are effective unless the CAUSE of the problem is identified. That is what we (I) do rather than just treat symptoms.

Headaches - Of course there are really bad things that are associated with Really bad headaches. But most headaches are not really bad. Some are vascular (we can do nothing about those, MD/DOs can) and some are muscular (we can do a lot for those).

In each of these cases we can identify the patterns that DON'T fit with what we can treat and those people get referred quickly. We don't intend to elimiinate or even reduce our traditional partnership with the traditional medical community, we are a part of it. The vast majority of PT patients, even in a functional direct access world, will be referrals from MD/DOs. That is perfectly fine. The purpose, as I see it, is that those people with known problems, like recurrent back pain, muscular headaches, tennis elbow, impingement syndrome are actually dissuaded from seeking PT because of the hoops that they need to jump through to get to us. If they could come off the street they would be more likely to do so. Sure there is $$ involved, but there is also convenience for the patient.

Look into the actual accusations that you make, about the overutilization of PT. It happens for sure, then look at other professions and compare the frequency and the volume and the dollar figure and see who you would rather spend your money with. You claim that there is lots of insurance fraud in the PT world, I would like to know why you think that and if you have any evidence.

PTs are taught how to do a type of differential diagnosis. No we do not diagnose liver disease, or thyroid dysfunction, or kidney stones, or brain tumors, or pneumonia but those disorders do not fit into the patterns that we see and will be referred. No we civillians cannot order imaging or read them but our partners in health care can and do. If you come to my clinic with back pain that you can provoke with movement or position I will assess you and provide treatment. If the symptoms don't change after 2-3 visits then off you go to your real doctor to look for other causes. Most of the back pain will get better and that saves loads of cash in CTs and MRIs and risks very little for the patient.
If you come to my clinic directly with back pain that keeps you up at night, you can't find a comfortable position, OTC meds don't help, you have lost weight etc . . . you are sent directly to the doc.

Physical therapy is not as you describe. If your experience is how you have characterized it, I am very sorry, because you have had the misfortune of encountering an abberation. Every profession has them. You suggest that the APTA is eluding research that would expose the provision of millions of dollars of uneeded services, that is a pretty bold claim. Again, I would like to see something to back up your claim. It seems to me that the APTA and its various sections provide some pretty solid peer reviewed research.

I think your arguements are weak.

 

[guetzow]

That's what the 40 year old profession of PA is for (And NPs 😉 ). If you are not happy as a "Therapist", Go to midlevel school. "Its not status or $$. Its about getting the respect that we deserve". Huh!?..... Status = respect... Again, if you're not happy, go to mid-level school. The profession you are attempting to supplant already exists.

 

[truthseeker]

That's what the 40 year old profession of PA is for (And NPs 😉 ). If you are not happy as a "Therapist", Go to midlevel school. "Its not status or $$. Its about getting the respect that we deserve". Huh!?..... Status = respect... Again, if you're not happy, go to mid-level school. The profession you are attempting to supplant already exists.

Wrong. No midlevel knows what I know.

 

[lawguil]

First, I don't dispute that there are marketing campaigns going on but I wouldn't characterize it as eliminating other professions from doing our job, simply protecting our scope of practice. (see the Arkansas case regarding mobilization vs. manipulation and other similar pending cases in other states where DCs are trying to eliminate mobilization/manipulation from the PT practice acts where it exists).

Our job and Our scope of practice! What do you mean by "our" Do you suggest that you own certain knowledge and skills. I understand the argument about restoring your right to do mobilizations and manipulations thus restoring competition amongst practitioners. But lobbying to prevent others trained in the movement sciences from practicing in settings that may compete with physical therapists eliminates competition and professional growth.


Second, I don't dispute that athletic trainers share a skill set with PTs in the orthopedic patient. I am also an ATC and know first hand what a good ATC can offer for evaluation and management of orthopedic injuries. I also know that I learned nothing about treating un-healthy patients. There was some instruction on dealing with diabetics and seizure disorders but nothing about most of the co-morbidities that are found in the general population. Further, the athletes that the ATCs generally work with when they are in school and learning are well known to them. Thorough history taking is limited to the injury. This is a gross generalization, the best ATCs take a thorough history but not all are the best, same goes for chiros and PTs.

I'm not sure what you point is! Perhaps I can elaborate since I clearly understand that the provisions of each profession are slightly different. ATC's have much more focus on pre-hospital care vs. the total inpatient and outpatient training of PT's. For the past three years the educational competencies for PT's and ATC's are exactly the same. Pathology, EBM, Diff Dx, "diseased populations" are now taught in ATC education. When you and I went to school, they weren’t.


The problem is that the ATCs are moving out of the traditional role that they had before, that is taking care of an athletic team and its members. While I don't see that as a problem for an ATC working with healthy orthopedic patients, I think if they work in an orthopedist's office, it is no different than referral for profit if the doc is having them do procedures and billing for physical medicine codes and getting reimbursed for that recommendation. Similar to owning an MRI clinic and referring everyone to have an MRI.

If the outcomes are the same or better, number of visits for care is reduced, billing is reduced, physician supervision and communication is better, why is this a problem. This is how the latest research is going to be targeted by the NATA. It's truly going expose the over utilization and billing of PT services. Tell me you have never said, see me 3 x week for 6-8 weeks. There are now people doing research on TKR and the like showing that 1 visit a week yields the same outcomes.

Other examples - most back pain patients will improve on their own within two weeks. What we (I should say "I do") is identify what they did wrong to cause the injury and try to teach them ways to make it less likely to happen in the future e.g. bad lifting technique, ergonomics at a desk, posture, abnormal hip muscle flexibility, weak abdominals after multiple abdominal surgeries, leg length discrepancies) Sometimes the two weeks is too long for someone to be debilitated and in pain and so treatments often are used to help someone return to work sooner than the two weeks.

Show me a meta analysis of the research that shows this to be true. Trust me, as a PT billing the system, you don't want the studies to be done!

Rotator cuff tendonitis vs. adhesive capsulitis - they are treated differently. both may have similar etiologies, in fact rct often comes before ac and is the underlying cause of ac. I get diagnoses all the time of ac from orthopedists that are not that. No capsular pattern, ROM limited by pain, not by structure.

Good for you! I'm sure the orthopods don't know the difference. They should see the orthopedic first so you don't waste the 6 weeks of PT the patients insurance company will pay for when the patient will need it after surgery. Also, a home program set up in the orthopedist office for ac by an ATC will yield the same results without exhausting their the PT visits. Further, there is some research that clearly shows that having a manipulation for ac followed by PT doesn't improve symptoms of pain (actually worse with manipulation and PT) and doesn't restore function any quicker! I would reference, but my name is on it.

plantar fasciitis - steriods, anti-inflammatory, night splints, limited weight bearing are all typical treatments given by MDs, and DPMs. None of which are effective unless the CAUSE of the problem is identified. That is what we (I) do rather than just treat symptoms.

I suspect that the DPM and many MD's can identify the problem. It isn't rocket science! Tell me what you're going to pick up on? Leg Length?....come on! The fact is that most cases of plantar fascitis can be managed very effectively with over the counter orthodics/arch support and calf stretching. The docs can handle this in one visit and decide which are appropriate to send to PT. The PT's will milk 6 plus visits out of something simple!

Headaches - Of course there are really bad things that are associated with Really bad headaches. But most headaches are not really bad. Some are vascular (we can do nothing about those, MD/DOs can) and some are muscular (we can do a lot for those). It's also been found that manual treatment and something as simple as touch can allow a patient to feel significantly better even if their problem is a brain tumor. So do you treat migraines without an MRI/CT/PED or do you just keep treating until they have a seizure?

In each of these cases we can identify the patterns that DON'T fit with what we can treat and those people get referred quickly. We don't intend to eliminate or even reduce our traditional partnership with the traditional medical community, we are a part of it. The vast majority of PT patients, even in a functional direct access world, will be referrals from MD/DOs. That is perfectly fine. The purpose, as I see it, is that those people with known problems, like recurrent back pain, muscular headaches, tennis elbow, impingement syndrome are actually dissuaded from seeking PT because of the hoops that they need to jump through to get to us. If they could come off the street they would be more likely to do so. Sure there is $$ involved, but there is also convenience for the patient.

Basically you want it to be easier for the patient to see the PT, WHY? Not to maintain a high standard of care, but for $$.

Look into the actual accusations that you make, about the over utilization of PT. It happens for sure, then look at other professions and compare the frequency and the volume and the dollar figure and see who you would rather spend your money with. You claim that there is lots of insurance fraud in the PT world, I would like to know why you think that and if you have any evidence.

First, the ATPA won't support funding for it! Very little research exists and what does exist, you can attack the science behind it to easily even though the point is clear and the APTA is nervous!

PTs are taught how to do a type of differential diagnosis. No we do not diagnose liver disease, or thyroid dysfunction, or kidney stones, or brain tumors, or pneumonia but those disorders do not fit into the patterns that we see and will be referred. No we civilians cannot order imaging or read them but our partners in health care can and do. If you come to my clinic with back pain that you can provoke with movement or position I will assess you and provide treatment. If the symptoms don't change after 2-3 visits then off you go to your real doctor to look for other causes. Most of the back pain will get better and that saves loads of cash in CTs and MRIs and risks very little for the patient.
If you come to my clinic directly with back pain that keeps you up at night, you can't find a comfortable position, OTC meds don't help, you have lost weight etc . . . you are sent directly to the doc.

Sounds like you're really great, why waste the visit with you in the first place. Let the docs do their job, decide which cases really need PT, and when you get them - do your job with the exclusive skills and knowledge that you have. But don't take patients just because you were trained or think that you can make them better more quickly if you treat them as opposed to simply letting their symptoms resolve on there own. That isn't exactly a good showing of EBM, at least not to the standards that are exacted in other healthcare professions.

Physical therapy is not as you describe. If your experience is how you have characterized it, I am very sorry, because you have had the misfortune of encountering an abberation. Every profession has them. You suggest that the APTA is eluding research that would expose the provision of millions of dollars of unneeded services, that is a pretty bold claim. Again, I would like to see something to back up your claim. It seems to me that the APTA and its various sections provide some pretty solid peer reviewed research.
but you won't see them publishing research that will adversely affect their profession's purse!

I think your arguments are weak.

Wonderful!

 

[guetzow]

RNs do a type of Dx as well, but they do 'Not' practice medicine. Mid-Levels = Practice 'Medicine' (Order imaging/Procedures/labs/write scrips, etc), PTs = 'Therapy'. Sounds like this drum beating is mostly a prestige/$ issue. Time to change careers, maybe? There's no shame in that. I was a respiratory "Therapist" at one time, myself.

 

[truthseeker]

Tell me you have never said, see me 3 x week for 6-8 weeks. There are now people doing research on TKR and the like showing that 1 visit a week yields the same outcomes.

I have never said that. I treat people until they are able to manage themselves. My goal is to reduce costs and not sacrifice outcomes.

Basically you want it to be easier for the patient to see the PT, WHY? Not to maintain a high standard of care, but for $$.

I work for a salary and it is irrelevant how much I bill my patients.

First, the ATPA won't support funding for it! Very little research exists and what does exist, you can attack the science behind it to easily even though the point is clear and the APTA is nervous!

It is not clear. The research is funded before the findings occur. I believe that the research when it is published will show exactly what you claim the NATA is trying to prove, except without the step to the doctor (remember, a very few cases anyway. The vast majority of all PT patients will arrive by way of their physicians) Sounds like you have already concluded that whatever the findings of that research will be declared invalid by your sense of statistics or whatever your intuition tells you is right.

I suspect that the DPM and many MD's can identify the problem. It isn't rocket science! Tell me what you're going to pick up on? Leg Length?....come on! The fact is that most cases of plantar fascitis can be managed very effectively with over the counter orthodics/arch support and calf stretching. The docs can handle this in one visit and decide which are appropriate to send to PT. The PT's will milk 6 plus visits out of something simple!

You're right, it isn't rocket science. Your use of the term arch support invalidates your entire line of reasoning. The arch needs to move, plantar fasciitis occurs because the arch moves without control or too far. Your mentality is like all of the people who come to the clinic with a cold and demand a one time fix with antibiotics that don't work on viral infections. Or the person who wants to take Hoodia or something like that to lose weight. There is a reason for musculoskeletal pain. If you treat the symptoms it will improve but it will come back. Its not about identifying the problem, its about using effective means to treat it and make it less likely to come back.

Good for you! I'm sure the orthopods don't know the difference. They should see the orthopedic first so you don't waste the 6 weeks of PT the patients insurance company will pay for when the patient will need it after surgery. Also, a home program set up in the orthopedist office for ac by an ATC will yield the same results without exhausting their the PT visits. Further, there is some research that clearly shows that having a manipulation for ac followed by PT doesn't improve symptoms of pain (actually worse with manipulation and PT) and doesn't restore function any quicker! I would reference, but my name is on it.

i would love to see the reference. What does your research say about the risk of general anesthesia? I am sure it is low, but it is lower if you aren't subjected to it. Remember, they didn't diagnose it properly in the first place. You continually make assumptions that PTs are about the money. Did you have a bad experience or what?

Show me a meta analysis of the research that shows this to be true. Trust me, as a PT billing the system, you don't want the studies to be done!

Ah, but I do want the studies to be done. We will be shown to have better outcomes and at a lower cost because we do it better, more completely and more efficiently than a self referring doc/ATC combo.

I'm not sure what you point is! Perhaps I can elaborate since I clearly understand that the provisions of each profession are slightly different. ATC's have much more focus on pre-hospital care vs. the total inpatient and outpatient training of PT's. For the past three years the educational competencies for PT's and ATC's are exactly the same. Pathology, EBM, Diff Dx, "diseased populations" are now taught in ATC education. When you and I went to school, they weren’t.

My point is that to my knowledge and in my experience, we were not exposed to anything but basically healthy individuals during my AT training. ATCs of my generation would not be able to identify red flags that indicate a non-musculoskeletal problem. If the training has changed, I stand corrected.

But lobbying to prevent others trained in the movement sciences from practicing in settings that may compete with physical therapists eliminates competition and professional growth.

The lobbying is to protect the public from potentially unscrupulous behavior. Stark laws prohibit self referral. The reasons for that are obvious. ATCs working in an orthopod's office is a very similar situation, just different credentials. What is to stop the family practice doc or the neurologist from doing the same?

On second thought, you're right, PTs are just a bunch of people who are frustrated because they couldn't get into medical school and are bitter and trying to run the medical profession out of business by treating hamstring strains. Oh, yeah, we are also trying to fleece the public for as much as we can. Further, we are going to try to call ourselves doctor in order to further confuse the public. I quit.

 

[guetzow]

And nursing, and respiratory therapy, ad nauseum; but they don't practice medicine either 🙂....."PTs are just a bunch of people who are frustrated"....Some, definitely. I see a paralell between with the over-education of respiratory therapists, who 'know' a disproportionate amount compared with what they actually 'do'. Yet, there is no mad dash to supplant the role of pulmonogists and try to practice medicine, because they, too, are 'Therapists', not medical practitioners. It seems you have outgrown your role intellectually. Perhaps you should consider an MD in Sports Medicine?

 

[lawguil]

I work for a salary and it is irrelevant how much I bill my patients.

But if you can generate more revenue for a practice or open your own someday......direct access has the potential to increase your salary! It's self-serving. If all your patients will come from physicians anyway, why all the money, time and effort by the APTA to obtain direct access?

Sounds like you have already concluded that whatever the findings of that research will be declared invalid by your sense of statistics or whatever your intuition tells you is right.

You'll notice I wrote the word Hypothesis not conclution!

You're right, it isn't rocket science. Your use of the term arch support invalidates your entire line of reasoning. The arch needs to move, plantar fasciitis occurs because the arch moves without control or too far. Your mentality is like all of the people who come to the clinic with a cold and demand a one time fix with antibiotics that don't work on viral infections. Or the person who wants to take Hoodia or something like that to lose weight. There is a reason for musculoskeletal pain. If you treat the symptoms it will improve but it will come back. Its not about identifying the problem, its about using effective means to treat it and make it less likely to come back.

Alright smarty pants - what do you do when an arch "moves to far" or is hyermobile or spends a little too much time in the loose packed position (durational)? Surely we could have a pissing match about orthodic fabrication, but it quite often involves something called a scaphoid pad! In some circles they call it 'arch support'. Sorry.

i would love to see the reference. What does your research say about the risk of general anesthesia? I am sure it is low, but it is lower if you aren't subjected to it. Remember, they didn't diagnose it properly in the first place. You continually make assumptions that PTs are about the money. Did you have a bad experience or what?

Who diagnosed it wrong? I'm not following you. I'm talking about treatment, not a misdiagnosis!


Ah, but I do want the studies to be done. We will be shown to have better outcomes and at a lower cost because we do it better, more completely and more efficiently than a self referring doc/ATC combo.

I'm glad you do and I do too. It's nice to hear that you can diff dx better than an MD/DO, you know more than an orthopod about orthopedics, and can rehab better than an ATC. Rehabs a protocol - you can train a monkey to do it. save you breath, i know your response!


My point is that to my knowledge and in my experience, we were not exposed to anything but basically healthy individuals during my AT training. ATCs of my generation would not be able to identify red flags that indicate a non-musculoskeletal problem. If the training has changed, I stand corrected.
The training has changed - in fact it changed before it changed in the PT curriculum. It wasn't until about 3 years ago that diff dx and radiology started getting serioius in the PT world.

The lobbying is to protect the public from potentially unscrupulous behavior. Stark laws prohibit self referral. The reasons for that are obvious. ATCs working in an orthopod's office is a very similar situation, just different credentials. What is to stop the family practice doc or the neurologist from doing the same?

First, a PT is better than an ortho/ATC team because they can do a better job at diff dx than a physician even though they don't have the training and they can tell a patient how to do quad sets, SLR's, use modalities and mobilizations better than an ATC. Sounds like the PT education is just as encompassing as a chiropractors. They can treat everything and anything at anytime without referral! So much for a multi-disiplinary approach to care!

Further, we are going to try to call ourselves doctor in order to further confuse the public. I quit

I agree, it will confuse the patient!

 

[lawguil]

And nursing, and respiratory therapy, ad nauseum; but they don't practice medicine either 🙂....."PTs are just a bunch of people who are frustrated"....Some, definitely. I see a paralell between with the over-education of respiratory therapists, who 'know' a disproportionate amount compared with what they actually 'do'. Yet, there is no mad dash to supplant the role of pulmonogists and try to practice medicine, because they, too, are 'Therapists', not medical practitioners. It seems you have outgrown your role intellectually. Perhaps you should consider an MD in Sports Medicine?

Well said!

 

[lawguil]

http://72.14.207.104/search?q=cache...ss+is+More"+brochure&hl=en&gl=us&ct=clnk&cd=1


When Less Is More:National Athletic Trainers’ AssociationCertified Athletic Trainers provide care to patientsat a lower cost, in fewer treatments and at higher patient satisfaction level.Results:• Study group 1: With a Certified Athletic Trainer (ATC) as the rehabilitationprovider, the patient averaged 8.9 visits. • Study group 2: With a physical therapist performing the rehabilitation, patients averaged 17.8 visits.Cost Savings:• Study Group 1: Certified Athletic Trainer as the providers - 8.9 visits=$421.95• Study Group 2: Physical therapist as the providers - 17.8 visits=$2,341.00• Average savings to the payer of rehabilitation services by using ATC to perform the rehabilitation =$1,919.05Patient Satisfaction:On a scale of one to three:• Study Group 1: Certified Athletic Trainer ranked 2.95• Study Group 2: Physical therapist ranked 2.68Methodology:• Subjects were randomly selected by chart review by attending surgeon.• Surgical dates occurred during 2002-2004.• Case selections were based on diagnosis, operative procedure, absence of comorbitities/surgical complications.• Eight-week formal rehabilitation therapy program initiated within six days ofpost-op at outpatient therapy facility. The rehabilitation was supervised by a licensed Certified Athletic Trainer or licensed physical therapist. Therapy reimbursed as incident to the physician’s services.• Rehabilitation protocols developed by physical therapists and approved by the surgeon and by the ATC in conjunction with surgeon.Study conducted by Scott Gudeman, MD, OrthoIndyThe Bottom Line:Less Time! • Less Expensive!Happier Patients!2005© National Athletic Trainers’ AssociationFor More Information Call:National Athletic Trainers' Association2952 Stemmons Freeway, Dallas, Texas [email protected] • Phone: (214) 637-6282 • Fax: (214) 637-2206 • www.nata.orgUnique Health Care ProvidersATC- 8.933.3%PT-17.866.6%Number of Visits Required😛T- Physical Therapist; ATC - Certified Athletic Trainer$0$500$1000$1500$2000$2500Group 1Certified Athletic TrainersGroup 2Physical Therapists$421.95$2,341.00Therapy Cost:Group 1Certified Athletic TrainersGroup 2Physical TherapistsPatient Satisfaction:0.01.02.03.02.952.68

 

[lawguil]

This is what the AMA, AAPMR and AOSSM think about the CMS proposal. They seem to recognize the benifits of the MD/DO and ATC team and understand the danger of a provider with who wishes to practice autonomously without physician oversight (aka..the physical therapist)


http://www.nata.org/members1/committees/gac/cms/ama_comments.pdf
http://www.nata.org/members1/committees/gac/cms/aapmr_comments.pdf
http://www.nata.org/members1/committees/gac/CMS/AOSSM_comments.pdf

 

[truthseeker]

Alright smarty pants - what do you do when an arch "moves to far" or is hyermobile or spends a little too much time in the loose packed position (durational)? Surely we could have a pissing match about orthodic fabrication, but it quite often involves something called a scaphoid pad! In some circles they call it 'arch support'. Sorry.

Smarty pants here. You control the height of the arch by controlling the first metatarsal and the rearfoot, not by holding up the scaphoid. Arches are meant to stay in the air, very few callouses on the scaphoid. If you ask someone who fixes arches for a living like a stone mason, they will tell you that you control the arch and maintain its function by stabilizing the pillars, not by putting a post underneath the keystone. What is the function of the arch anyway? its to provide shock absorption and to give a quick stretch to the muscles of the lower limb in all three planes to enhance automatic contraction. If you prevent the arch from moving you reduce efficiency.

Who diagnosed it wrong? I'm not following you. I'm talking about treatment, not a misdiagnosis!

In my original example, the patient came over with a diagnosis, from the orthopod, of adhesive capsulitis. They had no capsular pattern, full ROM and positive impingement signs.

I'm glad you do and I do too. It's nice to hear that you can diff dx better than an MD/DO, you know more than an orthopod about orthopedics, and can rehab better than an ATC. Rehabs a protocol - you can train a monkey to do it. save you breath, i know your response!

I didn't say that. I said or meant to infer that with musculoskeletal cases I can see patterns that are not musculoskeletal. In other words, if someone comes in with left shoulder pain and it does not fit any musculoskeletal/movement disorder patterns they get referred to their doctor. I think clinically, good PTs are as good as good orthopods at diagnosing things. We don't have all the tools (imaging, arthrograms, myelograms,discograms etc . . . )so what we assess, we have to do so clinically with history taking and knowledge of biomechanics etc . . . How many people go to an orthopedist who really "doesn't do backs" and gets muscle relaxers and Vicoden and bed rest? Maybe an MRI that shows nothing? How many times do they go to the doctor whatever kind with back pain and leave with a diagnosis of low back pain. What did they gain? where is the miraculous diagnosis?


The training has changed - in fact it changed before it changed in the PT curriculum. It wasn't until about 3 years ago that diff dx and radiology started getting serioius in the PT world.

Whatever. I disagree but I guess you are in charge of surveying the curricula of the various professions.

First, a PT is better than an ortho/ATC team because they can do a better job at diff dx than a physician even though they don't have the training and they can tell a patient how to do quad sets, SLR's, use modalities and mobilizations better than an ATC. Sounds like the PT education is just as encompassing as a chiropractors. They can treat everything and anything at anytime without referral! So much for a multi-disiplinary approach to care!

If you think that rehab is a protocol and that it is SLR and quad sets then you live in a box. You have no clue what rehab is. If that is what your physical therapist did with you then no wonder you have a major problem with the profession. Nowhere did I say that we can treat everything. You are completely delusional if you think I said or even think that. The multidisciplinary approach to care is exactly what I am advocating. PTs act as a screening tool for the family practice docs. If someone thinks they have a sprain or strain, they come to me. If that is what they have, treatment gets expedited. If it is not what they have, then they get referred to the person that can help them. Heck, thats exactly how ATCs function in the athletic world.

 

[truthseeker]

http://72.14.207.104/search?q=cache...ss+is+More"+brochure&hl=en&gl=us&ct=clnk&cd=1


When Less Is More:National Athletic Trainers’ AssociationCertified Athletic Trainers provide care to patientsat a lower cost, in fewer treatments and at higher patient satisfaction level.Results:• Study group 1: With a Certified Athletic Trainer (ATC) as the rehabilitationprovider, the patient averaged 8.9 visits. • Study group 2: With a physical therapist performing the rehabilitation, patients averaged 17.8 visits.Cost Savings:• Study Group 1: Certified Athletic Trainer as the providers - 8.9 visits=$421.95• Study Group 2: Physical therapist as the providers - 17.8 visits=$2,341.00• Average savings to the payer of rehabilitation services by using ATC to perform the rehabilitation =$1,919.05Patient Satisfaction:On a scale of one to three:• Study Group 1: Certified Athletic Trainer ranked 2.95• Study Group 2: Physical therapist ranked 2.68Methodology:• Subjects were randomly selected by chart review by attending surgeon.• Surgical dates occurred during 2002-2004.• Case selections were based on diagnosis, operative procedure, absence of comorbitities/surgical complications.• Eight-week formal rehabilitation therapy program initiated within six days ofpost-op at outpatient therapy facility. The rehabilitation was supervised by a licensed Certified Athletic Trainer or licensed physical therapist. Therapy reimbursed as incident to the physician’s services.• Rehabilitation protocols developed by physical therapists and approved by the surgeon and by the ATC in conjunction with surgeon.Study conducted by Scott Gudeman, MD, OrthoIndyThe Bottom Line:Less Time! • Less Expensive!Happier Patients!2005© National Athletic Trainers’ AssociationFor More Information Call:National Athletic Trainers' Association2952 Stemmons Freeway, Dallas, Texas [email protected] • Phone: (214) 637-6282 • Fax: (214) 637-2206 • www.nata.orgUnique Health Care ProvidersATC- 8.933.3%PT-17.866.6%Number of Visits Required😛T- Physical Therapist; ATC - Certified Athletic Trainer$0$500$1000$1500$2000$2500Group 1Certified Athletic TrainersGroup 2Physical Therapists$421.95$2,341.00Therapy Cost:Group 1Certified Athletic TrainersGroup 2Physical TherapistsPatient Satisfaction:0.01.02.03.02.952.68

Might be true. So the study was sponsored by Dr. Gudeman who employs ATCs. And the subjects were selected by him. No conflict there.

 

[MacGyver]

truthseeker you dont get it.

"Screening" is supposed to be done by people with a broad general medical education, not specialists.

YOu got it backwards arguing that SPECIALISTS should be doing the screening. Your proposal is hte same thing as having cardiologists be the initial contact for patients.

Doesnt make any sense..... you screen with the generalist FIRST who then refers to specialists

 

[lawguil]

Smarty pants here. You control the height of the arch by controlling the first metatarsal and the rearfoot, not by holding up the scaphoid. Arches are meant to stay in the air, very few callouses on the scaphoid. If you ask someone who fixes arches for a living like a stone mason, they will tell you that you control the arch and maintain its function by stabilizing the pillars, not by putting a post underneath the keystone. What is the function of the arch anyway? its to provide shock absorption and to give a quick stretch to the muscles of the lower limb in all three planes to enhance automatic contraction. If you prevent the arch from moving you reduce efficiency.

And how do you control the first met and rearfoot? In no place did I say that you prevent the arch from moving! Please let us know! And please, for the purpose of proving your point - do it without using the words scaphoid pad or rearfoot postings. Obviously it's what the pt presents taht you treat.

 

[lawguil]

usual treatment for plantar fasciitis.....conservative treatment = heel chord stretches/plantar fashia stretching and OTC orthodic inserts. If treated by a physical therapist, you'll need 3 weeks of therapy with copays, time away from work and no guarantee’s! Thanks, lawguil


http://www.wheelessonline.com/ortho/plantar_fasciitis

 

[truthseeker]

usual treatment for plantar fasciitis.....conservative treatment = heel chord stretches/plantar fashia stretching and OTC orthodic inserts. If treated by a physical therapist, you'll need 3 weeks of therapy with copays, time away from work and no guarantee’s! Thanks, lawguil


http://www.wheelessonline.com/ortho/plantar_fasciitis

Assess the foot posture. If rearfoot and/or forefoot varus, post it medially. If heel cord tight, stretch it, if balance bad, train it. tape the arch for immediate pain relief. Usually two or three visits total. Get a grip.

 

[lawguil]

Assess the foot posture. If rearfoot and/or forefoot varus, post it medially. If heel cord tight, stretch it, if balance bad, train it. tape the arch for immediate pain relief. Usually two or three visits total. Get a grip.

Agree, but if I were you I would consider stretching the heel chord regardless if it's assessed as tight and I use OTC inserts or heel cushioning instead of expensive custum orthodics as research suggests that patients find them to provide better results. 1 visit max by an MD/ATC = same results, less hastle for the patient, and less billing = good for everybody!

Non Operative Treatment:
- of note, one of the major negative factors in determining the effectiveness of non operative treatment is standing more than 8 hrs per day;
- heel cord and plantar fascia stretching:
- in patients w/ even mild heel cord contracture, the mainstay of plantar fasciitis should be heel cord stretching;
- several retrospective studies show that this is the most effective form of treatment; - this will unload stress over the midfoot and will aleviate plantar fascial pain in the majority of patients:
- in the acute phase stretching can be done by applying POP
- dorsiflex and add stretching effect to the fascia itself - can be initially very painful);
- references:
- The effects of duration and frequency of Achilles tendon stretching on dorsiflexion and outcome in painful heel syndrome: a randomized, blinded, control study.
- Tissue-Specific Plantar Fascia-Stretching Exercise Enhances Outcomes in Patients with Chronic Heel Pain. A Prospective, Randomized Study.
foot orthotics:
- for most patients foot orthotics will provide only fair success;
- in the prospective randomized study by G. Pfeffer MD et al 1999, it was found that when used in conjunction with a stretching
program, a prefabricated shoe insert is more likely to produce improvement in symptoms than a customized polypropylene device;

http://www.wheelessonline.com/ortho/plantar_fasciitis

Your cost to treat plantar fasciitis - 100-300 for custom orthodics 100+ for intial eval and two follow up visits at 75$ (approximatly) = $350-550 for treatment. My cost is $15 max for inserts and $100 consult = $115 with same results.

 

[deleted6669]

Wrong. No midlevel knows what I know.

I'm guessing the physical therapist who went to pa school with me has that one covered......he works in an ortho practice now and gets to utilize both skill sets.
he can do initial evals, ongoing therapy, preop/intraop/post op care as well as write his own rxs as needed.
kind of a sweet deal...makes about 125k/yr with no overhead......

 

[PublicHealth]

I'm guessing the physical therapist who went to pa school with me has that one covered......he works in an ortho practice now and gets to utilize both skill sets.
he can do initial evals, ongoing therapy, preop/intraop/post op care as well as write his own rxs as needed.
kind of a sweet deal...makes about 125k/yr with no overhead......

I find it interesting how all the mid-levels (PAs, PTs) that you describe are banking into the 100Ks. Where are you that they're so well reimbursed? PAs where I'm from (New England) make $60-80K.

 

[deleted6669]

I find it interesting how all the mid-levels (PAs, PTs) that you describe are banking into the 100Ks. Where are you that they're so well reimbursed? PAs where I'm from (New England) make $60-80K.

most of the pa's I know have been out of school> 10 yrs and work in specialty practice.
the natl avg now for all pa's is 81k so only a new grad should make 60-70k at this point.

 

[MSHARO]

I have not read the thread real closely, but I decided to chime in on this topic anyway. I won't even comment on the DPT. I have done this in the previous posts. For anyone to say it is just PT's that are driving up costs because they are trying to rake in the dough is not exactly a fair or accurate statement. The waste comes from all aspects. It comes from the business side of PT pushing for higher revenues, it comes from PT's not willing to take a stand on what is actually indicated for their patients, and it also comes from physicians who do not know how to appropriately utilize PT or accurately diagnose musculoskeletal conditions. But doesn't this kind of waste happen right now in every field of health care? I won't even go into chiropractic field...

When I worked as a ATC, PT, one of my biggest complaint was when physicians would write scripts for 3x week for 6-8 weeks. When I would then try to talk them out of it or to cut pts loose earlier, I almost had to fight them about it. Is this cost effective? Or what about a patient who has had knee pain/back pain/whatever...who is doing fairly well, but you would still like to follow because they are still not at the functional level they want to or should be at and you just need to progress or modify their exercises once a month or so? Does it make sense to have them go back and see the physician every month or have to write them and get a script for a known, well controlled problem? Is that cost effective?

Personally, I rarely felt I needed to see someone more than once a week. There may be some exceptions with patients with acute back pain or possibly post-op, etc, but that is pretty rare. It was definately not the norm. But maybe that is just me. Was there pressure from corporate headquarters to bring patients in more, sure, but if that much therapy is not indicated, it is not indicated. You have to take a stand somewhere.

I think that for cost effectiveness, direct access for PT's makes sense from several aspects. It is no more costly for a patient with a plantar fasciitis, as has been the example used, to go to a PT for an evaluation, even with the possibility that they may need to be refered out than it is to go to a physician and then onto a PT. That is unless the treatment is incorrect, inappropriate, or perfromed by an incompetent clinician. But this too can happen on both ends. How many times did I have these patients already come in with custom orthotics, night splints, expensive NSAIDs? Way too often. If I had seen them first would it really have cost more? Another example that was brought up. 10 people come in off the street to see me the physician with ankle sprains they got playing pick up basketball. Do you seriously think it is cost effective to screen ALL with x-ray's? Which just happens to be in the physicians office and I get to bill for (now where's the money at?) This is only the case if you are an idiot who cannot perform a physical exam. What if they came into me as a PT first and it turns out that because I can actually do a physical exam, 3/10 needed a referral back to an MD for diagnostic imaging because they may have a fracture. And what if 1/10 actually has a fracture? Is this more expensive or about PT's getting more money than all 10 going to see their physician and then all 10 coming to me for a PT eval? To me it seems the physicians would just not want to lose those 7 vists and x-ray's (again where is the money at?) In my experience, the way it worked out without direct access, all 10 would go to the physician, 5-10 would get x-rays, a few may even get MRI's, and all would eventually come to see me for a PT eval. That doesn't sound cheaper...

With direct access, I know that I would have had more control over how I treated my patients instead of the stupid scripts for e-stim, US, 3x week for 4 weeks crap I recieved. I would have been better able to dictate what the patient needed from a PT standpoint. Which is what I was trained in if I remember right... And to say that I would not be able to screen patients for non-PT related conditions is also not very accurate statement as well. I think that most competent PT's would be able to screen for non-movement realted conditions, at least as much as most physicians can screen for musculoskeletal conditions. Again...this is just SCREENING, not diagnossing, medical conditions. As a PT, there is no way I am trying to make a diagnosis prostatic adenocarcinoma. But if I have a 70 year-old male with constant LBP, with a history of fever, weight loss, urinary retention, etc...little bells go off in my head and say "Maybe this isn't simple LBP maybe I should refer." I learned that first year in PT school. I probably learned that earlier in PT school than I did in medical school.

I am sure that several people will chime in here and say that only physicians can do this kind of screening...blah...blah...blah. However, I bet these these people really don't have the experience in all of these fields to make an accurate judgement. Are there cases where a PT may miss something? Sure, but this happens in physicians offices as well. I have seen it on numerous occassions. In all honesty...how much musculoskeletal training do you get in medical school? Not much... So if it all about the "training you get in medical school argument" and that only physicians can have direct access, I'm not buying it. Are primary care physicians really qualified to screen musculoskeletal problems then? Even if you take into account three years of residency for primary care etc.? No, they can make sure it is not non-musculoskeletal, but then for the most part they then either need to give them a prescription for meds or send them to PT. PTs pretty much spend 3 or more years focusing on movement related conditions.

That's my rant... I have to go to bed.

 

[guetzow]

Your bad experiences do not change the facts. PTs don't practice medicine, nor should they ever. They are THERAPISTS. Most of your complaints are relevant only to poor practitioner-therapist communication (On who's part, I do not know....), and poor practitioner musculoskeletal management skills, which I'm sure exists (Just as poor therapists, RNs, and EMTs exist). Neither of these reasons are remotely good enough to let THERAPISTS practice medicine.

 

[MSHARO]

Who ever said that PT's should practice medicine? Did I? All I indicated is that there is a very clear difference in the scope of practice between medicine and PT. Do you know the differeces between the scope of practices? As a PT, I should definately not be able to practice medicine. But I should be able to know when something that may have originally looked like a PT problem, actually seems to be more of a medical problem, that I should refer them to a physician. If a PT is not able to do this, they ARE incompetent and should not be practicing because that is part of the physical therapy profession. However a physician, also has no business practicing physical therapy. Physicians should know that certain problems are better treated by physical therapy and then they should refer them to a PT. Why is a two way street like this so hard to comprehend? What is the real argument here is what is the difference between a medical problem a PT problem. THAT is the question. You seem to think that EVERYTHING that a PT does is a MEDICINE problem that should be delegated to an underling. I personally do not see it that way. Maybe as a PA (which is what it sounds like you are) that is what your training was about. But as a former PT, I can certainly tell you mine was not. I bet most PT's on this board would hopefully agree with that.

There have been several argument that people have reported as reasons why PT's should be denied direct access, but most are flawed. The argument against direct access based upon level of training is flawed. If that were the case, primary care physicians should not be able to treat musculoskeletal conditions. Musculoskeletal conditions should only be seen by orthopods or PM&R. Do you really know how much musculoskeletal training primary care physicians get? How about in medical school? NOT MUCH! Certainly not the 3+ that PT's get, and if you are also and ATC, add 4 more to that. Do you think that all 4 years of medical school and 3 years of residency is directed towards musculoskeletal conditions? Now, do I think that primary care physicians should not have direct access to patients with musculoskeletal conditions since they do not have extensive training in this. Of course not. They have been taught enough essentially SCREEN (and in a few cases treat if they have the training) these conditions. If it is not a medical condition, but a movement problem (aka PT problem) they should then REFER to and orthopod or a PT. Just as I pointed out with the PT who sees a pt that has a MEDICAL problem, not a PT problem should refer to a physician.

The argument that it is all because the PT's want is money is also somewhat flawed as the arguments that people make for this point can easily be reversed. Is the reason why physicians don't want direct access about patient safety/scope of practice etc, or is it about their desire to not to lose income from these patients visits? It actually is probably partly true in each case for both PT's and MD's.

I have still yet to hear a valid reason from anyone on why PT's should not have direct access.

 

[guetzow]

That's where this is headed. A pig in lipstick is still a pig. Unhappy THERAPISTS that want to practice medicine need to go back to school.

 

[MSHARO]

Typical. You can't come up with a legit reason so you make stupid comments like that. And who said I was unhappy as a therapist? I actually really enjoyed what I did as a PT for the most part and I still love the field. That had nothing do do with why I decided to go to medical school. I just found that my true passion was orthopedic surgery; so I decided to go back to school. Personally I just get tired of idiots making false accusations, inaccurate comments, about something they really know nothing about just to stir things up. Obviously these comments are coming from a individual who is not able to practice medicine or physical therapy. As for more education...maybe you should look into it. Personally, after this degree, I think I'll have enough.

 

[guetzow]

You stand corrected.

 

[MSHARO]

How so? Because I went back to school?

 

[beephlatPT]

How so? Because I went back to school?

Hey MSHARO,
from a fellow PT planning on med school in the next couple of years, how has the transition been for you thus far?

 

[guetzow]

Congrats guys, "moving on" is much more productive than attempting to supplant entire professions 🙂

 

[ProZackMI]

Ever notice how the people who have the most to say about this issue are physician ASSISTANTS? You know, those folks who couldn't make it into medical school and actually practice medicine. Those folks who love it when patients confuse them for "doctors" and call them "doctor". I love these PAs who claim to practice medicine. Sorry PAs, but you're ASSISTANTS, not PHYSICIANS.

I personally don't care whether PTs have direct access. I doubt they ever will gain this status, but things are changing so fast in health care (e.g., CRNAs/Midwifes with enhanced scopes of practice, NPs, PAs, ODs with RxPs, PharmDs with CPP designations and RxPs, PsyD/PhDs with RxPs in some states, expanding in others, etc.), who can tell? If PT is changing for the better, so be it. I don't think MDs/DOs have anything to fear from PTs enhanced education or direct access issues. I would think, however, that if PTs get direct access, the DCs won't be so happy!

 

[guetzow]

Yaaaaawn. I'm going to swim in my pool now........

 

[Skialta]

Congrats on beating each other up. I practiced in a state that had direct access but it did not mean squat. Insurance companies are driving the car, they are the ones who really need the convincing. Being a PT in private practice and also for a company, I think money is quite a motivating factor. While MSHARO sounds like a good clinician how many others out there would use up the patients outpatient PT benefits only to then send them to a physician because they are not well? I would really like to see a pilot program done so that one could compare costs because I am not truly convinced that PT seeing the patient first would be a cost benefit when you took into account the full spectrum of patients and disease.

 

[adamdowannabe]

Ever notice how the people who have the most to say about this issue are physician ASSISTANTS? You know, those folks who couldn't make it into medical school and actually practice medicine. Those folks who love it when patients confuse them for "doctors" and call them "doctor". I love these PAs who claim to practice medicine. Sorry PAs, but you're ASSISTANTS, not PHYSICIANS.

If a person (licensed by the state medical board to do as such) see's an individual complaining of a malady, takes a Hx, does a physical exam, makes a Dx on said H&P, and then counsels said individual with treatment plans and options, and does or does not write a Rx for the Dx............. Then bills an insurance company for services rendered.

Would you agree with me, that the above listing of events is a decent description of what it is to practice medicine?




I smell......... a supposedly over educated; troll.

 

[deleted6669]

"I smell......... a supposedly over educated; troll."

macgyver is the biggest troll on this forum...probably a high school kid......

 

[ProZackMI]

"I smell......... a supposedly over educated; troll."

already well known. zack and macgyver are the biggest trolls on this forum...both are probably high school kids......

Wow, you got me! Yep, I'm 15...oh well!

 

[MSHARO]

If a person (licensed by the state medical board to do as such) see's an individual complaining of a malady, takes a Hx, does a physical exam, makes a Dx on said H&P, and then counsels said individual with treatment plans and options, and does or does not write a Rx for the Dx............. Then bills an insurance company for services rendered.

Would you agree with me, that the above listing of events is a decent description of what it is to practice medicine?




I smell......... a supposedly over educated; troll.

Actually...no...I wouldn't agree that this is practicine medicine exclusively. It kinda sounds a lot like what I was taught as a PT as well. We were taught to make a movement diagnosis based upon the history and physical exam. The term diagnosis is not exclusively reserved for medicine (unless the physicians were lucky enough to get into into their states practice act early). But this is not the case in every state. In many states, a PT is allowed to make a Dx.

As for whether it would cost less to treat with direct access....I am not sure if it would be cheaper in all honesty. But I really don't think it would be more expensive. And as Skialta pointed out, it may depend on the patient populations, the diagnosis, but I also think that it would depend on the practice style of the clinicians and how they utilize their visits, etc. There have been studies that more patient driven/independent therapy with less visits is more cost effective and often has similar outcomes. But I haven't been able to keep up with that literature with regards to which diagnoses it has been studied for.

I also in all honesty don't think that direct access would actually be utilized to a great extent either. I just don't think that there have been many valid arguments for why it should be limited. The cases where I think it would be utilized would be the patient who was d/c from PT and then a month or two later increases their activity and wants to go back to the PT. Or the patient with the lower grade injuries such as a sprained ankle, strained HS, or chronic nagging problems such as low back pain, shoulder pain, etc. It would just be more convenient for these patients and for the PT. As I mentioned before. It would help cut down on the paper work, trips back and forth from office to office, more time off of work to attend all of these visits on the patient's part etc.

 

[lawguil]

Actually...no...I wouldn't agree that this is practicing medicine exclusively. It kind of sounds a lot like what I was taught as a PT as well. We were taught to make a movement diagnosis based upon the history and physical exam.

But do you understand the difference b/t what a physical therapist does and what a primary care physician does?


The term diagnosis is not exclusively reserved for medicine (unless the physicians were lucky enough to get into into their states practice act early). But this is not the case in every state. In many states, a PT is allowed to make a Dx.

A Dx of what? mechanical low back pain vs. an infected prostate? Tell me, when is the last time you did a physical evaluation that included a pelvic exam, prostate exam, breast and other genital exam, used a stethoscope for something other than checking BP, ect.....then because of your exam and the history decided that perhaps we should order some imaging and/or labs and new how to interpret the results? You have to have the knowledge of what could be suspected, but PT training doesn't train you for this - buddy! Your "training" in diff. Dx. is extremely light and tailored for the provisions of physical therapy. You are NOT trained as a generalist, but as a type of movement specialist! Maybe when you finish medical school - you'll understand the difference b/t you're PT educational and medical education!


As for whether it would cost less to treat with direct access....I am not sure if it would be cheaper in all honesty. But I really don't think it would be more expensive.

What's the sales pitch going to be then! Access to care? I would be interested in learning the percentage of NMS injuries that physicians actually handle themselves as opposed to sending them directly to PT. My guess is it's a lot and it's much cheaper and just as successful. The physicians at my local ER seem to have it figured out that with an grade II or better ankle sprain, the most important care a person can receive is ruling out the fracture, not sending them to PT! And oh yea - you can't order them or read them! Tell me how it's cost affective for the patient to go to the PT first, decide that perhaps he should do what's right and send him to a physician who can order and interpret the imaging, then have the physician send him back to PT (that's if he doesn't understand that there is not need to send an ankle sprain back to the PT unless the pt is at a high risk of falling or something like that!) But with direct access we would have a senseless visit to the PT when the injury needed to be evaluated by a physician and fracture ruled out. Further, it's likely that the PT would want follow up after the injury and if they had direct access, the patient could come back whether the physician felt it was ness Cary and continue gouging the system!


And as Skialta pointed out, it may depend on the patient populations, the diagnosis, but I also think that it would depend on the practice style of the clinicians and how they utilize their visits, etc. There have been studies that more patient driven/independent therapy with less visits is more cost effective and often has similar outcomes. But I haven't been able to keep up with that literature with regards to which diagnoses it has been studied for.

you would be a better practitioner if you kept up with it and much happier that you're in med school! In fact as an experienced clinician, I'm sure you have you're own hypothesis just as I do!

I also in all honesty don't think that direct access would actually be utilized to a great extent either.

I think that a good PT who valued a multi-disciplinary approach would prefer that everything stay the same!

I just don't think that there have been many valid arguments for why it should be limited. The cases where I think it would be utilized would be the patient who was d/c from PT and then a month or two later increases their activity and wants to go back to the PT. Or the patient with the lower grade injuries such as a sprained ankle, strained HS, or chronic nagging problems such as low back pain, shoulder pain, etc.

WoW! -


It would just be more convenient for these patients and for the PT. As I mentioned before. It would help cut down on the paper work, trips back and forth from office to office, more time off of work to attend all of these visits on the patient's part etc.

What about competition from other healthcare providers in the movement sciences? The ATPA doesn't seem to fond of that!