Doctorate

[truthseeker]

Actually.. there are 6-year MD programs in the US for students right out of high school too! McMaster university in Canada has an MD program that is 3 years too! The Universities in the the UK and Australia also have 4 year graduate entry programs too! The University of Pacific in SanFrancisco has a 5-year program for students out of high school to earn a DDS and only a DDS.. no other Bachelors degree in 5 years! AND this is an American ADA program!

Sorry.. but there are american doctors and dentists who only have a medical degree as well! In the UK and australia these days.. most people have to obtain a first degree too just like the US in order to gain admission to med school too. Most go to 4 year programs... for example Cambridge Med has both options.

Medical and Dental school degrees are still only undergraduate professional degrees.. not doctorates. No matter how you obtain them.

Are you sure a DPT degree is 8 years long? I hadn't heard that one before.
You must mean most obtain a 4 year bachelors and then do the 4 years to get the DPT? So.. DPT is 4 years not 8. Sorry... your bachelors in communication doent equate as part of your DPT curriculum sorry.
yeah.. you know what 2-3 years go.. people were doing 4 years of college, then doing 4 and geting an MSPT degree.. which isnt any different. and a couple of years before that they were doing sometimes doing 4 years of college and then applying to do a BSPT degree. Just because many people complete one prior degree before matriculation at a health professional program.. doesnt mean that then that health program automatically confers you a doctorate degree. There are some people I'm sure who want to do a bachelor of engineering degree at MIT.. and maybe in order to be competitive enough to get in.. they have to first complete another degree somewhere else and then reapply to get in. But that doesnt mean that then they can just automatically get in to MIT and do engineering but instead get a Doctor of engineering. It just doesn't work that way.

If you want a doctorate degree.. First you should complete a first degree in a particular subject, then move onto a Masters and/or PhD in that subject matter. Or I would say that the clinical doctorates would be legit if you already have expereince in that field.. say if someone completed a 4 year bachelor of Physical therapy.. then did a 2-3 year Masters of Physical therapy, then completed a 4 year clinical Doctorate of Physical therapy. Each one building on the other's knowledge.. not just skipping straight to the doctorate.

You say correctly that the DPT program is not 8 years in length. I am counting my 4 years of undergraduate education (in athletic training, not communication) but then, you cannot count the 4 years that a pre-med student spends as a chem or bio major either. The point is that Medical school is 4 years. two of which are spent in the classroom and the rest is on clinical rotations. I am not dissing that program, its just that PT school is two years of classroom and 1 year of clinicals. Not that much different, in terms of time, than medical school. Ours is focused in a small area of healthcare, medical school is distributed over the broadest of areas.

I did a 4 year bachelors in athletic training, a 2 year masters of PT, and a 2 year DPT program. Many are doing the same.

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[chicoborja]

I respectfully disagree. The "DPT" is in no uncertain terms in any shape or form comparable to the PhD in America. If it were comparable, they would call it a PhD - trust me. The PhD changes who you are and the DPT simply gives the average warrior a diploma to put on the office wall; and it will go right beside your colleagues who earned a BSPT 8 years ago whom has forgotten more than you leaned in 8 years of DPT school.

I'd have to disagree with this statement. Although the PhD is most certainly harder than its corresponding allied health profession's clinical doctorate (e.g., PT, audiology), I'd have to say in some fields the difference is less pronounced. For example, in audiology for quite some time those that wanted to educate themselves beyond the master's would enroll in PhD programs. Many of these graduates were not interested in research but rather wanted to pursue clinical practice. Consequently, a clinical track was added to these former research PhD programs. Those pursuing the clinical track still had to complete a doctoral disseratation; however, they had increased clinicals with, I'm assuming, decreases in other research areas to compensate. Many of these clinical PhDs have changed over to AuD (clincial doctorate) programs with minimal differences. The dissertation is no longer required and a doctoral essay (essentially a master's thesis) takes its place. Fewer statistics courses are also a change. Although these PhDs were more skilled and familiar with research, the difference between the two graduates is not astronomical, especially when comparing the two in clinical practice.

Although it is ideal to believe that a PhD in any given field will be as rigorous as a PhD in any other given field, that is not the case. I would put my neck and say that post-professional PhDs are far less rigorous than pure academic PhDs. For example, a PhD in PT, audiology, OT, nursing is not likely to be as rigorous as a PhD in biochemistry, neuroscience, or toxicology.

 

[lawguil]

I agree that the DPT is not much different than an MPT. However, it is arguable that the MPT degree underrepresented the level of knowledge held by the PT professional. In addition, I agree that it is a political ploy. I think that the DPT reflects a more appropriate level of education rather than the Masters. What do you call it when you add courses to a master's program?

I might add that the DPT is not that much different than the MPT, which is not that much different than the BSPT. So the MPT underrepresented the level of knowledge held by the PT professional. What about undergraduates who major in engineering, meteorology, bio, english lit., mathematics. Try doing 50+ credits of physics and mathematics as part of your undergraduate degree and then tell me how difficult PT training is and how the MPT under represents the level of knowledge held by the PT professional. I see PT students everyday struggle to make it through physics I & II and desperately seek out meteorology and pre engineering students as there study and lab partners. In fact that is what we encourage them to do to get through the natural science courses and into the PT training. Once you get to the PT part its smooth sailing.

 

[delicatefade]

If you agree that it was a political ploy than you should agree that it had nothing to do with the level of knowledge held by PT's. I didn't even think that my Master's Program (which is not a low ranked program) was even on par with master's programs in other areas of study (engineering, physics, etc.) I was embarassed to tell my cousin who was working on his M.S. in chemical engineering that I was in a master's program when we compared the intensity, depth, and difficulty of the courses we were taking.

 

[BackTalk]

Again, JD, DDS, and DC.. none of these are "Doctorate" degrees.. they are simply undergraduate professional degrees.

no lawyer goes by the term Doctor.. Dentists do because of the job they perform, ie. diagnosis, Rx rights, surgery.. etc. Id say DC holders too.. but again.. I still think chiropractic is a bit dubious and borderline.. but still.. I suppose you could clump them in too if you really wanted too. But even then.. even doctors, dentists, and cough.. "ahum" chiros.. still even they are not holders of "true" doctorate degrees.

The united states recognises british degrees such as Bachelor of Medicine, Bachelor of Dentistry, and Bachelor of Laws ... all as equal to MD, DDS, and JD in the US. these are all simply undergraduate professional degrees.. basic degrees in their respective fields. Not real "doctorates".

UK US
MBBS = MD
BDS = DDS
LLB = JD

Listen, if it doesn't say "MD" then it doesn't mean ****. Welcome to the club of fake doctors!

 

[truthseeker]

If you agree that it was a political ploy than you should agree that it had nothing to do with the level of knowledge held by PT's. I didn't even think that my Master's Program (which is not a low ranked program) was even on par with master's programs in other areas of study (engineering, physics, etc.) I was embarassed to tell my cousin who was working on his M.S. in chemical engineering that I was in a master's program when we compared the intensity, depth, and difficulty of the courses we were taking.

You make an excellent point. To me, the master's program in PT did not seem as difficult as the same degree program in chemical engineering would be. But don't you think that the Chem E grad student might think that PT school was hard? Given that we are interested in what we study, and arguably are not interested in chemical engineering, what we like to study should seem easier to us and vice versa. The intelligence required to get through a Chem E graduate program is certainly formidable, don't misunderstand, but so is the integration of the material required to be a good physical therapist.
I don't understand why there is such a percieved problem for a profession to lengthen its curriculum and obtain a terminal degree. My master's program had 17 hours more than the requirement for a masters. Some programs, I am sure, have even more.

 

[truthseeker]

Listen, if it doesn't say "MD" then it doesn't mean ****. Welcome to the club of fake doctors!

another enlightened comment.

 

[CVPA]

Listen, if it doesn't say "MD" then it doesn't mean ****. Welcome to the club of fake doctors!

Narcissistic *****......

 

[OzDDS]

Listen, if it doesn't say "MD" then it doesn't mean ****. Welcome to the club of fake doctors!

Wow.. we found a smart one

 

[chicoborja]

Originally Posted by BackTalk
Listen, if it doesn't say "MD" then it doesn't mean ****. Welcome to the club of fake doctors!


What do you expect from a chiropractor.

 

[OneiroKnight]

With the exeption of "backtalk" we are all discussing things in a rational way, and we each have reasonable perspectives, albeit different. There is no reason to call each other mush brains. We disagree on some things and agree on others; why be angry, or hostile, or juvenile?

I have spent a considerable amount of time and effort on my post graduate education, and look forward to another 4 years of challenge, whether I want a doctoral degree in nursing or in medicine. I am over 30, and married, which means I have learned a bit of humility, aside from the humility grad school taught me.

A clinical doctorate, a research doctorate, a professional doctorate, an academic doctorate, a philosophy doctorate, an educational doctorate, juris doctorate, medical doctorate, all have different foci and challenges, depending on the mind of the student. Some may be more rigorous than others. Probably depends on your mindset. The depth and breadth vary. Some of you have a significant point that universities want more money, and that this contributes to the creation of new programs. But often new programs are inspired at higher levels, such as national organizations, though admittedly these may be fostered from pushy universities. Regardless, in my discipline, any doctorate that I have seen thus far, amounts to hard work, research, time, and the ability to produce results that are publishable and usable, and there is no fluff. When you get that piece of paper, you have most certainly earned it.

 

[zenman]

I've got 3 master's, MSN, MBA and my wife. What does that make me? Oh, since I'm also a Zen Shiatau therapist, you can call me Dr. Feelgood!

 

[lawguil]

With the exeption of "backtalk" we are all discussing things in a rational way, and we each have reasonable perspectives, albeit different. There is no reason to call each other mush brains. We disagree on some things and agree on others; why be angry, or hostile, or juvenile?

I have spent a considerable amount of time and effort on my post graduate education, and look forward to another 4 years of challenge, whether I want a doctoral degree in nursing or in medicine. I am over 30, and married, which means I have learned a bit of humility, aside from the humility grad school taught me.

A clinical doctorate, a research doctorate, a professional doctorate, an academic doctorate, a philosophy doctorate, an educational doctorate, juris doctorate, medical doctorate, all have different foci and challenges, depending on the mind of the student. Some may be more rigorous than others. Probably depends on your mindset. The depth and breadth vary. Some of you have a significant point that universities want more money, and that this contributes to the creation of new programs. But often new programs are inspired at higher levels, such as national organizations, though admittedly these may be fostered from pushy universities. Regardless, in my discipline, any doctorate that I have seen thus far, amounts to hard work, research, time, and the ability to produce results that are publishable and usable, and there is no fluff. When you get that piece of paper, you have most certainly earned it.

As long as you believe it; right. That's all that matters! Another successful sell for the University L.

 

[lawguil]

You make an excellent point. To me, the master's program in PT did not seem as difficult as the same degree program in chemical engineering would be. But don't you think that the Chem E grad student might think that PT school was hard? Given that we are interested in what we study, and arguably are not interested in chemical engineering, what we like to study should seem easier to us and vice versa. The intelligence required to get through a Chem E graduate program is certainly formidable, don't misunderstand, but so is the integration of the material required to be a good physical therapist.

Having an aptitude for a particular subject area certainly makes it more managable, but there is a thing called ability as well. Chem E. is right up there on the difficulty scale. The point, there are undergraduate liberal art and professional degree programs that are argueably more difficult than the DPT or the AuD or the nursing clinical doctorate. Doing two thousand credits of undergraduate work doesn't give you a doctorate, it simply gives you a bunch of undergraduate degree's. Further, I had to take 6 credits of research methods adn complete a thesis for my undergraduate degree. Does this qualify it as a doctorate - NOPE. L.

 

[CVPA]

Regardless, in my discipline, any doctorate that I have seen thus far, amounts to hard work, research, time, and the ability to produce results that are publishable and usable, and there is no fluff. When you get that piece of paper, you have most certainly earned it.

I agree. The same holds true for the ones that I have looked into that have been in my discipline. Obviously, I can't speak for all, but I have looked into a few.

 

[J Lucas]

The mindset of some people in this thread is laughable at best. Im not sure what small town some of you guys are from but when you reach more populated areas, no one gives a damn if your a medical doctor or a chicken doctor. Physician's don't receive the same amount of respect that they use to. You guys are dilusional if you think saying your a Medical Doctor means something MORE than any other given title. Im assuming because this is a forum geared toward pre-meds that the focus here is pro Physician but come on ....you guys make just as many mistakes as the next Professional. The unreachable status of "Physician" has been washed away and now the public is realizing that alot of Physicians are just HMO puppets and are in it for the money. This is why there is an increasing focus on preventative and holistic medicine to save you the trip to that Physician who is going to try and stick you with some over priced drug prescription for the next 15 years of your life.
Unbelievable...

 

[lawguil]

The mindset of some people in this thread is laughable at best. Im not sure what small town some of you guys are from but when you reach more populated areas, no one gives a damn if your a medical doctor or a chicken doctor. Physician's don't receive the same amount of respect that they use to. You guys are dilusional if you think saying your a Medical Doctor means something MORE than any other given title. Im assuming because this is a forum geared toward pre-meds that the focus here is pro Physician but come on ....you guys make just as many mistakes as the next Professional. The unreachable status of "Physician" has been washed away and now the public is realizing that alot of Physicians are just HMO puppets and are in it for the money. This is why there is an increasing focus on preventative and holistic medicine to save you the trip to that Physician who is going to try and stick you with some over priced drug prescription for the next 15 years of your life.
Unbelievable...

Jlucas, Sounds like you have it all figured out. If you actually understood the nature of the post, you would realize that it has very little to do with physicians and a lot to do with people trying to be physician-like with various organizations overstating the credentials of whom they represent. Further, the last I new physicians didn't make a whole hell of a lot money from the prescription drugs they prescribe. You should really try to target an audience that will actually buy your daffy idea's.

"I?m not sure what small town some of you guys are from but when you reach more populated areas, no one gives a damn if your a medical doctor or a chicken doctor." - however you cared enough to comment. You really sound like a person that doesn't give a damn. Keep trying buddy! L.

 

[delicatefade]

word

 

[ayndim]

I can't believe how this thread has gone. The original topic was really about more training (academic or clinical) for midlevels. I am not sure why the premeds and med students see them as such a threat. Certainly, the practicing providers out there (MD and midlevel) seem to have respect for each other. There is a shortage of many providers out there, especially in rural or poorer areas. These are places many midlevels are willing to work in. And that the areas can afford them more easily. So by providing additional training it will make them better providers when they are the only providers out there. Many don't have an MD to consult with. I see a CNM and a NP but I am not in a poor/rural area and they can consult with the MD if need be. Not everyone is so lucky. And a midlevel w/o an MD consult is better than no care at all.

BTW, I would go for a doctorate if I felt the need but I wouldn't expect to be referred to as Dr. X as an NP. In fact, I would not allow it. That is because to me midlevels are more down to earth and part of the draw is being on a first name basis. Probably why they are less likely to be sued to. So it is not all about the title. Personally, I would like to see the NP's (think PA's already do) do a year or two of residency with a hospital. Hospitals just love the cheap labor so probably wouldn't be a problem.

 

[delicatefade]

Yes, they often are a threat (and this is coming from a PT) - the big push for clinical doctorates among the allied health professions is often just a political ploy to grab a bigger piece of the pie and often has little to do with expanding the educational base of the providers. Now, that can be a good thing or a bad thing depending on what side you are on. For instance, expanding the scope of practice of PT's to include direct access (which has been one of the reasons for the DPT push in PT education) is a great thing from a practicing PT's perspective but maybe not such a great thing when you consider that the education hasn't really changed all that much during the transition, CEU's are still not required for continued PT licensure in many cases, and that despite the "increase" from MPT to DPT education, the quality of applicants has actually decreased.

 

[J Lucas]

So... Physicians dont get kickbacks from drug companies for advocating their drugs to patients over others?

 

[deleted6669]

ayndim-
just a point of clarification....residencies are optional for pa's.

 

[OneiroKnight]

I can't believe how this thread has gone. The original topic was really about more training (academic or clinical) for midlevels. I am not sure why the premeds and med students see them as such a threat. Certainly, the practicing providers out there (MD and midlevel) seem to have respect for each other. There is a shortage of many providers out there, especially in rural or poorer areas. These are places many midlevels are willing to work in. And that the areas can afford them more easily. So by providing additional training it will make them better providers when they are the only providers out there. Many don't have an MD to consult with. I see a CNM and a NP but I am not in a poor/rural area and they can consult with the MD if need be. Not everyone is so lucky. And a midlevel w/o an MD consult is better than no care at all.

BTW, I would go for a doctorate if I felt the need but I wouldn't expect to be referred to as Dr. X as an NP. In fact, I would not allow it. That is because to me midlevels are more down to earth and part of the draw is being on a first name basis. Probably why they are less likely to be sued to. So it is not all about the title. Personally, I would like to see the NP's (think PA's already do) do a year or two of residency with a hospital. Hospitals just love the cheap labor so probably wouldn't be a problem.

I agree with your statement on the perceived threat. I have met few physicians who act defensive or threatened by the existence of midlevel providers. As an RN I was never threatened by the existence of LPNs. Most docs seem to work along side us colleagially. I have had many physicians involved in training us as NP students. When I rotated along side med students, the docs would teach us the same things, as far as differential and treatment, and then usually go into a bit more depth of the pathophys processes with the MS.

 

[CVPA]

So... Physicians dont get kickbacks from drug companies for advocating their drugs to patients over others?

J:

I believe that there was once a day when this was true. Those days are gone. Cynics will, of course, respond that I am being naive, but I don't think so. Although pharmaceutical companies pay certain physicians as consultants to speak at CME dinners (provided by the drug company, of course), out and out kickbacks are (in my opinion) too risky and not worth the return for the companies. Furthermore, with the onset of Healthcare Compliance laws, Big Brother is watching pharmaceutical companies with a scrutinizing eye now more than ever before. What works almost as good are pharmaceutical reps who are, how should I say....pleasing to the eye. I have seen it work countless times with both male and females.

 

[truthseeker]

Yes, they often are a threat (and this is coming from a PT) - the big push for clinical doctorates among the allied health professions is often just a political ploy to grab a bigger piece of the pie and often has little to do with expanding the educational base of the providers. Now, that can be a good thing or a bad thing depending on what side you are on. For instance, expanding the scope of practice of PT's to include direct access (which has been one of the reasons for the DPT push in PT education) is a great thing from a practicing PT's perspective but maybe not such a great thing when you consider that the education hasn't really changed all that much during the transition, CEU's are still not required for continued PT licensure in many cases, and that despite the "increase" from MPT to DPT education, the quality of applicants has actually decreased.

As you know, the scope of practice for physical therapy has included direct access for many years in many states. The problem is that it is not practiced routinely because most insurance companies require a referral from another provider in order to cover PT services. In Minnesota, that includes MD, DO, DDS, PA. FNP, and DC. The clinical doctorate is, in part, to demonstrate to the bureaucrats at the insurance companies that PT is really a direct access provider for musculoskeletal injuries. E.G. if someone pulls a hamstring rounding 3rd base, they are wasting their money if they go to their MD first. So, my point is that direct access is already legal and we are prepared to provide those services in specified populations. We are also trained to refer those people that fall outside our scope of practice. And, as opposed to some DCs in my town, we do refer to other providers. I am looking forward to the responses from the DCs that are all mad about that comment, but we had a little old lady whose primary care giver was a DC. She "was doin' great!" but when she finally was convinced to go to a traditional medical doctor, she was found to be diabetic, had breast cancer, hypertension, and hyperlipidemia. How long would the DC have treated her for the back pain that was metastatic breast cancer without resolution that lasted for more than the 3 days until her next appointment?

PTs do not treat people that long without getting results. I am on a rant, sorry

 

[lawguil]

As you know, the scope of practice for physical therapy has included direct access for many years in many states. The problem is that it is not practiced routinely because most insurance companies require a referral from another provider in order to cover PT services. In Minnesota, that includes MD, DO, DDS, PA. FNP, and DC. The clinical doctorate is, in part, to demonstrate to the bureaucrats at the insurance companies that PT is really a direct access provider for musculoskeletal injuries. E.G. if someone pulls a hamstring rounding 3rd base, they are wasting their money if they go to their MD first. So, my point is that direct access is already legal and we are prepared to provide those services in specified populations. We are also trained to refer those people that fall outside our scope of practice. And, as opposed to some DCs in my town, we do refer to other providers. I am looking forward to the responses from the DCs that are all mad about that comment, but we had a little old lady whose primary care giver was a DC. She "was doin' great!" but when she finally was convinced to go to a traditional medical doctor, she was found to be diabetic, had breast cancer, hypertension, and hyperlipidemia. How long would the DC have treated her for the back pain that was metastatic breast cancer without resolution that lasted for more than the 3 days until her next appointment?

PTs do not treat people that long without getting results. I am on a rant, sorry

I personally think that it is about time that every healthcare profession demand that DC develop standards to prevent this from happening. Shouldn?t somebody be taking this DC's license to practice away. I personally think that direct access should be taken away from PT and DC in the states that it is allowed. Further, I think that the average weekend warrior who rounds third base and strains his hamstring can be handled by a primary care physician without a lot of stress. My experience with PT's is they are not the best at handling acute injuries. So why allow them to touch somebody until x-rays, blood work, pathology is ruled out. - just my 2 cents. Everybody has a role in healthcare, why doesn't everybody just do there job? L.

 

[truthseeker]

I personally think that it is about time that every healthcare profession demand that DC develop standards to prevent this from happening. Shouldn?t somebody be taking this DC's license to practice away. I personally think that direct access should be taken away from PT and DC in the states that it is allowed. Further, I think that the average weekend warrior who rounds third base and strains his hamstring can be handled by a primary care physician without a lot of stress. My experience with PT's is they are not the best at handling acute injuries. So why allow them to touch somebody until x-rays, blood work, pathology is ruled out. - just my 2 cents. Everybody has a role in healthcare, why doesn't everybody just do there job? L.

I think the reason is that MDs don't always know the best way to treat musculoskeletal injuries. I disagree that PTs don't know how to treat acute injuries. example: Most MDs (or DOs) will treat a grade II inversion ankle sprain with 1-2 weeks of non weight bearing and the use of crutches, put them in a brace or some such nonsense.
A good PT, after one or two visits, will have the patient walking without a limp after one or two visits. What this accomplishes is the dependent pedal edema is cleared much faster by a moving joint than by a stationary one that is elevated for 1-2 hours per day. Further, the injured ligament (s) is (are)not placed under abnormal stresses simply by walking, so there is no increased risk for further injury. IF everyone did their jobs, the primary care physicians would refer ALL musculoskeletal injuries to PT. If nothing else, to teach the patient how to avoid the previouse injury e.g. poor lifting technique causes back injury, or tight hamstrings cause poor lifting technique etc . . .
Direct access for PT is important, in my view, to allow patients a choice of where they seek intervention for those cases that are in the purview of PT.

BTW - What lab tests and X-rays would you order for the weekend warrior? There are reasons that healthcare costs are out of control.

 

[lawguil]

I think the reason is that MDs don't always know the best way to treat musculoskeletal injuries. I disagree that PTs don't know how to treat acute injuries. example: Most MDs (or DOs) will treat a grade II inversion ankle sprain with 1-2 weeks of non weight bearing and the use of crutches, put them in a brace or some such nonsense.
A good PT, after one or two visits, will have the patient walking without a limp after one or two visits. What this accomplishes is the dependent pedal edema is cleared much faster by a moving joint than by a stationary one that is elevated for 1-2 hours per day. Further, the injured ligament (s) is (are)not placed under abnormal stresses simply by walking, so there is no increased risk for further injury. Direct access for PT is important, in my view, to allow patients a choice of where they seek intervention for those cases that are in the purview of PT.

BTW - What lab tests and X-rays would you order for the weekend warrior? There are reasons that healthcare costs are out of control.

I see the same thing done by physicians all the time and I agree that an inversion ankle sprain can be treated better, but two weeks without weight bearing and then weaning yourself to weight bearing status also does the trick with patients and athletes that I have seen. The fact of the matter is that a patient that experiences a grade II inversion ankle sprain is going to get better regardless if they see a physician or physical therapist. Why send an insignificant ankle sprain of this type to a physical therapist when healthcare costs are out of control. However it does make sense to have a grade II inversion ankle sprain x-rayed to rule out fracture. I've been burned before by what I thought were simply inversion ankle sprains. I send all my athletes with grade II ankle sprains for x-rays. I agree - some will think that's conservative. L.

 

[truthseeker]

I see the same thing done by physicians all the time and I agree that an inversion ankle sprain can be treated better, but two weeks without weight bearing and then weaning yourself to weight bearing status also does the trick with patients and athletes that I have seen. The fact of the matter is that a patient that experiences a grade II inversion ankle sprain is going to get better regardless if they see a physician or physical therapist. Why send an insignificant ankle sprain of this type to a physical therapist when healthcare costs are out of control. However it does make sense to have a grade II inversion ankle sprain x-rayed to rule out fracture. I've been burned before by what I thought were simply inversion ankle sprains. I send all my athletes with grade II ankle sprains for x-rays. I agree - some will think that's conservative. L.

I think you are 100% correct to xray a grade II sprain. I probably should have used the example of a grade I. I also agree that the ankle sprain will get better on its own. However, some people don't want to wait that long. Good PT can accelerate the recovery time and make future injury less likely by improving proprioception etc . . . an athlete missing two weeks of critical games, or a self employed carpenter missing two weeks of roofing are things we can make go away. Healthcare costs are high but the services we provide do have value. If a person can't work because of an ankle sprain, it is often costing them more because of the loss of income.

 

[truthseeker]

Sure.. but there is a difference between someone who is given the title of "doctor" and a doctorate degree holder.

You don't have to be the holder of a doctorate degree to be called doctor.. ie. someone who is "doctoring you" or performing diagnosis, prescription and/or surgery. example dentists and physicans. No matter what the degree is called.. DMD/DDS/MD or BDS/BDent/MBBS/MbChb. These are all med/dent degrees.. but not a single one of them is technically a doctorate degree... they are all undergraduate professional degrees. which grant the holder to the title of "doctor", because of what they do.

Conversly.. any one who holds a "true" doctorate degree.. ie. PhD, DSc.. also is granted the title of "doctor".. but this is given because of academic acheievment.. not because of job performed.

Allied health professionals.. unless they attain a "true" doctorate.. ie. PhD, DSc.. I don't think you should be granting that title to every PT, OT, Nurse, or audiologist who wants it or who completes what is "really" a basic first degree in that field.

And what exactly is the first degree in MD? They don't even have amaster's degree first, nor do DDS, DO, OD, DPM, DVM, or DC. Some don't even get a bachelor's first.

So much for the "true doctorate" degree theory.

 

[lawguil]

I think you are 100% correct to xray a grade II sprain. I probably should have used the example of a grade I. I also agree that the ankle sprain will get better on its own. However, some people don't want to wait that long. Good PT can accelerate the recovery time and make future injury less likely by improving proprioception etc . . . an athlete missing two weeks of critical games, or a self employed carpenter missing two weeks of roofing are things we can make go away. Healthcare costs are high but the services we provide do have value. If a person can't work because of an ankle sprain, it is often costing them more because of the loss of income.

My point is that a grade two ankle sprain will probably be x-rayed (A grade one-there is very little chance that the person goes to the physician and even less reason to refer the pt to PT.) At that time let the physician use his best judgment whether there is any urgency to return this person to functional status. A physician is very capable of this which takes me to my point that there is no need for direct access in PT. Further, how quickly is this person going to get an appointment? Are they going to make special arrangements with the PT clinic to get them in that day for a lousy ankle sprain? This is a very specific example that can easily be applied to the global issue of direct access. And if this person is an athlete involved in critical games, let the ATC take care of the issue. You?re doing a better job defending my position than your own. L.

 

[truthseeker]

My point is that a grade two ankle sprain will probably be x-rayed (A grade one-there is very little chance that the person goes to the physician and even less reason to refer the pt to PT.) At that time let the physician use his best judgment whether there is any urgency to return this person to functional status. A physician is very capable of this which takes me to my point that there is no need for direct access in PT. Further, how quickly is this person going to get an appointment? Are they going to make special arrangements with the PT clinic to get them in that day for a lousy ankle sprain? This is a very specific example that can easily be applied to the global issue of direct access. And if this person is an athlete involved in critical games, let the ATC take care of the issue. You?re doing a better job defending my position than your own. L.

first of all, you are assuming that the school has an ATC, which they don't. Secondly, the patient is going to go to someone if their function is significantly limited. Then, in order to actually get something done to their benefit, they will then need to be referred to PT. IF they go to the doctor first, that delays the PT visit by a day or two. (maybe three if they go in on saturday) those people with injuries that could be triaged by an ATC can be triaged and treated by a good PT. BTW i am an ATC as well and I understand your point of view as an ATC. However, as a trainer, do you require your team doctor to evaluate everything you treat? Or do you treat those things you can easily identify and refer those things that are suspicious to the team doctor. You sound very intelligent in your posts so I think I know the answer.
PTs with good training can evaluate an injury in the clinic as well as an ATC can. Sometimes better, sometimes worse. Apply the same rules to PT as you do ATC in the training room and you will find why I am in favor of direct access for PT.

 

[FoughtFyr]

I personally think that it is about time that every healthcare profession demand that DC develop standards to prevent this from happening. Shouldn't somebody be taking this DC's license to practice away. I personally think that direct access should be taken away from PT and DC in the states that it is allowed. L.

There have been extensive threads here on this question, but it simply comes down to this - there are, within chiropractic, at least three distinct group each of whom have a very different vision of chiropractic - especially in regard to it's scope. There are "straight" chiropractors who hold dear the principles of Palmer and the belief that nervous system dysfunction holds the key to most health problems. Then there are the "mixers" who agree that there is little scientific basis for most of Palmer's theories, but who feel chiropractic is a useful modality for treatment neuro/muscular/skeletal problems. Then there are the "psuedo-mixers" who hold on to Palmer's theories and try and expand them through "new" and decidedly non-medical practices. These folks are often very "anti-medicine" and truly believe that the "Rosetta Stone" to all of health lay within their grasp. Each of these groups is "entrenched" in the profession and have resist standardizing the profession in any vision but their own. These groups infight so much that it is impossible to even define chiropractic care anymore because the care you will recieve will vary so greatly based on which "camp" your practitioner comes from.

- H

 

[BackTalk]

As you know, the scope of practice for physical therapy has included direct access for many years in many states. The problem is that it is not practiced routinely because most insurance companies require a referral from another provider in order to cover PT services. In Minnesota, that includes MD, DO, DDS, PA. FNP, and DC. The clinical doctorate is, in part, to demonstrate to the bureaucrats at the insurance companies that PT is really a direct access provider for musculoskeletal injuries. E.G. if someone pulls a hamstring rounding 3rd base, they are wasting their money if they go to their MD first. So, my point is that direct access is already legal and we are prepared to provide those services in specified populations. We are also trained to refer those people that fall outside our scope of practice. And, as opposed to some DCs in my town, we do refer to other providers. I am looking forward to the responses from the DCs that are all mad about that comment, but we had a little old lady whose primary care giver was a DC. She "was doin' great!" but when she finally was convinced to go to a traditional medical doctor, she was found to be diabetic, had breast cancer, hypertension, and hyperlipidemia. How long would the DC have treated her for the back pain that was metastatic breast cancer without resolution that lasted for more than the 3 days until her next appointment?

PTs do not treat people that long without getting results. I am on a rant, sorry

I refer patients to other providers. I think the main problem is many times a DC will refer his or her patient to another provider only to have that provider take the case over. For instance, I had a patient who had a bad knee so I sent her to an orthopedist for a consult. He took the case over and sends my patient to his own physical therapy center. On top of that he tells her she doesn't need chiropractic care for her other complaints we were treating. What a dick! Is this how you thank someone for sending you a referral? So he is black listed in my town and none of the DC's will refer to him. I feel this is probably the reason some of the DC's in your town don't refer. If the orthopedist thinks she needs some rehab or wants us to try some other things before he determines to do a knee replacement then send her back!

As a physical therapist why do you not refer to chiropractors? It goes both ways in my town. Want referrals? Then you need to give some. I would refer most all my extremity cases to you if you sent most all your bad backs and necks to me. I would even let the MD do all initial patient workups and then give us clearance.

I don't know what to say about your "little old lady". People many times exaggerate. That's why I never take a patients word for it and will get the medical records or talk to the doctor personally.

Many times three days is not enough time to see if a patient is going to respond to care. You're either really good or doing your patients a disservice by releasing them from care prematurely. It's not uncommon to have 2-3 weeks of care before you can determine if your care is helping the patient.

I personally think that it is about time that every healthcare profession demand that DC develop standards to prevent this from happening. Shouldn?t somebody be taking this DC's license to practice away. I personally think that direct access should be taken away from PT and DC in the states that it is allowed. Further, I think that the average weekend warrior who rounds third base and strains his hamstring can be handled by a primary care physician without a lot of stress. My experience with PT's is they are not the best at handling acute injuries. So why allow them to touch somebody until x-rays, blood work, pathology is ruled out. - just my 2 cents. Everybody has a role in healthcare, why doesn't everybody just do there job? L.

FoughtFyr did a good job explaining the different chiropractic camps. If the DC was treating the patient for those ailments then the guy should have his license yanked. I disagree that direct access should be taken away from chiropractors. Most of us are very well trained and function well as primary care practitioners. We are not Primary Care Providers. In my state we are allowed to function as primary care providers but it is next to impossible to do so. I can't admit a patient to the hospital or even write orders. What am I going to tell the nurses? Roll him over and give him a good "snap" twice an hour? We lack the tools and necessary residency to be able to function in that capacity. As a DC I am trained to order and interpret x-rays, blood work and to rule out pathology.

 

[lawguil]

As a DC I am trained to order and interpret x-rays, blood work and to rule out pathology.

Sorry, I'm not convinced! X-rays; sure. If you lack the tools and necessary residency, how could you be trained to rule out pathology. Classroom training at a chiropractic school is not going to cut it. Please don't get me wrong; I have respect for the "mixers", but I prefer to utilize osteopaths and physical therapists. I see far more consistent results with my athletes. As far as the "scratch my back and I'll scratch yours with respect to referrals, you would probably get more referral from other professionals if you were part of a respected profession
.

 

[lawguil]

first of all, you are assuming that the school has an ATC, which they don't. Secondly, the patient is going to go to someone if their function is significantly limited. Then, in order to actually get something done to their benefit, they will then need to be referred to PT. IF they go to the doctor first, that delays the PT visit by a day or two. (maybe three if they go in on saturday) those people with injuries that could be triaged by an ATC can be triaged and treated by a good PT. BTW i am an ATC as well and I understand your point of view as an ATC. However, as a trainer, do you require your team doctor to evaluate everything you treat? Or do you treat those things you can easily identify and refer those things that are suspicious to the team doctor. You sound very intelligent in your posts so I think I know the answer.
PTs with good training can evaluate an injury in the clinic as well as an ATC can. Sometimes better, sometimes worse. Apply the same rules to PT as you do ATC in the training room and you will find why I am in favor of direct access for PT.

Truthseeker, We could probably go back and forth with this for a long time, but we should at least agree to disagree. I personally hate to see a profession that I love and have a great deal of respect for reduced to the league of a chiropractor because they want direct access and a clinical doctorate when the BSPT was working fine. I see the profession regressing in a lot of ways and I find that disturbing. I've shared my experiences and I have tried to do it at face value. As far as you being an ATC, I hope you continue to promote the profession, however, I hope that the NATA can avoid moving to an entry-level masters or clinical doctorate. Although ATC's want a piece of the reimbursement pie, they remain removed from most of main stream medical providers. I believe ATC's provide decent care and they do it without a lot of drama. L.

 

[OzDDS]

And what exactly is the first degree in MD? They don't even have amaster's degree first, nor do DDS, DO, OD, DPM, DVM, or DC. Some don't even get a bachelor's first.

So much for the "true doctorate" degree theory.

Hmm.. maybe you should re-read my post. I completely agree with you!.. that is exactly what I said.

I said ->

No matter what the degree is called.. DMD/DDS/MD or BDS/BDent/MBBS/MbChb. These are all med/dent degrees.. but not a single one of them is technically a doctorate degree... they are all undergraduate professional degrees. which grant the holder to the title of "doctor", because of what they do.

I never said the MD was a "doctorate degree"... but what I did say was that they are called doctors because of the job they perform. They are physicans.. and thus refered to as Doctors.. but this designation is not conferred because of the "Doctorate level of the MD".

 

[OzDDS]

But.. along that note.. a DPT is not a doctorate level degree either... but I also don't think they should be refered to as Doctor because they are also not physicians like an MD/MbChb/Mbbs (or US-DO) is. I include DDS/BDS/DMD as one entitled to being referred to as Doctor, because they at least do the same first two years of the Medicine course at most all programs and are trained in diagnosis and are licensed to perscribe and perform surgery as well. (and they have had this right for over 200 years since the inception of dentistry.) During WWII some of the most advances in facial trama facial reconstruction was made by dental surgeons.. also it was a dentist who is credited with the discovery and the foundation of the field of anesthesia.

I wouldn't consider any of the other "health" professions you listed as "doctors" besides maybe possibly Podiatry. (and vet's if your not only referring to "doctors" of people)

 

[chicoborja]

But.. along that note.. a DPT is not a doctorate level degree either... but I also don't think they should be refered to as Doctor because they are also not physicians like an MD/MbChb/Mbbs (or US-DO) is. I include DDS/BDS/DMD as one entitled to being referred to as Doctor, because they at least do the same first two years of the Medicine course at most all programs and are trained in diagnosis and are licensed to perscribe and perform surgery as well. (and they have had this right for over 200 years since the inception of dentistry.) During WWII some of the most advances in facial trama facial reconstruction was made by dental surgeons.. also it was a dentist who is credited with the discovery and the foundation of the field of anesthesia.

I wouldn't consider any of the other "health" professions you listed as "doctors" besides maybe possibly Podiatry. (and vet's if your not only referring to "doctors" of people)

The fact that you don't feel that the DPT as well as other allied health professional doctorates are at a doctorate-level does nothing to refute the fact that they are indeed doctoral degrees awarded by accredited institutions. You repeatedly state that these are not doctoral degrees but what I believe you mean is that you don't believe that they should award professional doctoral degrees in these fields;however, irregardless of anyone's perceived notions, these degrees are indeed doctorates. Additionally, I'm afraid the fact that other countries award a MBBS instead of an MD does not change the fact that in the US an MD is every bit a doctorate and a professional degree. It does not matter if the coursework is identical, it has more to do with established institutions and traditions. OzDDS, you've also stated that professional doctorates are not true doctorates because they can be attained w/o a bachelor's degree. That may be true in professional schools of medicine, dentistry, optometry, etc. but strangely enough that does not hold true for the doctorates in question for allied health professionals (DPT, AuD, DNPr). These programs are housed within academic graduate schools rather than professional schools. Consequently, these programs indeed require a bachelor's degree for entry. I dont disagree with you that these fields should remain at the master's level and strengthen their existing programs within the current structure; however, My contentions were with the more trivial points I mentioned above.

 

[OzDDS]

I'm afraid the fact that other countries award a MBBS instead of an MD does not change the fact that in the US an MD is every bit a doctorate and a professional degree. It does not matter if the coursework is identical, it has more to do with established institutions and traditions.

Yes, you can call them doctorates.. why.. Because the university succumbed to money and changed the name to say "doctorate". But this really change what it truely is? No!


If the US states that they are "legal equivilents" of each other. Which it does! ie.
MD = MBBS

That means one of two things:

1) Says that another countries bachelor degree is to the level of a doctorate in the US.

or

2) Says that a Doctorate in the US is no greater level than a bachelors.




I'd have to say that the better definition would be #2.
.. for one because this is the first degree in that field that is offered. ie. an MD does not build on prior Medical knowledge and training (a previous bachelors in bio does not count as this is technically a different field)


Just because you complete a prior degree before entering medicine.. even if it is required.. that does not make it a doctorate in that field of study.

Actually ask some of the medical students from the Australia or the UK. There are many medical schools that 'require' a previous degree before you can begin the program. (Graduate entry programs) But the degree you recieve is still a "bachelor of medicine" (MBBS).

The British system (upon which the US education system is founded btw) still keeps to the true definition and tradition of education. and apperantly has chosen (rightfully so) to keep it's honor and history rather than succumbing to money and has successfully kept it's political pressure groups from misinterperting and changing it's foundation.

 

[group_theory]

OzDDS, why does it matter whether a degree is a true doctorate or not? Whether it is a MD or MBBS, you still have to work hard at attaining that degree, and earning the priviledge of asking personal questions to people, and seeing them at a time when they are most vulnerable. People who are sick will certainly not care whether you hold a true doctorate or not - they just want to get better. If a local shaman can make them feel better by evoking the spirits of Cthulhu, then people will go to that shaman, even if he only holds a "fake doctorate"

In academia, people don't care if you hold a PhD or MD or MBBS. If you can get grants and generate quality research, then people won't care if you hold a "true" doctorate or not. It's all mental masturbation. I've seen PIs with only the MBBS who run large labs and get lots of NIH funding. I've seen quality research come from MDs. I've seen crappy research come from PhDs. In the end, it doesn't matter whether you have a true doctorate or not, if you can generate research and bring in the $$$$, people won't care.

To quote a former professor of mine, "I don't see what's the big deal about getting a doctorate. I mean, all my friends have one"

 

[truthseeker]

Hmm.. maybe you should re-read my post. I completely agree with you!.. that is exactly what I said.

I said ->


I never said the MD was a "doctorate degree"... but what I did say was that they are called doctors because of the job they perform. They are physicans.. and thus refered to as Doctors.. but this designation is not conferred because of the "Doctorate level of the MD".

Sorry

 

[OzDDS]

Sorry

It's Aight!

 

[fapt]

And what exactly is the first degree in MD? They don't even have amaster's degree first, nor do DDS, DO, OD, DPM, DVM, or DC. Some don't even get a bachelor's first.

So much for the "true doctorate" degree theory.

that is traditional...MD's always think that they are true doctorate, and another are not.

In my opinion, I agree that direct PT acess is really importment. Many patients don't want to cost much money for the samn pain...If they need refer, they have to suffer the pain for a longtime without directly treating. They can go to the PT clinic for the treatment and PT differentates if they can be treatment by our scopes, then they refer to another specialist. I think this is a good way. In hospital, there are many Dr. with different special expertises. If they meet the trouble or disease they can not treat, they would refer to another Dr. for help. We can transfer this this situation to PT, If patients with musculoskeletal disorders go to PT, we can help them. We have to refer to Dr. if they have another diseases causing the pain that we can't help under PT scopes.

 

[BackTalk]

Sorry, I'm not convinced! X-rays; sure. If you lack the tools and necessary residency, how could you be trained to rule out pathology. Classroom training at a chiropractic school is not going to cut it. Please don't get me wrong; I have respect for the "mixers", but I prefer to utilize osteopaths and physical therapists. I see far more consistent results with my athletes. As far as the "scratch my back and I'll scratch yours with respect to referrals, you would probably get more referral from other professionals if you were part of a respected profession
.

I'm equally sorry that I'm not convinced ATC or PT has the ability to take on a direct access role.

What I meant by lacking the tools was the use of prescription medication. Lacking the ability to use meds doesn't affect the ability to rule out pathology but rather the ability to treat. When someone comes in the office with symptoms beyond what we recognize we refer them to a specialist for a consult. If we recognize it and it's out of our scope of practice we refer them out. Most medical doctors do the same thing.

Most patients seek the services from a chiropractor for NMS complaints. We usually do not have any medical emergencies present to the office. If we do, we have an ER about 10 min away.

Some chiropractic programs have arrangements with local hospitals to participate in grand rounds. Although this is not a replacement for a residency, it at least gives us exposure to sick patients.

You can utilize whatever profession you like. Being in England it's my understanding that an osteopath isn't a medical doctor nor trained like one in the states. If you were in the states I would understand your reasoning for using a DO. As for the physical therapists, are you saying they are better trained than a DC and that is why you use them?

You're right that chiropractors lack respect from other healthcare providers. Respect is something that has to be earned and as a whole, chiropractic hasn't done that. Either way it doesn't change my view on referrals. I have orthopedists and neurologists wanting referrals from me. So if you want a referral that's fine, as many times I have cases that require the services of a neuro or ortho. The thing is, you need to send them back to me for the rehab and you also need to send your non-surgical cases to me. Many MD's burn bridges with chiropractors by trying to take the case over or for not referring patients to the chiro that routinely refers to them.

 

[FoughtFyr]

What I meant by lacking the tools was the use of prescription medication. Lacking the ability to use meds doesn't affect the ability to rule out pathology but rather the ability to treat. When someone comes in the office with symptoms beyond what we recognize we refer them to a specialist for a consult. If we recognize it and it's out of our scope of practice we refer them out. Most medical doctors do the same thing.

Hey BT,

I know that you and I have hashed this out ad nauseum on other threads but I still do not believe that chiropractors are equipped to rule out pathology. It is simply put, "the eyes can not see what the mind does not know". For instance, because the theory of chiropractic (which is instrumental in the cirricula design of chiropractic colleges), puts little "stock" in germ theory, there is little training in microbiology. In medical schools, mircobiology is one of the most extensive courses. How is it that you, as a chiropractor, could reliably "find" infectious disease? Out of respect, I am not going to post a lengthy list of primary conditions that could present as NMS complaints; conditions for which you do not have the training in, or access to, the modalities needed to diagnose. But understand they are out there.

Also understand that the difference between a chiropractor and other healthcare professionals in the theory that underlies your training. All other practitioners discussed here, be they DPTs, DDSs, clinical psych, etc., train in the "medical model". You didn't. Because of that, integration is difficult, if not impossible, on a widespread basis.

I agree, PTs are not trained extensively in mircobiology either. And I do not agree with direct access for PTs. But I do understand their frustration in DCs having that access. And, as a business reality, I lean towards allowing it. Why? Because in the end, if I have to have my patient initially present to a PT or a chiropractor, I would rather they present to the PT. At least with PTs there is little possibility of running into a "straight" who believes they can cure anything with manipulation.

- H

 

[truthseeker]

Hey BT,

I know that you and I have hashed this out ad nauseum on other threads but I still do not believe that chiropractors are equipped to rule out pathology. It is simply put, "the eyes can not see what the mind does not know". For instance, because the theory of chiropractic (which is instrumental in the cirricula design of chiropractic colleges), puts little "stock" in germ theory, there is little training in microbiology. In medical schools, mircobiology is one of the most extensive courses. How is it that you, as a chiropractor, could reliably "find" infectious disease? Out of respect, I am not going to post a lengthy list of primary conditions that could present as NMS complaints; conditions for which you do not have the training in, or access to, the modalities needed to diagnose. But understand they are out there.

Also understand that the difference between a chiropractor and other healthcare professionals in the theory that underlies your training. All other practitioners discussed here, be they DPTs, DDSs, clinical psych, etc., train in the "medical model". You didn't. Because of that, integration is difficult, if not impossible, on a widespread basis.

I agree, PTs are not trained extensively in mircobiology either. And I do not agree with direct access for PTs. But I do understand their fustration in DCs having that access. And, as a business reality, I lean towards allowing it. Why? Because in the end, if I have to have my patient initially present to a PT or a chiropractor, I would rather they present to the PT. At least with PTs there is little possibility of running into a "straight" who believes they can cure anything with manipulation.

- H

bingo! You nailed my arguement for direct access for PT. PT is trained in a medical model and are much more likely to refer anything that "doesn't fit" the NMS patterns. The reason MD/DOs don't refer, is that the foundation of chiropractic (subluxation theory) is not based upon science. It is true that chiropractors help people. I do not dispute that. My problem is, do they help them solve problems or do they treat symptoms. They argue that MD/DOs simply prescribe meds to do the same and that is true in many cases. But I have seen many a patient with chronic back pain because of a leg length discrepancy diagnoses by their DC, who they have seen for months, and never gotten a lift for their shoe. Further, PTs take courses in non NMS medical conditions and learn how many disease processes can mimic NMS complaints.
The variety of the standard of care in chiropractic is problematic for them. Often, PT's and DCs will look at a patient the same way but come away with very different treatment plans. The direct access for PT would simply give the public another avenue into the healthcare system. PT does not claim to be able to treat pancreatitis or diabetes, or hypertension, or ileus etc . . . and FoughtFyr rightly recognizes the difference.
Thank you for your thoughtful post.

BTW "the Holy Grail" IS the greatest movie ever.

 

[BackTalk]

I had a year of microbiology. Does medical school have several different courses in microbiology?

I don't see the point of arguing with you about chiropractic education. It seems that no matter what I say, you dwell on the chiropractic principles and philosophy which is for the most part, old school chiropractic.

Most general practitioners lack diagnostic skill in the NMS department. You say we have a problem differentiating between mechanical or pathological back pain or NMS complaints, look at your own doctors. I'm sure being a ER doctor you see plenty of doctors (MD/DO) missing things.

 

[BackTalk]

I've met plenty of PT quack jobs too. No profession is perfect.

Chiropractors refer patients out too, we know are limitations. I already mentioned the referral problem and why certain doctors don't get referrals from chiropractors. Most MD's have no clue as to what chiropractic is. Most have no clue what subluxation theory is either. This is the main reason they do not refer to chiropractors. Why would you refer a patient for something you had no clue about?

I find it hard to believe you had a patient with a leg length inequality that went unaddressed by the chiropractor. It's something we look at all the time.

So are you trying to say chiropractors do not take courses in non NMS conditions?

 

[truthseeker]

I've met plenty of PT quack jobs too. No profession is perfect.

Chiropractors refer patients out too, we know are limitations. I already mentioned the referral problem and why certain doctors don't get referrals from chiropractors. Most MD's have no clue as to what chiropractic is. Most have no clue what subluxation theory is either. This is the main reason they do not refer to chiropractors. Why would you refer a patient for something you had no clue about?

I find it hard to believe you had a patient with a leg length inequality that went unaddressed by the chiropractor. It's something we look at all the time.

So are you trying to say chiropractors do not take courses in non NMS conditions?

I have read many posts by you Backtalk, and I am certain that you are a chiropractor that I would refer to. You are a sensible person, and are a credit to your profession. If only all DCs were like you. I definitely acknowledge that there are PT "quack jobs". There are many that I would not want to rely upon to evaluate me or my mother in my absence. There are always failures in every profession. Question: what do you call the person who finishes last in their medical school class? Answer: Doctor.
That said, I truly believe that it is the lack of a consistent standard of practice in chiropractic that is your undoing. When sensible people like yourself say that DCs don't treat medical problems, you are ignoring a significant part of your professional population. There is a DC in my town who makes outrageous claims all the time and on the radio and in his advertisements in the newspaper. I actually had to report him for claiming to do physical therapy. He denied it and was absolved of all wrong doing by the state DC board. He claimed that it was an oversight and that the firm that he had hired for marketing assistance had done it without his knowledge. I thought it was interesting that it happened in the advertisement in the local high school athletic program, his business cards, and the little advertising blurbs you watch before seeing a movie at the local theater.

I was interviewing a woman for a secretarial position who happened to have worked in his office. She was incredibly well qualified. She had worked in his office as a clerical worker, was a chiropractic assistant, knew medical terminology, was able to take Xrays ( not really of benefit to me) and was a very personable person. In our interview and on her resume she said that she was in charge of the physical therapy done in his office. I asked her if there was a PT in the office and she obviously said no and I informed her that then there was no physical therapy being done. Our interview continued and she asked how is PT different than DC and I responded with question. Did you ever see patients that were diagnosed as having a leg-length discrepancy? She said "Oh yes, all the time." I asked her if people ever got lifts for their shoes and she said, almost never.
It is this kind of caricature of your profession that is ruining it. This guy is everything that traditional medicine doesn't like about DCs. He does not stay within his scope of practice, makes claims that are outlandish (but not disprovable) and is a very good salesman. There is nothing wrong with selling yourself, but this guy preys upon peoples hopes and convinces them that it is critical that they attend weekly sessions for life.

Finally, I am sure that you take classes in non-NMS disorders, its just that some DCs think that they can treat things that no science has ever shown that they can. (e.g. middle ear infections) PTs do not.
I read a post once, it might even have been from you. Palmer based the subluxation theory on the curing of a deaf man's hearing loss. That was a long time ago. The person who wrote the post said that he had asked all of his DC friends if they had ever cured deafness or known someone who had cured deafness and they all said no. If it was truly from the adjustment, wouldn't it have happened again since?
If subluxation theory is true, it should be easy to document its effectiveness in a controlled double blinded study that the entire scientific community could agree was legit. Instead it seems that it is based on anecdotes and theoretical principles that do not make scientific sense.

Regards