DPT's calling themselves doctors and physicians...WHY?

[truthseeker]

Sounds like you and I are largely on the same page with this issue. I'm not sure I fully understand this last questions though. I fully respect any extra training a provider undergoes. My only trepidation with a DPT is that a doctorate should reflect a significantly higher level of training than a master's degree. Right now the DPT is, only IMO, a dressed-up MPT.

We are asking for more rights and responsibilities as providers, but not really doing what it takes to earn those rights. I think we need to switch this around - more rigorous training followed by the demand for more rights and responsibility. I just don'tthink the DPT has enough meat on the bone to justify the elevated stature.

Here's a recommendation - make the doctorate a terminal doctorate vs an entry level doctorate. The doctoral program at Texas Tech is ~48 hours of additional coursework devoted entirely to clinical orthopedics. This would carry much more weight, again my opinion, than entry-level DPT.

But in most states, we are not really asking for more rights and responsibilities.
To clarify my unintelligible question. If a master's degree requires lets say 50 hours, and most PT master's degrees are 70 hours, then the tDPT asks for 18-20 more. if we graduated with a bare-bones masters, the tDPT is actually 38 hours more. (I made up the numbers but I know that my MS PT program was significantly more than the minimum requirements)

Yes, a terminal degree would be more impressive, but we are not trying to be MDs or DOs. We don't want to manage DM, COPD, cancer, remove skin tags, prescribe antibiotics for ear infections, do colonoscopies, prostate exams, etc . . . Our scope of practice is limited and gladly so. We do not need the broad education that the real docs do, we just need to be able to recognize when something is OTHER than what we can treat. I think the purpose of the DPT is not to put us on the level with the physicians, just to enhance our ability to recognize what we cannot treat and refer them appropriately.

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[PT2MD]

Also. I should apologize for my usage of "fluff and meaningless" in an earlier post as that was not appropriate or accurate. I don't believe your credential to be fluff, I just wish the increased training had more substance to it. Thanks for not getting mad as you should have gotten.

 

[newbie1kenobi]

But in most states, we are not really asking for more rights and responsibilities.
To clarify my unintelligible question. If a master's degree requires lets say 50 hours, and most PT master's degrees are 70 hours, then the tDPT asks for 18-20 more. if we graduated with a bare-bones masters, the tDPT is actually 38 hours more. (I made up the numbers but I know that my MS PT program was significantly more than the minimum requirements)

Yes, a terminal degree would be more impressive, but we are not trying to be MDs or DOs. We don't want to manage DM, COPD, cancer, remove skin tags, prescribe antibiotics for ear infections, do colonoscopies, prostate exams, etc . . . Our scope of practice is limited and gladly so. We do not need the broad education that the real docs do, we just need to be able to recognize when something is OTHER than what we can treat. I think the purpose of the DPT is not to put us on the level with the physicians, just to enhance our ability to recognize what we cannot treat and refer them appropriately.

That's exactly my concern, especially when it relates to the APTA vision of direct access where a PT's assessment determines if it's appropriate to refer to another healthcare provider (i.e., a physician). I guess a classic example would be low back pain which can be visceral as well as neuro- or musculoskeletal in origin.

 

[PT2MD]

That's exactly my concern, especially when it relates to the APTA vision of direct access where a PT's assessment determines if it's appropriate to refer to another healthcare provider (i.e., a physician). I guess a classic example would be low back pain which can be visceral as well as neuro- or musculoskeletal in origin.

I agree and will go one further. Sometimes a musculoskeletal complaint is but one of a cluster of symptoms indicating a much more serious pathology. If the therapist is able to assess and treat the musculoskeletal complaint but not able to pick up on the connections between the other issues, a risky delay in care could result.

Truthseeker, you make a lot of sense with you last post, but the APTA vision is to give us autonomy within healtcare. I think we are being a little duplicitous with our profession right now. One faction states we need autonomy, while the other simply wants the DPT credential without the expanded responsibilities. I think we need to identify what we want and get everyone on board toward a specific end. If vision 2020 is where we are heading, we all need to be on board if we will overcome the monstrous political battle toward this autonomy. I'm not sure we are there just yet.

I think as usual the solution will be some form of compromise. We will have expanded direct access, but the patients episode of care should be in conjunction with a physician. I think I am the best person to make relevant decisions regarding a patient's physical therapy and that should be our domain. However, I do think a physician must be a part of this process to make sure the patient is managed appropriately from a medical standpoint.

 

[sunflower77]

Calling oneself Dr. ABC is different than calling oneself a physician. There is absolutely nothing wrong for someone with a doctoral degree to address himself as Dr. Joe. Anyone with a doctorate degree is entitled to that, although as a profession, the name physician should be reserved for MDs.

I am amazed by how many people in this field have no respect to the PT profession. True, the curriculum is not as vigorous as that of MD. But by the same token, a DDS program is not as vigorous and comprehensive as a MD (excuse me, I know enough dentists who went to dental schools because they could not make it to medical schools); a Harvard medical degree is a whole lot more difficult to obtain than that from a third tier medical school. So should we stop calling dentists doctors too? While chiropractors, optometrists, audiologists, and college professors can all refer themselves as Dr. XXX, why can't people with a DPT degree be called that way? In many countries, medicine is not even a doctorate program (e.g., in China, you can finish medical schools in five years after you graduate from high school. And getting into medical schools is no more difficult than getting into accounting or computer science). But they are also addressed as medical doctors in United States. According to some people in this forum, they should be not called doctors as their curriculum is not vigorous enough.

I feel sorry for the DPTs who had to work for someone with low self-esteem and constantly feel inferior in front of MDs. MDs are a different profession. DPTs cannot do MDs' job. But MDs cannot do DPTs' job either.

This profession will definitely change, only in the better direction. Decades from now, pretty much all physical therapists will have doctoral degrees. This sensitive title issue will die down, at least among physical therapists themselves. Right now, we have lots of PTs with master or even bachelor degrees. They may be very good physical therapists but they cannot be called Dr. XXX so they don't like others to be addressed that way either. But, I say, too bad, you can either enroll in a transitional DPT program or you can keep telling people your school program was just as good except back then they didn't have a DPT program. But stop trashing your fellow DPTs.

Again, let me repeat my position, calling oneself Dr. ABC is different than calling oneself a physician. I agree DPTs should never address them as physicians just like college professors shouldn't. But calling oneself Dr. XXX is perfectly justified.

 

[sunflower77]

MDs and DDSs are generally better to do financially not because they are "real doctors", but because they are mostly self-employed or profit sharing partners of a practice. On the other hand, PTs are usually employed by hospitals and private practices with no profit sharing opportunities.

Many DPTs wonder why their salary is so low, this is why.

When the PT profession is transformed like that of chiropractors, ie. when PTs become profit sharing partners of their own clinics, this low pay status will change.

 

[delicatefade]

I agree and will go one further. Sometimes a musculoskeletal complaint is but one of a cluster of symptoms indicating a much more serious pathology. If the therapist is able to assess and treat the musculoskeletal complaint but not able to pick up on the connections between the other issues, a risky delay in care could result.

I agree more than ever with this statement now that I've spent some time on my 4th year ER rotation. We had a guy come in last week with upper back pain. He was young (40), absolutely no risk factors for CAD other than smoking, had just seen his PCP and pronounced clean as a whistle (minus the smoking), and was on no medications for HTN, cholesterol, or anything else.

He was a mechanic, did lots of heavy work, and had a perfect history for mechanical back pain. And he did have some musculoskeletal findings in the appropriate region. I had a hunch there was something else going on and asked the attending if we could order a CT chest with contrast. This is not to brag on myself; every once in a while we all get a little whisper in our ear that tells us something was not right.

The guy had a Stanford A aortic dissection and was in the OR within the hour.

Imagine this guy coming to a direct access PT clinic. The consequences for a physician missing this are bad enough, but the consequences of a PT missing something like this in a direct access environment would be devastating to the profession as a whole.

 

[delicatefade]

Again, I say wait until LPTA programs go to a doctoral level and watch the backlash as PT's try to prevent them from introducing themselves as Dr.

Calling oneself Dr. ABC is different than calling oneself a physician. There is absolutely nothing wrong for someone with a doctoral degree to address himself as Dr. Joe. Anyone with a doctorate degree is entitled to that, although as a profession, the name physician should be reserved for MDs.

I am amazed by how many people in this field have no respect to the PT profession. True, the curriculum is not as vigorous as that of MD. But by the same token, a DDS program is not as vigorous and comprehensive as a MD (excuse me, I know enough dentists who went to dental schools because they could not make it to medical schools); a Harvard medical degree is a whole lot more difficult to obtain than that from a third tier medical school. So should we stop calling dentists doctors too? While chiropractors, optometrists, audiologists, and college professors can all refer themselves as Dr. XXX, why can't people with a DPT degree be called that way? In many countries, medicine is not even a doctorate program (e.g., in China, you can finish medical schools in five years after you graduate from high school. And getting into medical schools is no more difficult than getting into accounting or computer science). But they are also addressed as medical doctors in United States. According to some people in this forum, they should be not called doctors as their curriculum is not vigorous enough.

I feel sorry for the DPTs who had to work for someone with low self-esteem and constantly feel inferior in front of MDs. MDs are a different profession. DPTs cannot do MDs’ job. But MDs cannot do DPTs’ job either.

This profession will definitely change, only in the better direction. Decades from now, pretty much all physical therapists will have doctoral degrees. This sensitive title issue will die down, at least among physical therapists themselves. Right now, we have lots of PTs with master or even bachelor degrees. They may be very good physical therapists but they cannot be called Dr. XXX so they don’t like others to be addressed that way either. But, I say, too bad, you can either enroll in a transitional DPT program or you can keep telling people your school program was just as good except back then they didn’t have a DPT program. But stop trashing your fellow DPTs.

Again, let me repeat my position, calling oneself Dr. ABC is different than calling oneself a physician. I agree DPTs should never address them as physicians just like college professors shouldn’t. But calling oneself Dr. XXX is perfectly justified.

 

[PT2MD]

But stop trashing your fellow DPTs.

Not trashing fellow DPT's (eventhough they aren't fellows - I'm a MPT). I just think the DPT is a watered-down credential that is doing some damage to our profession's reputation right now. Other professions look at our entry-level doctorate and justifiably question how, after only a few extra courses, we can earn a doctorate and market ourselves as autonomous practitioners.

It's not a personal issue. I have several staff PT's who are DPT's and we get along just fine. You're right, in twenty years this issue will likely fade away as BPT's and MPT's retire. I would much rather therapists move toward board certification as a means to distinguish their position among themselves. (Believe me, once you pass one of those very frigging hard exams, you will know what I'm talking about.) The entry-level DPT just seems a shallow credential right now. Who knows. In a few years, I may change my tune.

 

[Devon655]

I agree more than ever with this statement now that I've spent some time on my 4th year ER rotation. We had a guy come in last week with upper back pain. He was young (40), absolutely no risk factors for CAD other than smoking, had just seen his PCP and pronounced clean as a whistle (minus the smoking), and was on no medications for HTN, cholesterol, or anything else.

He was a mechanic, did lots of heavy work, and had a perfect history for mechanical back pain. And he did have some musculoskeletal findings in the appropriate region. I had a hunch there was something else going on and asked the attending if we could order a CT chest with contrast. This is not to brag on myself; every once in a while we all get a little whisper in our ear that tells us something was not right.

The guy had a Stanford A aortic dissection and was in the OR within the hour.

Imagine this guy coming to a direct access PT clinic. The consequences for a physician missing this are bad enough, but the consequences of a PT missing something like this in a direct access environment would be devastating to the profession as a whole.

DelicateFade...you should feel good that your previous experience as a PT likely helped you to determine that something wasn't quite right, don't you think? And remember...a PCP missed that AAA.
Working in the ER as a PT, which is happening, being able to differentially diagnosis is huge and we have caught many things that the physician missed (i.e. stroke, tumor, central problems). Do we treat them...of course not but we do have the knowledge and the responsibility to recommend a different course of action and stating that the patient is NOT correct for physical therapy.
Within the ER, I call the physicians just that...physicians when speaking to the patient. Not doctor. If there is a different specialist the patient is seeing I will say that. Most patients don't know the difference between the different 'doctors' of the MD world. I introduce myself as the physical therapist.
Along the lines of direct access. After being in the ER as a PT, I do not believe that we as a profession know what we are asking for when it comes to direct access. Do we have the skill sets and the knowledge to handle it? Absolutely. Chiros and massage therapists have direct access and we have a better base of knowledge than they do. It would put us on a better playing field with them. Do I want to compete with MDs, no...I am in a different profession. Do I want the patient to get the best care? Yes and sometimes that means convincing and educating MDs about our knowledge base as PTs and what we can do to work with the MD team. We need people that are transferring from PT into another medical profession to help us by spreading a positive message about PT. Hopefully no one got into PT to be a pseudo-MD. We wanted something different.
DelicateFade--> How many patients have you seen come through your ER after being treated by a chiro or after visiting a massage therapist for 6 months missing the big signs of cancer, or even a PCP who thought that the patient was full of crap and only gave them ibuprofen for their neck pain that turned out to be myelopathy?
PTs are not better or worse than MDs. We are not on a different level. We are in a different profession.

 

[delicatefade]

Actually, the PCP did not miss it. The patient wasn't having pain when he saw the PCP. And it wasn't an AAA. Still think you can handle it??? I agree: the PT profession does not know what it is asking for when it comes to direct access.

 

[newbie1kenobi]

Actually, the PCP did not miss it. The patient wasn't having pain when he saw the PCP. And it wasn't an AAA. Still think you can handle it??? I agree: the PT profession does not know what it is asking for when it comes to direct access.

I was just about to comment on that. AAA is different from an aortic dissection, which actually have different sets of risk factors. That would have been devastating as it would be an acute event and a surgical emergency.

 

[PT2MD]

Working in the ER as a PT, which is happening, being able to differentially diagnosis is huge and we have caught many things that the physician missed (i.e. stroke, tumor, central problems).

A question and comment: Where and in what capacity are PT's working in EDs? Now to the comment: WE ARE NOT TRAINED in DIFFERENTIAL DIAGNOSIS. This is the essense of a physician's role in the process.

This is why there are so many misunderstandings as to our role. There is no consensus as to what our "new" role should be. I'm all for progressing the field, but we need to get on the same page here.

 

[newbie1kenobi]

A question and comment: Where and in what capacity are PT's working in EDs?

I would go with Devon on this one. PT's can have a limited role in the ED, say, your bumps/bruises, contusions, sprains/strains and any other acute musculoskeletal injuries. Plus if anybody needs gait training with an assistive device, then PT's can take up this responsibility. Much like what a sports PT would do for athletic injuries on the field. Of course this would be after an ED physician has evaluated the patient and is triaged as non-emergent to free the physician up for the real emergencies.

 

[newbie1kenobi]

It is probably in essence a fasttracked outpatient PT referral.

 

[delicatefade]

It is probably in essence a fasttracked outpatient PT referral.

This is true. There has been an article about a PT working in the ER in PTMagazine.

A valid place for an orthopedic PT, provided triage is appropriately done.

 

[PT2MD]

Wow...learning is fun. It makes sense for the PT in the ED, but I can't think it's for our differential diagnostic skill? That can't be right or do I also stand corrected here?

 

[newbie1kenobi]

Wow...learning is fun. It makes sense for the PT in the ED, but I can't think it's for our differential diagnostic skill? That can't be right or do I also stand corrected here?

Well, I think Devon may be referring to just musculoskeletal and neuromuscular assessment, which we PT's do a darn good job in doing. I don't think we can say the same for other conditions though such as constitutional and systemic issues.

I'm interested in what Devon or any recent grad has to say being fresh from didactics as I have been out for so many years and am just relying on clinical experience.

 

[Taylor355]

I do introduce myself as a PT, not a DPT, I want my skills speak for themselves. I'm not afraid to share what my degree is, but having the title is certainly not the most important thing about any profession.

Occasionally, I come across a patient who talks about their 'doctor' and they are taking about their PT... and it does sound odd (especially when I know the person they speak of doesn't have a doctorate!). Likewise, I've witnessed PA's and NP's working in hospitals being called doctor by patients--and they did not even bother to correct the title... To most patients, it's how their treated, and how intelligent you come across, not your credentials.

 

[truthseeker]

I agree more than ever with this statement now that I've spent some time on my 4th year ER rotation. We had a guy come in last week with upper back pain. He was young (40), absolutely no risk factors for CAD other than smoking, had just seen his PCP and pronounced clean as a whistle (minus the smoking), and was on no medications for HTN, cholesterol, or anything else.

He was a mechanic, did lots of heavy work, and had a perfect history for mechanical back pain. And he did have some musculoskeletal findings in the appropriate region. I had a hunch there was something else going on and asked the attending if we could order a CT chest with contrast. This is not to brag on myself; every once in a while we all get a little whisper in our ear that tells us something was not right.

The guy had a Stanford A aortic dissection and was in the OR within the hour.

Imagine this guy coming to a direct access PT clinic. The consequences for a physician missing this are bad enough, but the consequences of a PT missing something like this in a direct access environment would be devastating to the profession as a whole.

It looks like you said that the PCP missed it. What is the difference. PT misses it or MD misses it. I am being facetious, but the point is if someone comes in with back pain, the first thing on your list, I don't care who you are, is NOT Aortic Aneurysm. What is your point?

 

[delicatefade]

It looks like you said that the PCP missed it. What is the difference. PT misses it or MD misses it. I am being facetious, but the point is if someone comes in with back pain, the first thing on your list, I don't care who you are, is NOT Aortic Aneurysm. What is your point?

My point is that this guy had a great history for musculoskeletal back pain with his profession. Had he waltzed into a direct access PT clinic seeking care, the results would have been absolutely devastating to the PT profession.

Of course aortic dissection isn't first on your list. That's the point. As a PT it SHOULDN'T be first on your list, and I don't think PT's should be the ones sorting these things out which is exactly what they are going to have to start doing if true direct access becomes a reality and patients start utilizing it more.

And no, the PCP did not miss it. The guy had gone it, pain free, for a well check up. At that time, there were no physical or historical findings to alarm anyone.

 

[truthseeker]

My point is that this guy had a great history for musculoskeletal back pain with his profession. Had he waltzed into a direct access PT clinic seeking care, the results would have been absolutely devastating to the PT profession.

Of course aortic dissection isn't first on your list. That's the point. As a PT it SHOULDN'T be first on your list, and I don't think PT's should be the ones sorting these things out which is exactly what they are going to have to start doing if true direct access becomes a reality and patients start utilizing it more.

And no, the PCP did not miss it. The guy had gone it, pain free, for a well check up. At that time, there were no physical or historical findings to alarm anyone.

So then when the guy comes in with complaints of back pain that are somewhat vague but partially related to exercise/activity, and you see him in your clinic, you look for an aortic aneurysm? pancreatic cancer? testicular cancer? or do you do what most MDs do anyway, refer them to PT. You may examine his testicles, but I amguessing you don't order an MRI on all of your back pain patients.

I am incapable of diagnosing any of the above. MY point is that 99% of MD/DOs don't really diagnose it either until the PT has done a clinical exam and found that they could not affect the symptoms with movement.

So in essence we are practicing direct access anyway, but not on an island, as part of a team. It is not like once they come in we never refer them on, we do that all the time already. Geez

 

[newbie1kenobi]

So then when the guy comes in with complaints of back pain that are somewhat vague but partially related to exercise/activity, and you see him in your clinic, you look for an aortic aneurysm? pancreatic cancer? testicular cancer? or do you do what most MDs do anyway, refer them to PT. You may examine his testicles, but I amguessing you don't order an MRI on all of your back pain patients.

I am incapable of diagnosing any of the above. MY point is that 99% of MD/DOs don't really diagnose it either until the PT has done a clinical exam and found that they could not affect the symptoms with movement.

So in essence we are practicing direct access anyway, but not on an island, as part of a team. It is not like once they come in we never refer them on, we do that all the time already. Geez

Again, an aortic dissection is different from an aortic aneurysm. They can occur acutely and so are not actually present during a well visit to a PCP, and mind you, can occur during a PT session if you don't monitor blood pressures for someone who is at risk. And yes, one of the differential diagnoses for mechanical back pain is aortic dissection.

On a more productive note while we're at it, this is a good learning opportunity and we should familiarize ourselves with this.

 

[truthseeker]

OK, what are the symptoms of an aortic aneurysm?

 

[PT2MD]

I use my favorite clinical decision support system (i.e. google.). Truthseeker, tell me you aren't getting rhetorical here!

 

[newbie1kenobi]

OK, what are the symptoms of an aortic aneurysm?

*This is just a brief summary and is not an exhaustive description.

Back pain would be one of them, but onset is usually gradual (depending on size and rate of aneurysm enlargement) unlike aortic dissections which are sharp and sudden. They're usually asymptomatic but could be discovered as part of an abdominal exam, i.e., discovering an abdominal pulsatile mass depending on the size, or as an incidental finding during a chest xray done for other reasons. You would have to tie in the patient's history and risk factors, (e.g., HTN, Marfan's for younger patients) and age is a factor so I would think for the abovementioned case, aortic aneurysm would be lower on my differential.

 

[truthseeker]

OK so tell me how that would show up on a regular MD/DO exam for someone with LBP. They may feel the abdomen but the rest would overlap with the more common etiologies of MSK back pain and be referred to PT and when the PT could not reprpduce or reduce the symptoms they would be referred back to the doc.

 

[newbie1kenobi]

OK so tell me how that would show up on a regular MD/DO exam for someone with LBP. They may feel the abdomen but the rest would overlap with the more common etiologies of MSK back pain and be referred to PT and when the PT could not reprpduce or reduce the symptoms they would be referred back to the doc.

I'm not sure which condition you are referring to.

If aortic aneurysm vs dissection were suspect (from the physical exam and HPI), that has to be confirmed by radiology. The patient would not be sent to PT if other conditions have not been ruled out yet.

 

[newbie1kenobi]

I guess the moral is, as a physician, when someone comes to you complaining of LBP, you wouldn't automatically think, "Aha! Musculoskeletal!" It would initially be high on your list of differentials, but you would be negligent not to do a full history and physical (i.e., medical) exam. Plus the imaging and diagnostic tools are also available to confirm the diagnosis.

It worries me to have somebody possibly having an aortic dissection or a ruptured AAA c/o back pain, see a PT and be initially evaluated only for musculoskeletal SSx, initiate Tx (say, about an hour, which might include some stretching and exercise) and actually aggravate his condition in the process prior to saying, "hey, this is not just LBP, you should see a doctor." By then it would be too late.

 

[bigdan]

MDs and DDSs are generally better to do financially not because they are "real doctors", but because they are mostly self-employed or profit sharing partners of a practice. On the other hand, PTs are usually employed by hospitals and private practices with no profit sharing opportunities.

Many DPTs wonder why their salary is so low, this is why.

Or maybe it's that MDs get paid more per unit of time that DPTs do; maybe that's why they make more. Here are Medicare 2008 Fee Schedule numbers:
Lap Oophorectomy (let's say it takes 30 min) by OB/Gyn: ~$615 (NYS)
PT Eval (let's say it also takes 30 min): ~$75 (same region of NYS)

I think APTA still has a long road ahead to financially "validate" the DPT; ie: what billable skill does the DPT possess that the doctorate-less PT does not?

dc

 

[truthseeker]

Dan I think you are comparing apples and oranges here. My PT evaluation, although it is skilled, does not require the technology, staff, and training of a laparoscopic oophorectomy. the surgery should cost more. I think you have a point though, but Sunflower is right also.

I don't have any problem with MDs and DOs making more money than I do. There are no physical therapy emergencies. If something is emergent, they get referred to someone else. We are not trained to manage that stuff.

I think this thread has morphed into something other than what it started as.

To answer the last part of your post, there are none. the difference between the ENTRY LEVEL DPT and the ENTRY LEVEL MS PT or MPT or BSPT is that the DPT has a broader knowledge base to more appropriately identify the borders of their scope of practice and recognize when a patient needs referral.

Its not always about money.

Because someone gains extra training, it could just be for the betterment of care, not necessarily financial gain.

 

[BoneKrusher]

Bottom line is if a DPT represents him/herself as a doctor, leading to believe any patient or potential patient that they are a physician, that PT will most likely stand to lose any case brought to a jury trial stemming from that misrepresentation. For this and also because it may pose undue hazards, I wouldn't recommend ANY DPT to refer themselves as doctors anywhere near a hospital, clinic or scene of an accident or emergency, UNLESS you precede/proceed it immediately with your professional title

PTs are not physicians and the way physicians are guarding their duties and responsibilities lately (I don't blame them), will not gain physician status anytime soon. Many professions are closing in on "slivers of physician skills", but none match the breadth and depth of allopathic/osteopathic medicine. Some foreseable duties that PTs may one day claim to help them gain such status may be the ordering of diagnostic imaging and exercise prescription. Even performing/interpreting EMGs may be out of step for PTs, since it is mostly Neurologists and PM&R handling these duties now-time will tell.

Cheers

 

[PTDoc]

I couldn't agree more. I am an OCS and think I'm a pretty sharp cookie in my setting. (Please don't get me near a SNF though) I think PT should be pursuing board certification vs doctoral degrees. There is a wide range of expertise between clinicians in physical therapy. What distinguishes them now is board certification. When we water the profession down with the DPT and the controversy it brings, I think we are paving the way for doing more harm to our profession than good.

You don't have to be called doctor to be important.

Your last sentence makes a valid point. It's not the title that makes you important.

I'd like to hear your opinion on the current belief by many Physical Therapists that the OCS has become irrelevant with it's current standards for eligibility and testing?

I agree with you about this - Physical Therapists (DPT's, MPT's, whatever) should all be striving toward board certification in a specialty. I disagree strongly with many of the posts concerning the use of the term "Doctor".

Perhaps the most important thing we can all do - as providers of health care - is educate our patients so they understand what we all do. Of course this would require everyone to educate themselves first.

 

[PTDoc]

Bottom line is if a DPT represents him/herself as a doctor, leading to believe any patient or potential patient that they are a physician, that PT will most likely stand to lose any case brought to a jury trial stemming from that misrepresentation. For this and also because it may pose undue hazards, I wouldn't recommend ANY DPT to refer themselves as doctors anywhere near a hospital, clinic or scene of an accident or emergency, UNLESS you precede/proceed it immediately with your professional title

PTs are not physicians and the way physicians are guarding their duties and responsibilities lately (I don't blame them), will not gain physician status anytime soon. Many professions are closing in on "slivers of physician skills", but none match the breadth and depth of allopathic/osteopathic medicine. Some foreseable duties that PTs may one day claim to help them gain such status may be the ordering of diagnostic imaging and exercise prescription. Even performing/interpreting EMGs may be out of step for PTs, since it is mostly Neurologists and PM&R handling these duties now-time will tell.

Cheers

From my experience, introductions or use of the term "Doctor" usually occurs something like this:

"Hi, I'm Dr. So and So - your Physical Therapist."

I've never heard of a Physical Therapist running around the hospital shouting "I'm a Doctor - let me handle this."

One of the largest misrepresentations occuring is the misrepresentation of how DPT's view their abilities and credentials compared to other healthcare providers.

 

[Shah_Patel_PT]

...................................

 

[Shah_Patel_PT]

I see no problem with referring to yourself at Dr. so and so. That is the title that a doctoral degree grants.
Referring to yourself as a physician, on the other hand, seems wrong to me. I would say, Hi there, I am Dr. Brightness, your physical therapist.
Seems straightforward to me.

I bet you......that PT will be the last one calling him/herself a doctor when a patient is crashing on the floor.

Calling yourself a doc...often confuses a patient....and should not be done. If you are a Phd...sure you can write Dr. on paper.....but should not be calling yourself as such in a hospital setting.

 

[ColoDPT]

I would not call 3 12 week clinicals mini residency...again this reference adds to the argument that DPTs might perceive themselves as physicians. They are more like clinical rotations. What PT2Md was referring to, in my opinion, is the DPT might affect clinical research. As stated earlier, it is a clinical doctorate and not an academic doctorate; consequently, the number of PhD/Dsc's at PT schools will begin to decrease (has already happened). Things might have changed since when I was in school but I remember speaking with a DPT about our research (I leave her school name out) she basically mentioned a case study. I told her this was not research. She said it was. I again told her that looking up dx and rx from a medical chart does not make it research. When I read the research that is happening in PT journals today, I scratch my head as it is relatively dull and poor...not making your students perform an actual research study will decrease the scientific validity of the profession and lead to PT's creating heavily qualitative studies no different than DC's (ie the 'it feels good studies' they love to use not factoring in therapeutic touch). Out of 5 research studies performed when I was in school only ONE (my study with 2 other PT students) was not qualitative.

The DPT affecting clinical research?! Are you kidding?! The DPT degree will only introduce positive change to both qualitative and quantitative research.
Case studies and case reports DO contribute in a positive manner. If nothing else, it allows those un-biased clinicians an alternative approach that that (or may not) be utilized in his or her own practice (whatever practice that may be: M.D, DO, PT, OT, etc). Also, I cannot speak for other PT programs out there, but we are required to complete a quantitative research project in order to graduate. In the 3 years of PT school, I spent 2 years doing one thing or another for my research almost every week. Just because someone's research isn't a "golden" RCT does not make it inferior. Ask yourself this, "How applicable are some of the RCTs out there that have 20 inclusion criteria, 50 exclusion criteria?" How often do you find a patient that meets everything? Again, that is just my personal experience but what do I know, I am a DPT student...
Here are some of my other thoughts on what I have read here:
1) "Not enough autonomy in PT." PT autonomy has been, and will be, a continual battle. To change professions to gain more autonomy tells me that you (whoever "you" may be) are not passionate enough about your profession to fight for the greater good of something; it tells me you do not have the fortitude to help the APTA, to fight for your practice act, to educate other healthcare professionals about your abilities and scope of practice.
2) "DPTs are not doctors." Believe it or not, DPTs are clinical "doctors" whether you like it or not. No one, NO ONE, owns the word "doctor." I will never call myself a physician and I hope that the PT profession avoids going that route at all costs. But why should I not be able to refer to myself as a Doctor of Physical Therapy, especially if I have completed a residency and/or fellowship and hold a board certification, involve myself in research, and continually update my practice pattern based of legitimate research?
3) A lesson in all of the psychometric values is sorely needed in the MD/DO/DPM/DC/Bs & MSPT realm. I cannot believe the times in clinic that I have watched provacativetests/measures done by all of the above-mentioned professions that hold no QUANTITATIVE evidence for testing what is says it tests for. What the DPT degree does an exceptional job of doing is exposing the students to an accessible means of research, the knowledge to critically asses the research, and the ability to utilize that knowledge in clinic.
4) The fact that there are so many disenchanted former PTs out there is sad. The profession is under-going positive change right now because of those that are willing to stay and fight for it. I hope that those of you making a career change enjoy it; less time w/ each patient, longer hours, more stress. Why enjoy life...?

This place is a great forum for exchange and I look forward to some of the post/replies in the future. PTs in general (and DPT/ PT PhDs specifically) are the agents of change out there. Get back on board, or like some others here, jump ship for greener pastures...

 

[ADUB]

Case Studies / Case Reports are research. They are frequently used by many researchers in many professions as pilot studies that get things rolling. Also, at least for me, it is interesting to read of cases that are presented and how the professional handled the case. If you desire, you can learn alot from them.

 

[PTbecomingDDS]

The DPT affecting clinical research?! Are you kidding?! The DPT degree will only introduce positive change to both qualitative and quantitative research.
Case studies and case reports DO contribute in a positive manner. If nothing else, it allows those un-biased clinicians an alternative approach that that (or may not) be utilized in his or her own practice (whatever practice that may be: M.D, DO, PT, OT, etc). Also, I cannot speak for other PT programs out there, but we are required to complete a quantitative research project in order to graduate. In the 3 years of PT school, I spent 2 years doing one thing or another for my research almost every week. Just because someone's research isn't a "golden" RCT does not make it inferior. Ask yourself this, "How applicable are some of the RCTs out there that have 20 inclusion criteria, 50 exclusion criteria?" How often do you find a patient that meets everything? Again, that is just my personal experience but what do I know, I am a DPT student...
Here are some of my other thoughts on what I have read here:
1) "Not enough autonomy in PT." PT autonomy has been, and will be, a continual battle. To change professions to gain more autonomy tells me that you (whoever "you" may be) are not passionate enough about your profession to fight for the greater good of something; it tells me you do not have the fortitude to help the APTA, to fight for your practice act, to educate other healthcare professionals about your abilities and scope of practice.
2) "DPTs are not doctors." Believe it or not, DPTs are clinical "doctors" whether you like it or not. No one, NO ONE, owns the word "doctor." I will never call myself a physician and I hope that the PT profession avoids going that route at all costs. But why should I not be able to refer to myself as a Doctor of Physical Therapy, especially if I have completed a residency and/or fellowship and hold a board certification, involve myself in research, and continually update my practice pattern based of legitimate research?
3) A lesson in all of the psychometric values is sorely needed in the MD/DO/DPM/DC/Bs & MSPT realm. I cannot believe the times in clinic that I have watched provacativetests/measures done by all of the above-mentioned professions that hold no QUANTITATIVE evidence for testing what is says it tests for. What the DPT degree does an exceptional job of doing is exposing the students to an accessible means of research, the knowledge to critically asses the research, and the ability to utilize that knowledge in clinic.
4) The fact that there are so many disenchanted former PTs out there is sad. The profession is under-going positive change right now because of those that are willing to stay and fight for it. I hope that those of you making a career change enjoy it; less time w/ each patient, longer hours, more stress. Why enjoy life...?

This place is a great forum for exchange and I look forward to some of the post/replies in the future. PTs in general (and DPT/ PT PhDs specifically) are the agents of change out there. Get back on board, or like some others here, jump ship for greener pastures...

1. First, I am very passionate about my profession. Just because I am becoming a dentist does not end my career as a PT. I am actually studying to work with dogs and plan on continuing this path even as a dentist. I do not agree with everything the APTA is advocating, and this does not make me any less passionate than any other PT. Being a devil's advocate can further the profession as well.
2. Yes, I already know DPT's are clinical doctor's. I have spoken at numerous APTA roundtables (when you were probably in high school) about clinical doctorates vs. academic doctorates (yes, some schools wanted a DsC instead of a DPT to demonstrate our knowledge base). A master of science is an academic degree while DPT is not. It is no different than a DC. Do we want to be chiropractors? Remember, DC's once referred to themselves as Doctors of Chiropractic Medicine and have now shifted to Chiropractic Physicians. How long will it take for the first Physiotherapy/Physical Therapy Physician to be advertised? And to refer to your clinical affiliation as a residency!? How bold...do you take call or have a general medicine residency prior to actual residency specialty? Does it last at minimum 3 years. And when did PT schools have fellowships? I thought we had certified specialists. No one owns the title of doctor, but it might and has confused DPT's practicing PT. For example, (in addition to my first post where I use an example of DPT filling out physician credentialing paperwork), a colleague had to deal with a DPT informing a patient she needed a MRA despite a internist and TWO neurologists making no suggestion. The DPT even documented it on the chart overstepping there scope in my opinion. The patient demanded the test requiring her to stay in the hospital for 3 more days when the test was not even necessary (MRA/MRI are expensive!). The DPT also wanted a MRI for dizziness with cervical neck flexion (take into consideration this c/o has been lasting over 3 years-not acute) despite no physical testing indicating weakness or paresthesia. This is perfect example how DPT's graduate thinking they have the knowledge to go toe-to-toe with MD's even specialists like a neurologist with no true understanding or training to understand when certain tests are necessary. Yes, DPT is a clinical doctorate. Go ahead a call yourself a "doctor of physical therapy" but do not tell me that a good number of DPT's feel entitled to a level near or even equivalent to a MD/DO. I have stated earlier that I would wish programs would better educate their students on these differences; however, I still encounter these types of DPT's and have heard other clinic managers and owners encounter similar situations. I hope this opens your eyes when you do graduate as a DPT.
3. As for a DPT's ability to assess research over another PT? The only changes to my program when it went to a DPT is that we just added a more in depth pharmacology course (the only thing we needed to add to become a DPT program), so please do not place yourself on such a high podium when comparing BS and MSPT's. Even DPT programs are different from one school to the next. Plus, research based practice is nothing new even when I was studying to be a PT. I know how to read research (and journals on clinical u/s imaging is not my cup of tea).
4. You are student. In the real world of PT, we get reimbursed nothing, and I do not see this changing anytime soon. Medicare continues to make cuts and since it is the gold standard for which all insurers follow, we will have to see many patients just to make it in the black. For a 30 minute block for a patient, I need to charge 3-4 units (CPT codes) just to cover my salary (or one of my PT's salary) and overhead costs, so I end up treating 2 and even 3 patients at one time. It used to be I could see a patient for 30 minutes 1:1, so your statement about longer hours is not realistic unless you accept being a part-time PT (as a PT needs high volume to sustain a practice as reimbursement for our procedures continue to drop). One positive is that the demand for PT's is high; however, the pay is not. I have accepted that I might lose patient interaction as a dentist (I love interacting with my patients), but positives such as owning my own practice, short work weeks (one can get by comfortably just working 30 hours a week as a dentist), and financial stability outweigh this. Despite my career change, I will still be in the PT arena and not "jumping ship." My patients might change from humans to canine (with the exception of manual techniques for TMJ), but I will and still be following the profession. I have devoted too many years of my life to PT to just completely walk away. I just started this specific forum to remind future "doctors of physical therapy" not to forget the therapist part of their title (and not end up as clinicians focused more on evaluating patients, setting up treatment plans, and letting PTA's do all "therapist" work).

 

[WHO DAT]

PTBecomingDDS please check your inbox.

 

[docphysio]

That is why education is important. The earning of any doctorate, or degree for that matter, carries all the rights and privileges associated with it. Title is a right and an earned privilege. Physicians were looked on as witches in some parts of the world during the early times of medicine but with organisation the profession has earned credibility. They did not accept the status quo and remained dormant, so why should Pt's? The DPT is just a step forward.
I think a lot of this bickering hinges on ignorance, ego and transition jitters. I have my DPT and am known as a physical therapist with a doctoral degree. I may be called doctor at times by my patients and i do not rebuke them, because I am a doctor. They know my profession and so do I. If there is a discrepancy I educate the person on the association of my doctorate.
There are other 'doctors' in my hospital who are psychologist etc
and they are called doctors as well. Why is the 'doctor' thing so divisive.
Change at times starts with dissent , then education, then acceptance.

 

[originalPT]

That is why education is important. The earning of any doctorate, or degree for that matter, carries all the rights and privileges associated with it. Title is a right and an earned privilege. Physicians were looked on as witches in some parts of the world during the early times of medicine but with organisation the profession has earned credibility. They did not accept the status quo and remained dormant, so why should Pt's? The DPT is just a step forward.
I think a lot of this bickering hinges on ignorance, ego and transition jitters. I have my DPT and am known as a physical therapist with a doctoral degree. I may be called doctor at times by my patients and i do not rebuke them, because I am a doctor. They know my profession and so do I. If there is a discrepancy I educate the person on the association of my doctorate.
There are other 'doctors' in my hospital who are psychologist etc
and they are called doctors as well. Why is the 'doctor' thing so divisive.
Change at times starts with dissent , then education, then acceptance.

I cannot agree any less. I just do not understand why our own colleagues in the profession can be so hateful about this DPT degree. The profession is moving forward whether they like it or not. We are Doctors in PT and not MD. if we keep bashing our profession like this, how do we expect physicians and other professionals to respect what we do and the knowledge base we gain as DPT. And yes there are residency and fellowship programs in PT. So the gentleman that thought we are calling internship as residencies please check your facts with all due respect. You can check at the APTA website for residency and fellowship programs in PT, which accepts PTs after they get their DPT or MPT degree. Our current healthcare environment dictates a new direction in our profession. Hence a DPT. With this said many DPT schools focus on radiology,pharmacology, differential diagnosis, research that are evidence based as an add-on to classes that many MPT programs may not have offered. So to all the haters, we the DPT respect your experience but if you are not happy being a PT please do not bash the profession. You realize about 180 PT schools are now offering DPT degree. You might as well get use to it and possibly think about getting a transitional DPT.

 

[MinnDasota]

Ive been browsing this forum for a while now and thought I would join in the discussion. So, hi to everyone!

Anyways, I respect everyone's opinions so far and hopefully you will accept mine. Obviously the debate as to who is a doctor is a good one, but as we all know, ultimately what matters is the patient. With this in mind, I hope this is the reason why we all have chosen to become a part of the health care team.

I do believe that if you have earned a doctor degree from an accredited university, then you have earned the right to that distinction. It is an honor and a privilege for all the hard work you put forth, whether in medical school or in PT school (both are very rigorous and hard to get into). My classmates and I have collaborated with many of the med students at my school and they are surprised and amazed as to what we've learned in PT school. It was obvious the respect they had for our program. Likewise, the respect was mutual. In the end, after all the student loans, as PT or med students, we knew we were learning to become the best clinicians possible to our patients.

To reply to some of the previous posts:
I can't speak for all PT schools, but my school is deeply ingrained in research (not just case studies). My research group has spent the last 2.5 years (IRB approved) studying the ACL and the female athlete. Most of it included testing of our subjects to support or disprove previous literature as well as supporting our own hypotheses. Some of my other classmates are involved in heavy research in childhood disorders (CP, autism) and neurological disorders (Huntingtons, parkinsons, stroke). All are IRB approved and none of which are mere "case studies". So research now, more than ever, is important in PT school as our profession strives for evidence-based practice.

There are residencies and fellowships in PT (however, they are different than clinical affiliations and internships which happen while in school). Unfortunately, there are only a limited number of residencies/fellowships available. The residencies occur in the post-professional phase in which the PT has finished schooling and is licensed. There are residencies in ortho, sports, neuro, geriatrics, womens health, etc and are usually 1 year in length. Ultimately, these residencies allow the PT to sit for the respective advanced certification exam. I am currently in the interview process for acceptance into a sports residency program (so yes, I may have another year of training) and I agree that advanced certification is important, but shouldn't diminish the DPT degree. Being a well-rounded clinician is the point of most PT schools and prepares us for the boards. Advanced certification/specialty is a plus, but at this point in the profession, doesn't seem to be for everyone.

When I chose to go into physical therapy, I chose it because I enjoyed sports medicine and rehab. I had no idea at the time that it was a doctor degree. I am all for the DPT as we strive for direct access and autonomy. I believe we do have the training to see patients without always having to see an MD first. In PT school, we ARE trained in differential diagnosis, but by no means does that mean we are trying to diagnose cancer or aortic disection (we leave that to the physicians). We are trained to see the red flags and make the appropriate recommendations. I have grown up in a "medical family" and I know the difference between a doctor vs. a physician (my dad's a distinguished MD and mom's a nurse). I am proud to be graduating with my DPT next month. I know my role in the health care field and hope that whatever our titles our, that we are treating our patients and each other with competency and respect.

I am a physical therapist with a doctor degree (soon). That's the way I see it. It's ok to be called a doctor if you have the degree. Just make sure your patients know what type of doctor you are!

 

[SuperKirby]

I agree completely. Calling yourself "doctor" in an academic setting is completely appropriate for PhD's and the like. The term "doctor" in a clinical setting implies a skill set not obtained by entry level DPTs. When someone runs up to an accident scene and announces he/she is a doctor, you should be able to assume they aren't an english professor. They are a trained physician capable of handling the situation. DPT's do not have the skills to handle many of the medical events physicians are exposed to on a regular basis. It's a matter of specificity of training.

Just because the chiros call themselves "doctors", doesn't mean we need to keep up with the Jones' and do the same. Incidently, the training for DPT programs is VERY similar to MPT programs with a few weak radiology and pharmacology courses.

You can call yourself a doctor all you want, but I don't think it's appropriate to mislead the public in such a shallow way.

i, like many agree and disagree. If you are hanging out with lawyers and accountants, or in any non clinical health field setting, u may call yourself doctor. u have the right to be called dr., u did indeed get a doctorate. if u are hanging out with nurses or radiologists or any health field area, school, work, or leisure, u are (name), a physical therapist. there is no need for the confusion in the health field.
even lawyers dont call themselves doctors, and they have a doctorate! dont get so cocky, you're only making 60k a year. =)

 

[jesspt]

dont get so cocky, you're only making 60k a year. =)

Yup, it is our salary that should convince the public and our associates that we are a doctoring profession.

Are you kidding me?

 

[PREMEDWOAHS]

Here is my 2 cents - if it is even worth that much to some of you..

I want to a Physical Therapist..I dont care if the title before it is Dr, Mr, Father, Captain, President-Elect --- when someone asks, I will say, I am a Physical Therapist becuase thats what I went to SCHOOL for, I didnt go to school to be a Doctor or a Mister, etc.

The title of Dr. is miniscule to me. I want to become a PT over an MD because I wanted to have more patient interaction, and becuase I felt the mobility of a person directly affects more aspects of a patients life than any other domain of medicine. If you take away someone's capabilities to move, you harm them mentally, occupationally, etc - It goes on with the pillars of wellness.

The title means nothing. If you want to prove your worth as a clinician - prove it through being a compassionate person, interested in their case, brushing up on your studies/techniques, and helping them keep realistic expectations after treatment and allowing them to resume the most normal and desired life possible. Maybe if you prove to your patient are a well rounded health care provider, the amount of education it took you to get there wont matter. And if one day they ask what the DPT after the name stands for? I wont hesitate to enlighten them on the difficult path to becoming a Doctor of Physical Therapy. Change takes time...to expect the career to be revamped in 15 years is ridiculous considering the evolution of modern medicine over the past 150 years.


Keep in mind I am only pre-health student. So go ahead and take a dump on me like most people in this forum would after what I just said..

 

[nhsvs]

No disrespect intended to DPT's, because they work hard for their degree and I consider them to be medical professionals. That being said, there are only three kinds of medical doctors: MD's, DO's, and DVM's.

 

[xMerryx]

I agree, those are medical doctors. I don't think there is anything wrong with calling someone a doctor eve if he/she is not a medical doctor because let's face it is not that unusual, BUT of course in a hospital setting it would be confusing to the patient if X person is a PT dressed in scrubs and introduces himself as a Doctor. No disrespect to anyone REALLY but some people (MDs or future MDs) get mad that other professionals are called Doctors, that could be perceived as if you care more about the title and that it should be a title so respected that only MDs deserve to have it (I'm not saying that's your motivation, but it could be perceived that way). As PREMEDWOAS wrote, I couldn't care less what I will be called, I want to be a PT, if someone calls me a Dr well, I will have a Doctorate degree so I can be adressed as Dr"Merry" maybe in a letter (maybe?) but I'm a PT I will not think: oh people could think I'm a physician. Of course with patients is different. By the way this topic is funny to me 'cause people refer to my boss as doctor and he has the Dr. degree in something to do with music :S I know is an extreme example but get my point?

 

[LAcDPT2be]

I'm new to this forum, so hello to all!

Wow. What a debate you all have going! It's exciting.
Quite honestly when I earn this degree I will just introduce myself to the patient as "your physical therapist". If someone asks I'll say I earned a Doctor of Physical Therapy. I'll put DPT after my signature on appropriate clinical documents and that's it. If someone calls me Dr. then it's true...I did earn the educational right to be called Dr....and I will go out of my way to make sure they know I am in no shape or form a medical doctor.

I'll be as bold to say give the patient some credit - most of them already know the DPT is not an MD/DO.

 

[xMerryx]

I'll be as bold to say give the patient some credit - most of them already know the DPT is not an MD/DO. [/quote]

Exactly!!!!