Healthiest states and direct access

[Fiveoboy11]

I was just checking out the healthiest/sickest states published by forbes and correlating that to unrestricted direct access to physical therapy. Here's what I found, and hopefully someone will confirm this.

I was checking the APTA pdf with a summary of direct access laws, I count 17 with unrestricted direct access (AK, AZ, CO, HI, ID, IA, KY, MD, MA, MT, NE, NV, ND, SD, UT, VT, WV).

In overall health ranking, of the top 17, 9/17 are unrestricted direct access states, of the bottom 17 (unhealthiest) 3/17 are unrestricted direct access. Of the states with the lowest diabetes 5/10 are unrestricted direct access states, while states with the highest diabetes, 2/10 are unrestricted direct access states. In terms of lowest obesity, 6/10 are unrestricted direct access. Highest obesity, 2/10 are unrestricted direct access. Lowest smoking 4/10 are unrestricted direct access. Highest smoking 3/10 are unrestricted direct access. Anyone else have thoughts because this seems amazing to me.


http://www.forbes.com/2010/12/06/healthiest-unhealthiest-states-lifestyle-health-uhc-table.html

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[Fiveoboy11]

Here's some more statistics, I'll have to hunt down the sources again if needed.

2/10 states with the most student loan debt per student are unrestricted direct access
13 out of the 25 best states for healthcare are unrestricted .... 4 out of the 25 worst states for healthcare are unrestricted
3/10 of the best paying states for PT's are unrestricted direct access

 

[facetguy]

On the issue of direct access, do PTs in direct access states do better financially? Do the majority of their patients still come in referred by physicians, or do they actually see many self-referred patients? Has there been any animosity on the part of physicians in those states?

 

[Fiveoboy11]

1) I'm not sure 2) As far as I know, the vast majority of patients seen by physical therapists in unrestricted direct access states are by referral for insurance purposes. 3) I'm unaware of any animosity of physician's or any other provider in states that have unrestricted direct access, there is strong animosity on the part of the AMA, ACA and Podiatry associations when the APTA tries to get laws changed for unrestricted direct access. Bunch of money mongering BS if you ask me.

Sad how businesses and non PT's can mooch off the hard work of an entire profession with no basis..

I think the above posts may demonstrate that states who are smart with healthcare decisions, including unrestricted access to physical therapy, are more likely to make other sound decisions, which is reflected more often that not, in the above stats.

 

[atstudent]

. Bunch of money mongering BS if you ask me.

Because we all know the APTA is not about that at all!

 

[facetguy]

I recall a conversation I had a number of years ago with an owner of several successful PT clinics, and his feeling was that things might be better off staying as they are (i.e., no direct access) so as to not 'bite the hand that feeds' I think were his words. If I were a PT, I would want direct access. After all, who else are the docs going to refer their patients to, so their lives really shouldn't be all that negatively impacted.

 

[Fiveoboy11]

Because we all know the APTA is not about that at all!

Oh yea, the APTA throws money around left and right. Naa, the APTA is actually a professional association with baseful arguments for the rights of patient's and physical therapists. Just to clarify, there is a joint statement between the APTA and NATA reflecting mutual respect from the recent lawsuit brought by the NATA. Find me something similar between the APTA and AMA/ACA.

 

[Fiveoboy11]

I recall a conversation I had a number of years ago with an owner of several successful PT clinics, and his feeling was that things might be better off staying as they are (i.e., no direct access) so as to not 'bite the hand that feeds' I think were his words. If I were a PT, I would want direct access. After all, who else are the docs going to refer their patients to, so their lives really shouldn't be all that negatively impacted.

To me that PT sounds like a bonehead. It's not about making referral sources happy and making the most money. It's about what's right and what's best for the patient.

I agree, I like how physician's constatnly refer to us, but somehow we're "dangerous" without their make believe supervision. How many deaths are the result of PT malpractice per year, zero? How about physician's per year (isn't it like 200k?). Looks like about 2.5 million people die each year. That's about 10 percent due to screw ups.

 

[atstudent]

Oh yea, the APTA throws money around left and right. Naa, the APTA is actually a professional association with baseful arguments for the rights of patient's and physical therapists.

So do you still believe that athletic trainers are not allowed to do manual therapy? Or shouldn't do manual therapy? And I think it's funny that athletic trainers are qualified to provide rehabilitation services to thousands of athletes each day and hundreds, if not thousands, of service members each day, but they aren't qualified to treat the general public...

And if PT/PTA combos are so superior to an athletic trainer, then why not let the athletic trainers gain reimbursement rights? Since you're so superior, you'll win that battle anyway, right?

But you're not for giving the patient the choice...

 

[truthseeker]

To me that PT sounds like a bonehead. It's not about making referral sources happy and making the most money. It's about what's right and what's best for the patient.

I agree, I like how physician's constatnly refer to us, but somehow we're "dangerous" without their make believe supervision. How many deaths are the result of PT malpractice per year, zero? How about physician's per year (isn't it like 200k?)..

I think you made a better point a few posts ago about how its really the AMA and the professional organizations that are opposed to direct access. I know that all of the docs at our clinic (small town 5300 people with 9 primary care providers 4 nurse practitioners, 2 surgeons and one PA) would rather the MSK stuff not be on their schedule at all. They realize it would be much more efficient for our department to screen them first and if something doesn't fit to refer them.

Usually its horses when you hear hoofbeats. Most of the time when something icky is going on the docs don't catch it the first time anyway if the primary complaint is, let's say, LBP. They refer them to us, we recognize that it is not mechanical and refer them back or notice odd neurological deficits that don't fit "normal" patterns, i.e it is "other" and we send them back for more diagnostics. If the docs did MRIs for every case of LBP to rule out bone mets or kidney stones they healthcare costs would really go crazy.

 

[facetguy]

I think you made a better point a few posts ago about how its really the AMA and the professional organizations that are opposed to direct access. I know that all of the docs at our clinic (small town 5300 people with 9 primary care providers 4 nurse practitioners, 2 surgeons and one PA) would rather the MSK stuff not be on their schedule at all. They realize it would be much more efficient for our department to screen them first and if something doesn't fit to refer them.

Usually its horses when you hear hoofbeats. Most of the time when something icky is going on the docs don't catch it the first time anyway if the primary complaint is, let's say, LBP. They refer them to us, we recognize that it is not mechanical and refer them back or notice odd neurological deficits that don't fit "normal" patterns, i.e it is "other" and we send them back for more diagnostics. If the docs did MRIs for every case of LBP to rule out bone mets or kidney stones they healthcare costs would really go crazy.

This has been my experience as well.

 

[Fiveoboy11]

So do you still believe that athletic trainers are not allowed to do manual therapy? Or shouldn't do manual therapy? And I think it's funny that athletic trainers are qualified to provide rehabilitation services to thousands of athletes each day and hundreds, if not thousands, of service members each day, but they aren't qualified to treat the general public...

And if PT/PTA combos are so superior to an athletic trainer, then why not let the athletic trainers gain reimbursement rights? Since you're so superior, you'll win that battle anyway, right?

But you're not for giving the patient the choice...

First of all, athletes (especially young ones) are nowhere near the same patient's as the elderly or even middle aged, or young non athletes if you ask me. The mechanisms of injury obviously are different to begin with, wouldn't you agree? Athletic trainers absolutely should be able to do manual therapy (on athletes). But, don't try to kid yourself into believing athletic trainers have the same training and skill to provide manual intervention to the average person with NMSK symptoms that are amenable to those interventions as PT's. On a case by case basis, I would pick ATC's over PTA's if I had a choice. I've mentioned on previous posts that I really have not been impressed by the vast majority of PTA's that I've worked with.

I'm in favor of having patient unrestricted direct access to athletic trainers and they can choose who to see. But I don't want to hear a generalized statement that ATC's are on par with PT's (on average) for manual interventions for the general public. PT's do it all day long on the general public (and have been for years), ATC's do not. Hasn't the physical therapy profession conducted by far the most research with regard to manual therapy? What does that tell you? At the same time, it is a pathetic joke that massage therapists and personal trainers have unrestricted access to probably the same patient group often times, while PT's/ATC's do not with far more expertise.

Based on your rationale and arguments I've seen so for, you would be in favor of PT's on the sidelines at sporting events masquerading as ATC's would you not? Or do you think ATC's are "superior" to PT's in this regard?

 

[truthseeker]

First of all, athletes (especially young ones) are nowhere near the same patient's as the elderly or even middle aged, or young non athletes if you ask me. The mechanisms of injury obviously are different to begin with, wouldn't you agree? Athletic trainers absolutely should be able to do manual therapy (on athletes). But, don't try to kid yourself into believing athletic trainers have the same training and skill to provide manual intervention to the average person with NMSK symptoms that are amenable to those interventions as PT's. On a case by case basis, I would pick ATC's over PTA's if I had a choice. I've mentioned on previous posts that I really have not been impressed by the vast majority of PTA's that I've worked with.

I'm in favor of having patient unrestricted direct access to athletic trainers and they can choose who to see. But I don't want to hear a generalized statement that ATC's are on par with PT's (on average) for manual interventions for the general public. PT's do it all day long on the general public (and have been for years), ATC's do not. Hasn't the physical therapy profession conducted by far the most research with regard to manual therapy? What does that tell you? At the same time, it is a pathetic joke that massage therapists and personal trainers have unrestricted access to probably the same patient group often times, while PT's/ATC's do not with far more expertise.

Based on your rationale and arguments I've seen so for, you would be in favor of PT's on the sidelines at sporting events masquerading as ATC's would you not? Or do you think ATC's are "superior" to PT's in this regard?

five0boy, you make some really strong points but you really come off like a jerk sometimes. When you do that, people turn you off. Let me try.

atstudent: the difference in training "how" to do manual therapy is the same in athletic training programs and PT programs. I know because I went through both. the difference is in the "why" do you do it part. If I may be so bold as to speak for 5-0 I would say that the difference between doing manual therapy on an athletic population or service population and someone off of the street is that you may not be trained to notice things that you are not exposed to in AT school. There is (or was) not much discussion of cardiac disease, stroke, pancreatitis, bowel obstruction etc . . . in the athletic population or in a 25 year old infantryman because it just doesn't occur there very often. The difference between AT and PT is the "why".

Like 5-0 said, you wouldn't want a PT on the sideline deciding whether or not someone had or did not have a concussion, whether or not someone is suffering heat illness, deciding if someone could be steri-stripped and returned to the game or if they needed stitches etc . . . sure, anyone can put on steri-strips or butterflies but "when" should you and when should you refer?

How many athletes do you encounter with 4 different lifetime diagnoses? por ejemplo: type II diabetes, coronary artery disease, rheumatoid arthritis, and ankylosing spondylitis?

the answer is obviously none because they wouldn't be able to compete in a wrestling tournament and have any fun doing it.

Sorry if I stepped on toes 5-0.

 

[atstudent]

truthseeker, you make a lot of good points. And 5-0, you and I are thinking similarily. Obviously a PT has a wider scope when it comes to rehabilitation than an athletic trainer. I'm not disputing that at all.

The point I am making is that 5-0 tried to make it sound like the APTA and PTs were the victims in everything politics and that just isn't true.

I work in a clinical setting and work with PT and PTA on a daily basis. I just believe that I should be able to treat patients that I am capable of treating and being appropriately reimbursed for that. For example, we had a freshman football player in the office today for an ankle sprain. If I am at the school, that is definitely something I can treat. Another football player was in for bilateral knee scopes which is one that I would treat in a school environment. Tomorrow, we have a volleyball/softball player with a UCL sprain coming in.

These are all patients that I am "qualified" to treat if I'm doing it for free, but I am "not qualified" to do it if there is money involved?

On the other hand, I know my limits too. Obviously the patient who has history of knee subluxations and has cerebral palsy is not a patient within my scope, my training, nor is it my desire to treat that patient. I don't know the "why" or the "how" of treating that individual.

 

[oldmanriver]

To me that PT sounds like a bonehead. It's not about making referral sources happy and making the most money. It's about what's right and what's best for the patient.

I agree, I like how physician's constatnly refer to us, but somehow we're "dangerous" without their make believe supervision. How many deaths are the result of PT malpractice per year, zero? How about physician's per year (isn't it like 200k?). Looks like about 2.5 million people die each year. That's about 10 percent due to screw ups.

Spoken like someone who has never actually had someone's life in their hands.

 

[Fiveoboy11]

Spoken like someone who has never actually had someone's life in their hands.

That's right, your job is dangerous. Do your own job.

 

[oldmanriver]

That's right, your job is dangerous. Do your own job.

I see from your posts that you like to operate in a vacuum. Fortunately for your patients, that is not possible. I can safely say that most of my colleagues have no interest in directing physical therapy, however, that is not to say that we don't monitor our patients as they progress through it. Part of taking care of patients involves realizing that nothing occurs in isolation and that all treatments have downstream consequences in sometimes predictable, and sometimes not so predictable fashion. You would probably benefit from lightening up a little bit and getting rid of the chip on your shoulder.

 

[Fiveoboy11]

I see from your posts that you like to operate in a vacuum. Fortunately for your patients, that is not possible. I can safely say that most of my colleagues have no interest in directing physical therapy, however, that is not to say that we don't monitor our patients as they progress through it. Part of taking care of patients involves realizing that nothing occurs in isolation and that all treatments have downstream consequences in sometimes predictable, and sometimes not so predictable fashion. You would probably benefit from lightening up a little bit and getting rid of the chip on your shoulder.

Monitoring and directing a patient as they progress through physical therapy is the physical therapists job.

From my experience, many physicians do try to control PT, and they don't know when to start or stop PT. Coincidentally they're not trained in physical therapy.

Seems to me like you're advocating for more of the same. The healthcare system is nowhere near it's potential in the US, and PT/physician interaction is a joke. But, let's just keep on with it the way it is.

 

[oldmanriver]

Monitoring and directing a patient as they progress through physical therapy is the physical therapists job.

Again you are missing the point, but I'm not sure that it is possible to reason with you or if you will ever get it. I hope for your patient's sake that you do before someone is seriously injured. I don't know what you have experienced in your career that has made you the way you are but I suggest that you step back for a second, listen to the things you say, and then decide if this is how you want to be known professionally.

There are many things wrong with the health care system but the interaction between PTs and physicians is not even in the top 100. Please stop taking yourself so seriously.

 

[truthseeker]

you may well work in an unusual setting. Mine is very collegial. Attitude might have something to do with it.

 

[Fiveoboy11]

Again you are missing the point, but I'm not sure that it is possible to reason with you or if you will ever get it. I hope for your patient's sake that you do before someone is seriously injured. I don't know what you have experienced in your career that has made you the way you are but I suggest that you step back for a second, listen to the things you say, and then decide if this is how you want to be known professionally.

There are many things wrong with the health care system but the interaction between PTs and physicians is not even in the top 100. Please stop taking yourself so seriously.

Looks to me like you're a 3rd year medical student, you began medical school in 2010, or later? I understand your points, but feel free to write out in detail, "the point" with reasoning so maybe we can talk with some civility.

 

[oldmanriver]

Looks to me like you're a 3rd year medical student, you began medical school in 2010, or later? I understand your points, but feel free to write out in detail, "the point" with reasoning so maybe we can talk with some civility.

I guess your powers of deduction are as developed as your reasoning. The point is clearly stated in previous posts.

 

[Fiveoboy11]

I guess your powers of deduction are as developed as your reasoning. The point is clearly stated in previous posts.

You have said nothing that isn't obvious.

 

[truthseeker]

wow

 

[oldmanriver]

You have said nothing that isn't obvious.

Very classy. You do your profession a disservice every time you speak.

 

[oldmanriver]

You have said nothing that isn't obvious to a ******ed person.

Very classy. You do your profession a disservice every time you speak.

 

[Fiveoboy11]

I guess your powers of deduction are as developed as your reasoning. The point is clearly stated in previous posts.

Does this look classy to you? I invited civilized conversation and this is what you responded with. For the record I deleted the last part of my comment before I thought anyone had read it.

 

[fozzy40]

Because we all know the APTA is not about that at all!

 

[GTT4DPT]

Wow. What just happened? Imagining this conversation...

Attitude might have something to do with it.

You have said nothing that isn't obvious.

 

[truthseeker]

read back what 5-0 said. He accidentally wrecked his whole arguement.