Why do you keep giving us your resume?
Midlevel encroachment on PAIN
- Thread starter docsleeper
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Why do you keep giving us your resume?
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Yup. Might ask him to increase your clozapine. Axis II calling.
I'm highly trained in writing PT scripts. But if I had to choose between you and no PT....
At least your entertaining.
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Jesus Christ I'm tired of pointing out to uninformed people that they need to READ THE FREAKING IOM REPORT BEFORE THEY CITE THIS BS STATISTIC.
That "200k" number you are talking about was for ALL MEDICAL ERRORS, not just doctors' mistakes. That means nurses giving the wrong dose, "systems" errors, poor communication, sepsis from bedsores in hospitals, etc. Labeling all of that 200k as doctors' fault is a joke.
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Yeah I've heard this story before.... I also heard you got accepted to Harvard and Hopkins medical schools with full ride scholarships but you knew you couldnt join the "evil empire" physician profession so you opted for the job where you got to take more direct care of patients.
Yeah I've heard this story before.... I also heard you got accepted to Harvard and Hopkins medical schools with full ride scholarships but you knew you couldnt join the "evil empire" physician profession so you opted for the job where you got to take more direct care of patients.
No, it had nothing to do with PA...to be honest I wasn't even considering it at that point, and didn't even know what a PA was.
I went into the military for two reasons, one, because I was a broke fool. Also, I wanted to serve like my father had in Vietnam. It wasn't until the military that I met my first PA. Got out and still didn't know what I wanted to do....hell, I still don't. I sometimes think of going back into economics (labor econ), and then sometimes think of starting a company, or going to work as a carpenter...
But you are certainly free to interpret what I said however you would like.
I don't believe I have, I was commenting on why I think health care in the military works so much better, and gave my background for thinking so.
I was aware of the 17 states with "unlimited access." However, this document at least the wording makes it sound like a lot more states don't require a referral.
As I said, don't hate the player, hate the game. Why don't you blame the insurance companies as well?
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All kneel before Zod. I mean fiverboy. How did we ever get along before your excellence.
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Yes there are other states with direct access with restrictions. Insurance companies are definitely a joke. Medicare does not even recognize PT's as "providers." Insurance companies are so brilliant that they think lowering reimbursement more and more is some type of solution. The US has by far the greatest amount of healthcare cost per capita in the world, yet quality of the care is at about the 40th out of about 160 countries if I remember right. There's no reason why the US shouldn't be number one in rated healthcare.
Why do insurance companies not reimburse for physical therapy? You got me, it makes no sense whatsoever. PT's in australia, UK, new zealand, ireland, brazil, india, spain, norway, netherlands, finland, denmark, thailand, and many more are recognized by government reimbursed insurance. PT's in the US are by far the most educated.
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Whatever you say, lord god physician doctor lobelsteve, MD, DO, PT, DC, OT, SLP, AuD, OD, PharmD, etc.
Fiveoboy,
I consider myself MORE skilled at WRITING PT prescriptions, and DIRECTING a plan of care than many of the Physical Therapists I know.
I am sure that as a DPT with exceptional skills, you have seen a lot of "shake and bake" for back pain. And "Spinal Decompression". Both of which have been scientifically proven to be WORTHLESS. These waste resources.
I on the otherhand, pay attention to the mechanics of the spine, much the way I am sure YOU do. But since I don't lump all PTs together as hacks (like the shakers and bakers), please don't lump all physicians together either.
I would suspect that if you got off your high horse for a minute, and actually got to know some of the posters on this forum, you would find a bunch of HIGHLY SKILLED physicans who work in collaborative relationships with many physical therapists to provide excellent, efficient care to their patients with MSK disorders.
I consider myself MORE skilled at WRITING PT prescriptions, and DIRECTING a plan of care than many of the Physical Therapists I know.
I am sure that as a DPT with exceptional skills, you have seen a lot of "shake and bake" for back pain. And "Spinal Decompression". Both of which have been scientifically proven to be WORTHLESS. These waste resources.
I on the otherhand, pay attention to the mechanics of the spine, much the way I am sure YOU do. But since I don't lump all PTs together as hacks (like the shakers and bakers), please don't lump all physicians together either.
I would suspect that if you got off your high horse for a minute, and actually got to know some of the posters on this forum, you would find a bunch of HIGHLY SKILLED physicans who work in collaborative relationships with many physical therapists to provide excellent, efficient care to their patients with MSK disorders.
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Considering yourself something and reality are two different things. Personally, I find it exceedingly rare to receive a referral with helpful information written on it. Consider that frequency and duration, and specific interventions written on the referral are not helpful. You can believe otherwise all you want, it doesn't change what's real. PT's do this funny thing called an evaluation, and that determines the POC. Not your script, order or prescription. Probably based on the extremely poor education physician's recieve with regard to physical therapy. How much training do you have during a residency with a PT? Zero? But somehow it seems to me that physician's think they know what they're talking about. Fascinating.
Further, what percentage of physician's are PM&R? Less than 5%? What physician specialties do you think refer most to PT? My guess would be family medicine and internal medicine. What do you think the result of that is with regard to MSK issues?
Take a look at the annual medical expenditure for MSK issues in the US.
I'm sure there is highly skilled physicians, no doubt. The vast majority should be highly skilled at doing what they<< are trained to do. Sorry to say I see little if any "collaboration" among physician's and PT's. You guys think PT is something you order, prescribe, script, and oversee/direct. Where's the collaboration? It's a referral, and in many states it's clearly stated that physical therapists are in charge of directing PT in the PT practice act. Too bad many physicians are either ignorant of this or think they're above the law.
I will concede that there are many PT's who are hacks, and in my experience it's the ones who are "old school" and BSPT's, from the perspective of EBP. Keep in mind as well that the vast majority of physician's are incompetent when it comes to PT. The reason is obvious (to me anyway), they're not PT's, and this is reflected in research and money expenditures. Compare the care people recieve, and percent of GDP spent in the US vs a country with direct access to PT's.
From your standpoint, you should be making no complaints about PT's who are "hacks." Why should someone make effort to be the best they can and learn more when some brainwashed physician thinks they can write garbage on a script as PT's are orderlies. What's the incentive? It's hard to have high moral and motivation considering all the BS. The lack of skill and knowledge among some PT's is the blame of politics, insurance companies, and brainwashed BS more than anything if you ask me.
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In reality, most of us docs don't care what you do with the patient, because there is no one set of exercises, modalities or other PT treatments that have been scientifically proven as better than the others. Every PT always thinks their set of protocols is proven. Few have good studies to back them up.
What we want is someone who will get the patient more mobile with less pain than when they came to us. Feel free to apply all you know to accomplish that. Current laws in many states require a doctor's Rx for PT. so we write it.
We don't read your full initial or progress notes, any more than we read a consulting doctor's full note. We go to the bottom to see what your plan is, and sign off, because the law or your facility asks us to sign off. We know you all look at our orders, laugh, and then do what you feel is the right thing to do despite what we think should be done.
If the patient gets better, wonderful. If they didn't, we review what was done and see if there's something different that can be done.
In my clinic, it's works well that we have PT on site, along with established protocols for many diagnoses. Otherwise, we trust the therapists to apply their expertise and training. We do collaborate often. We talk or send notes electronically.
This is the reality and many docs fool themselves into thinking they are "overseeing" PT. We just recommend it.
However, when PTs start trying to do other things, new things, it raises our eyebrows. PTs doing needle EMGs, e.g. We will never trust even a DPT to do them correctly.
What we want is someone who will get the patient more mobile with less pain than when they came to us. Feel free to apply all you know to accomplish that. Current laws in many states require a doctor's Rx for PT. so we write it.
We don't read your full initial or progress notes, any more than we read a consulting doctor's full note. We go to the bottom to see what your plan is, and sign off, because the law or your facility asks us to sign off. We know you all look at our orders, laugh, and then do what you feel is the right thing to do despite what we think should be done.
If the patient gets better, wonderful. If they didn't, we review what was done and see if there's something different that can be done.
In my clinic, it's works well that we have PT on site, along with established protocols for many diagnoses. Otherwise, we trust the therapists to apply their expertise and training. We do collaborate often. We talk or send notes electronically.
This is the reality and many docs fool themselves into thinking they are "overseeing" PT. We just recommend it.
However, when PTs start trying to do other things, new things, it raises our eyebrows. PTs doing needle EMGs, e.g. We will never trust even a DPT to do them correctly.
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In reality, most of us docs don't care what you do with the patient, because there is no one set of exercises, modalities or other PT treatments that have been scientifically proven as better than the others.
This is not the case. At all. I concede that there are a fair amount of PT's who are not keeping up with the evidence. FYI there are clinical practice guidelines that are being rapidly developed by the ortho section of the APTA, all of which I personally follow. There are lots and lots of guidelines and evidence for certain conditions receiving certain interventions. If you want you can give me a particular diagnosis and I'll give you what I know in terms of practice guidelines.
Every PT always thinks their set of protocols is proven. Few have good studies to back them up.
What we want is someone who will get the patient more mobile with less pain than when they came to us. Feel free to apply all you know to accomplish that. Current laws in many states require a doctor's Rx for PT. so we write it.
Fair enough, there are many that don't as well. In the majority of cases the physician referall, OR PA/NP is for insurance purposes, not state law purposes. There's over 40 states that do not require a referral, 47 if I remember right. I have no problem whatsoever with a physician referral, I have a big probelm with orders, scripts, etc. Semantics yes, but it makes a huge difference. A little respect across the board goes a long way.
We don't read your full initial or progress notes, any more than we read a consulting doctor's full note. We go to the bottom to see what your plan is, and sign off, because the law or your facility asks us to sign off. We know you all look at our orders, laugh, and then do what you feel is the right thing to do despite what we think should be done.
Not the law, insurance guidelines do. We're required by law to forward the eval and f/u info to you, not get your approval. Minus 3 states if I remember right.
If the patient gets better, wonderful. If they didn't, we review what was done and see if there's something different that can be done.
In my clinic, it's works well that we have PT on site, along with established protocols for many diagnoses. Otherwise, we trust the therapists to apply their expertise and training. We do collaborate often. We talk or send notes electronically.
, I'm impressed
This is the reality and many docs fool themselves into thinking they are "overseeing" PT. We just recommend it.
However, when PTs start trying to do other things, new things, it raises our eyebrows. PTs doing needle EMGs, e.g. We will never trust even a DPT to do them correctly.
I have to disagree with you here as I feel it's unfounded. Overall your post was nice to read. At least it had some reasoning based in reality.
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You act like our are gods gift to the forum and your narcissism. Makes you feel helpful for posting worthless drivel. This is a physician forum for PMR docs and I for one pity you. Your loss of reality testing is evident in your inability to operate in the appropriate social context of the forums. Best of luck doing what you do in Arizona. Please keep it that way.
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I guess I should go back to the lowly PT forum with your other servants...
My job is not to suckle up to you in the healthcare arena, nor is it on this forum. This thread is about another profession encroaching on pain management physician's scope of practice. My relevance here is that I'm a PT, and my argument is that physician's encroach on PT's scope of practice all day long. Thus the hippocracy that you don't see, acklowledge or understand with sound reasoning. So, if you're too dense to comprehend that then I don't know what else to say. By the way, eat my shorts.
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Not that you asked for it, but my opinion is that if you're in a position to do so, you should make an effort to go to medical school.
You are a troll, pure and simple. You post inflammatory things and refuse to see that the physican's "encroachment" on PT is miniscule with the exception of needing a physician's RX to get paid from insurers.
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I remember in the 5th year of med school, as an OMM fellow, already with training that far surpasses what any PT, PA, or NP has (I had not even started internship, residency, or fellowship yet, that would be another 5 years more), I though I was god's gift to MSK care.
I did not know what I did not know. The PA and PT posting here are in that boat. They exhibit the classical signs of insecurity and have the potential to be dangerous as providers, exhibiting that they "do not know what they do not know".
I work closely and positively with the PTs, PAs, and NPs at my hospital. Most of them do a great job. The best one's know their limitations, just as I know mine. The worst one's think they know it all and no one can tell them anything. Interestingly, their pts do the worst b/c they are such egomaniacs that they cannot even see their own failings, don't refer the pts to who they need, etc.
I have no problem walking down the hall to the ortho PA and say "you look at a lot more ankle films than I do, what do you think?", just as they bring most spine imaging to me for review.
I did not know what I did not know. The PA and PT posting here are in that boat. They exhibit the classical signs of insecurity and have the potential to be dangerous as providers, exhibiting that they "do not know what they do not know".
I work closely and positively with the PTs, PAs, and NPs at my hospital. Most of them do a great job. The best one's know their limitations, just as I know mine. The worst one's think they know it all and no one can tell them anything. Interestingly, their pts do the worst b/c they are such egomaniacs that they cannot even see their own failings, don't refer the pts to who they need, etc.
I have no problem walking down the hall to the ortho PA and say "you look at a lot more ankle films than I do, what do you think?", just as they bring most spine imaging to me for review.
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Medical students have nowhere near the level of knowledge that the average PT has, let alone PT's with further training in MSK. Check the evidence. Your commentary here is baseless and projected nonsense. There's studies showing PT's have better diagnostic accuracy than ortho surgical residents (PT, PhD and PT, FAAOMPT) and non significant difference compared to ortho surgeons. Another study has been done showing PT's are better diagnostically than non MSK physicians and not significantly worse than orthopods. I'll await your dismisal and reasoning how your training in your 5th year of medical school was superior to an ortho surgeons.
Perhaps you are as great as you think, and you are god's gift to MSK, but perhaps you are not...even now.
By the way, I'm aware you've been brainwashed not to respect PT's your whole career, but please do not group PT's with PA's and NP's. We do not practice medicine "under your supervision" nor do we want to. PT's are PT's, PT's are not PTA's.
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Post your 'evidence' with links to full text articles, I would be interested to read these and evaluate the quality.
You, again, "do not know what you do not know" and apparently have little insight into osteopathic medical school or pre-doctoral manual med fellowships that they offer. I have never met a PT who had any hands on skills in terms of SMT that were even close to a DO who have done a OMM fellowship, although I have been impressed with some chiros. The PT at my hospital who is considered the 'guru' in my part of the state in terms of spine and SMT has caveman level SMT skills compared with my training. They knew the basics and the most common patterns and the most basic techniques. They were of course impressed with their own skills, as you appear to be.
I am not knocking PTs, they have a role and many do it well. If you are arguing that pt's with shoulder pain would be better of with a PT vs ortho or PMR in all cases, you are incorrect. I cannot even keep track of how many referrals I have seen where PT dx: "x" and it was clear to me it was "y" w/in 5 min.
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here's the 'evidence', where's yours?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953315/ (full text)
http://www.ncbi.nlm.nih.gov/pubmed/15773564 (abstract -- i have the full text on order from my alma matter and I'll post it when i get it)
Clearly "you don't know what you don't know"
I've seen numerous patients with diagnoses that clearly were not correct as I'm sure you have from PT's. I'm sorry but at your fellowship level in 5th year of DO school nowhere comes close to PT's such as Stanley Paris, Ola Grimsby, James Dunning, John Childs, Tim Flynn, and many many more. Perhaps you should advocate for a OMM fellow (5th year med student) vs an FAAOMPT trained PT study for common MSK diagnoses that are amenable to manual therapy and exercise. Then we'll see who's superior. LOL.
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http://jbjs.org/article.aspx?articleid=488998 (med students vs PA students)
Posted by facet guy on another forum topic
"Since we are on the topic of musculoskeletal knowledge/education among medical students, I thought these might be of interest:
http://www.ncbi.nlm.nih.gov/pubmed/9...ubmed_RVDocSum
Gave a standardized MSK quiz to recent med school grads.
82% failed.
Published in J Bone Joint Surg.
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum
Same authors did follow-up a few years later.
78% failed. (A trend toward improvement, no doubt.)
Published in J Bone Joint Surg.
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum
Gave MSK quiz to med students, residents and staff physicians.
79% failed.
Published in J Bone Joint Surg.
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum
Modified version of MSK quiz given to students at Univ of Washington (not a bad school, if I'm not mistaken).
4th year students did better than 'younger' students.
Still, less than 50% of 4th years "showed competency" (I'm guessing that means failed).
Published in Clin Ortho Relat Res.
(I won't mention the study of what happened when chiro students were given the same test. Oh, heck, why not...)
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum
Not perfect, but way better."
Posted by facet guy on another forum topic
"Since we are on the topic of musculoskeletal knowledge/education among medical students, I thought these might be of interest:
http://www.ncbi.nlm.nih.gov/pubmed/9...ubmed_RVDocSum
Gave a standardized MSK quiz to recent med school grads.
82% failed.
Published in J Bone Joint Surg.
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum
Same authors did follow-up a few years later.
78% failed. (A trend toward improvement, no doubt.)
Published in J Bone Joint Surg.
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum
Gave MSK quiz to med students, residents and staff physicians.
79% failed.
Published in J Bone Joint Surg.
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum
Modified version of MSK quiz given to students at Univ of Washington (not a bad school, if I'm not mistaken).
4th year students did better than 'younger' students.
Still, less than 50% of 4th years "showed competency" (I'm guessing that means failed).
Published in Clin Ortho Relat Res.
(I won't mention the study of what happened when chiro students were given the same test. Oh, heck, why not...)
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum
Not perfect, but way better."
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here's another
http://www.biomedcentral.com/1471-2474/6/32 (see figure 1)
Why don't you post some evidence that supports your BS?
http://www.biomedcentral.com/1471-2474/6/32 (see figure 1)
Why don't you post some evidence that supports your BS?
Nobody here is questioning the MSK knowledge of "most" medical students and physians. But you are arguing with a bunch of physians who, like you, practice MSK medicine EVERY DAY. We are the people who scored well on those exams.
And I am done arguing with the troll. Now on ignore.
And I am done arguing with the troll. Now on ignore.
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Exactly, he wants to compare his field (which does only MSK) to the non-MSK trained in the medical field. How about, if we are going to make this a competition, the med students get to compete on pharmacology, etc? In all seriousness, I do not see a single study there that compares PTs to PMR, or even D.O.'s. I would expect a PT to know shoulder exam's better than a MD med student who has no interest or few MSK rotations. That same med student may rock it in general surgery though and it certainly more well rounded in medical care in general.
I do appreciate posting the articles, though not the wacky commentary attached
I am curious how much training PTs get in reading MRIs? I mean, w/o a rad report, can they look at a spine, shoulder, or hip MRI images and read it as well or better than a radiologist, as a PMR doc for example would be expected. Can they interpret EMG/NCS and other essential MSK/neuro testing? Can they identify and work up with appropriate lab tests rheum disease that may mimic more common MSK issues? Serious questions
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PT's do not receive much on reading MRI's and x-rays although we are exposed to it. What we are skilled at is utilizing the imaging report in addition to the other examination findings to determine the POC, AND PT's know when a x-ray or MRI is indicated or can be beneficial in determining POC or referral. I highly doubt a PM&R physician would approach a radiologist in reading MSK x-rays or MRI's.
PT's with an ECS credential can interpret EMG/NCS tests, PT's without this additional training can not. PT's are not allowed to order lab tests but we are aware of screening questions and S/S that mimick MSK and thus know when to refer.
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A troll is someone who remarks to instigate an argument. You guys are inflammatory just as much as I am, beginning with the OP's thread topic.
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I think you are right on. My next venture will be teaming up with lawyers in their attempts to sue para medical professionals -aka midlevels. Can you imagine the headlines? Where you treated by an *NP/PA/CRNA* -where you not given the option of a dr? Then call me! I will fight for you! Lol. I can see this happening. I am personally very annoyed by midlevels who have little community college/online courses and think they know everything bc an MD/DO gives them orders and they carry them out. Such a sad state of our medical profession.
I also a very frustrated by this 2 tiered system we have. We should probably take a number of things to the supreme court and say hey-do you want drs practicing or midlevels? We should not have both. But this is my opinion.
Fiveoboy11,
You obviously have strong feelings and opinions on several issues mentioned on this thread. Have you done any work in advocacy and policy with the APTA? Any teaching opportunities at medical schools?
fozzy40
You obviously have strong feelings and opinions on several issues mentioned on this thread. Have you done any work in advocacy and policy with the APTA? Any teaching opportunities at medical schools?
fozzy40
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Ok, sorry folks, this is so much fun that I find it hard to stop, I will quit feeding the troll after this.
Dude (or dudess), thank you for confirming that you 'do not know what you do not know'. Any true MSK clinician knows that a radiology report is usually not worth the paper it is written on, esp. when it comes to spine/MSK. I frequently call our rad to point out things they missed as do my PMR and ortho partners. The PAs in our group do not have as much confidence and need to rely on us or rads for MRI. based on your info, and confirming my experience, PTs also do have have this skill. (although nice try dancing around the answer).
There is no way you can claim to be MSK competent as a physician/complete clinician and not know your way around an MRI image (not report). This is a high yield example of separating the big leagues from the little leagues.
It is RARE that the rads finds the symptomatic MSK/spine pathology, of course, I count on them to notice the liver cyst or kidney cyst on a spine MRI while I focus on the discs and facet joints, etc. We work together and have mutual respect. We discuss cases and know our limits. I have saved their asses more than once on misses, and they help me out too. So yes, it is normal and expected that a MSK clinician needs to be able to read an MRI better than rads when that MRI has to do with your area of expertise. Of course, if there is any doubt, I can always look at their cuff tendons with MSK US, but I'm sure you have training in that too.
You can keep your superiority in PE of a shoulder vs. a allopathic med student, I will give you that one. However, that med student knows thousands of other things you do not...and a 5th year DO OMM fellow will rock your world hombre, as I said the 'manual med certfied' PT at my hospital knows v. little on that topic compared to a OMM fellow or chiro.
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You're just like a politician, twisting things around left and right. READ THE ARTICLES AND MY POSTS AGAIN. I'll let the best PT's around the world to bow down to your greatness and follow your lame excuse for physical therapy knowledge as you apply it onto your scripts.
Arrogant dick.
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I'm a member of the APTA and ortho/geriatrics sections, and sitting for the OCS this year, but not much beyond that. Thought about applying to a full time job with the APTA earlier this year but I'd have to move across country to do so, so not going to happen. I'm very interested in teaching at a PT school someday, but I'm afraid I have too much of a grudge to embrace medical students and try to teach them something about physical therapy. Seems to me that physician's and medical students/pre med have this innate "i'm better than you" arrogance ingrained within them. I don't care to be around that.
Where was I inflammatory?...I merely stated that WITH SIGNIFICANT extra training that PAs can manage some spine patients on their own and perform some injections...
I never stated that PAs should practice completely independently, nor did I ever suggest that physicians weren't needed....
You are putting words in my mouth.
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Are you out of your mind? I know of NO ONE among my colleagues encroaching on your scope of practice. This is an inflammatory, exaggerated, broad brush stroke on us MSK PHYSICIANS, who have no desire to bill your codes or whatever nonsense you are talking about. Stay out of our PHYSICIAN forum.
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I'll stay in here and argue with you guys as long as I want, get over that you're a msk physician for a change. Here's a reference for you demonstrating how physician's bill for physical therapy to medicare. It doesn't matter if you've seen something. Have you seen a million dollars? (oh wait, bad example for this group).
http://oig.hhs.gov/oei/reports/oei-09-02-00200.pdf
This analysis shows that in 2004 only, physician's billed for over 500 million dollars in medicare claims for physical therapy.
2002 physician physical therapy claims: 353 million dollars
2003: ?
2004: 509 million dollars
The total medicare expenditure for 2004 was 297 billion.
Any legitimate comments to explain this? Obviously many of you guys are uninformed with your "I haven't seen that so get out of here, you're not a MSK PHYSICIAN", and "you don't know what you don't know", "we don't practice physical therapy" (but you bill for it), and we prescribe physical therapy but we don't practice it.
Check the evidence and know what YOU're talking about.
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Well then, I guess then you're preaching to the choir. Take your contempt and vitriol elsewhere. Your comments (ranting) come across as angry, and there's been no constructive discussion here, just a one sided temper tantrum. Good luck in your cause.
Thanks for the study.
I do agree that it's wrong for anyone but physical therapists to identify their practice as physical therapists and bill, which is the target of this paper.
That being said, these are the points/questions I took away from it:
1) N = 51 (likely POPTs or something to that effect)...not sure what kind of conclusions you can draw from this.
2) Only 2 of the physicians sampled here are PM&R practices. The rest seem to be PCP practices. Perhaps they maybe more of a problem prescribing PT inappropriately. It's interesting that of a random sample that there are no neurologists, orthopedic surgeons, rheumatologists, or orthopedic surgeons.
3) It's an interesting assertion that if physical therapy TRULY had direct access that medicare billing (or any other carrier) might be less. I find that hard to believe but maybe you have some studies from other countries that have a similar healthcare system.
4) If there truly is abuse (which there is any field), has their been any physical therapist movements where they refused to treat patients that they deemed inappropriate? I usually hear therapists requesting more therapy versus they were given too many visits. Has anyone else heard different?
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If the patient has private insurance with no therapy limits, I commonly see patients who have done 6 months or more of 3x/week therapy. When you read the notes you usually see it consisting of hot packs, US and massage, traction, "soft-tissue mobilization" and then 15 minutes on the seated bike. Lots of money being generated for the PT practice, patient not significantly better.
I had one patient get turned down for PT not too long ago. The therapist stated that the patient does not have any functional deficits to correct. The patient reported to me the therapist said "Your only problem is that you are fat." I sent him elsewhere and he is doing better.
The only other patients I see get turned down by PTs are those with Medicaid. The only places around here that take these patients are the hospitals.
(Stands back and waits for the "Yeah? Well doctors abuse insurance, too!")
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Everybody probably abuses insurance at some time whether intentional or unintentional. I have probably broken rules before and not realized it. But five hundred million dollars of wasted money. Everyone seems to think PT is easy and that just about anyone can do it, it isn't. All that money was wasted, think about what could've been done with it to provide better care to patient's. How about funding pro bono services for PT for the patient's you mention above, how many episodes of care could that pay for as provided by a PT. 500,000?
PT episodes of care would likely be drastically reduced in my opinion if we got rid of this frequency and duration garbage. It is arbitrary.
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I know of many instances where PT's refused to treat a patient because they felt it was inapprorpiate. Keep in mind that there is numerous cases where PT's receive scripts that say to continue that we don't agree with. Also keep in mind that a PT's job is in jeapordy if we disagree with a "script" because instantaneously that referral source may be lost and the ownership doesn't like that. Thus pressure to follow arbitrary scripts. It is the physical therapists job to determine when to continue physical therapy. Is it relevant to you if a PT disagrees with your decision to continue opiods or injections?
I would like to see some published evidence cited for some of the commentary and arguments I've heard throughout this thread. People keep asking me for evidence, how about you guys show me some.
after previously saying this "A troll is someone who remarks to instigate an argument."
ummmm...............
and can you take the boldface off? its not like your pointles ramblings all of a sudden have meaning when they are in a darker font.
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I'll stop using bold when you guys stop trying to big time me with your MSK PHYSICIAN all caps. It's unfortunate that you find my posts to be pointless ramblings but no surprise since I find yours to be the same.
I guess I'll take it as a compliment since know therapist to date has neither refused to treat my patients or see them less than the visits prescribed.
We all have pressures. If you (and others) feel this strongly on this forum, then shouldn't PTs in that position advocate for more efficient therapy scripts/visits in daily practice as well? No one is putting a gun to your head and ultimately it's your ethical decision to make to practice how you want to practice.
What points need evidence again? I've lost track...haha
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I guess I'll take it as a compliment since know therapist to date has neither refused to treat my patients or see them less than the visits prescribed.
Well that's good I guess, hopefully they actually agree with your requests
We all have pressures. If you (and others) feel this strongly on this forum, then shouldn't PTs in that position advocate for more efficient therapy scripts/visits in daily practice as well? No one is putting a gun to your head and ultimately it's your ethical decision to make to practice how you want to practice.
PT's are training to gain full autonomy so we don't need a script. What's wrong with you referring someone with your report vs with a script? It's antiquated
What points need evidence again? I've lost track...haha
Find me evidence that shows:
PT's are wannabes (show me evidence that a significant amount of PT students/PT's are those who were rejected from medical school or that PT's think they are physician's or want to be)
physician script writing does anything to help the patient, improve outcomes, or lessen chance of ill effects or lessen costs
PT's are incompetent in manual skills
PT's lack knowledge in non MSK screening
physician's do not have a high prevalence of personality disorders, especially vs other professions
Physician's have training in physical therapy
Support for US healthcare system in terms of MSK outcomes and cost vs other countries with direct access to PT
That ought to do for now
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This post has been very informative. I had no idea physicians could bill for PT. I will now begin to bill for PT in my office. Thanks guys!
#1 I'm not sure anyone said this and I don't think there are any studies on this.
#2 Again, I don't think that a single person here thinks that PTs actually pay attention to our scripts with the exception of precautions. I know that PT is independently in the military and many other countries. However, comparing our health care system against any other country's is likely apples to oranges. This is the system we are in. It's not perfect and in many states a physician directed script is required by many payors. So, that being said, a physician directed script is effective and improves outcome for patients if it means no therapy at all.
See #1
The Childs' is the main study that shows that OCS certified PTs score higher than "orthopedists and staff physicians." However, if we go by the logic that whoever "scores higher" should treat musculoskeletal conditions "best" then that still leaves it to "orthopedists and staff physicians." I don't think that's best either though.
See #2
Support for US healthcare system in terms of MSK outcomes and cost vs other countries with direct access to PT
See #2
