The JockDoc

lighting up the court
15+ Year Member
Nov 16, 2003
298
2
Status
Attending Physician
As long as they don't masquerade as docs, they can say whatever they want. Docs will still have a far better end product than the pts can deliver. Its up to docs to market their businesses and it should be an easier task if you have a better product.
 

truthseeker

Senior Member
10+ Year Member
Sep 2, 2004
1,001
311
Status
As long as they don't masquerade as docs, they can say whatever they want. Docs will still have a far better end product than the pts can deliver. Its up to docs to market their businesses and it should be an easier task if you have a better product.
It really depends upon the type of patient now, doesn't it. I wouldn't want a physiatrist doing my ACL reconstruction or rotator cuff rehab, I would want a good PT. I think there is a bit of territorialism here. PTs don't try to put themselves over as physicians. Why does that keep coming up?

Now, having a physiatrist oversee and coordinate the medical and rehab care of a multi-disciplinary team is where the doc is by far the better provider.

Really, what is it that physiatrist do that PTs don't? Well, there is medication prescription and management, ordering and interpreting labs, systemic medical diagnosis, in some cases a better working knowledge of OT and Speech than the PT, ordering and interpreting imaging. Rather than try to knock down other professions, do what you do better than anyone else.

Discuss.
 

The JockDoc

lighting up the court
15+ Year Member
Nov 16, 2003
298
2
Status
Attending Physician
It really depends upon the type of patient now, doesn't it. I wouldn't want a physiatrist doing my ACL reconstruction or rotator cuff rehab, I would want a good PT. I think there is a bit of territorialism here. PTs don't try to put themselves over as physicians. Why does that keep coming up?

Discuss.
so the link in question says " Therapists are the experts in treating a wide range of people with neurological and orthopedic conditions, impairments or injuries that may not only be painful but prevent them from doing the things they want to do. Someone once wrote that “Physicians put life back into the patient but Physical Therapists put the living back into life.”

If you have a condition that limits your ability to walk, move about, participate in recreational activities, work, go to the grocery store, develop a fitness program or just about anything else you might want to do, then a Physical Therapist is what you need.
"

That essentially covers a lot of what a doc - especially a physiatrist - would be in the best position to care of in very broad, sweeping generalizations. They may not call themselves docs, but i think that there are plenty of "neurological or orthopedic conditions" that patients should see a doc for first, and then perhaps PT as an adjunct to treatment.
 

truthseeker

Senior Member
10+ Year Member
Sep 2, 2004
1,001
311
Status
so the link in question says " Therapists are the experts in treating a wide range of people with neurological and orthopedic conditions, impairments or injuries that may not only be painful but prevent them from doing the things they want to do. Someone once wrote that "Physicians put life back into the patient but Physical Therapists put the living back into life."

If you have a condition that limits your ability to walk, move about, participate in recreational activities, work, go to the grocery store, develop a fitness program or just about anything else you might want to do, then a Physical Therapist is what you need.
"

That essentially covers a lot of what a doc - especially a physiatrist - would be in the best position to care of in very broad, sweeping generalizations. They may not call themselves docs, but i think that there are plenty of "neurological or orthopedic conditions" that patients should see a doc for first, and then perhaps PT as an adjunct to treatment.
True, but many times the referral doesn't happen unless the patient asks for it. No matter what happens with direct access for PT, the vast vast majority of referrals will come from physicians. I understand the difficulty of defining what PMand R docs do, because it is very similar to what PTs do (obviously just the physical stuff, MD/DOs do some things that are well outside PT scope of practice) However, in most areas, where PM and R has no presence, the PT is the professional that best deals with many of the things that they referenced in their advertisement.

Really, do you order MRI for every case of LBP? Of course not. you say to them, yup, you have low back pain. Go see the PT. Great, thanks for the referral, but we can do the same screening you can except without the imaging. There was a study a couple years ago where they compared the difference between FP, ortho, and PTs in what imaging they ordered (it was a military study) and the PT and orthos were nearly the same, both better than the FP. If we see something that doesn't fit, off they go to you.

Small town Minnesota, 5500 people, 9 family practice docs, two NPs, one orthopedist day per week, and 6 chiros. The three PTs are best suited to do the day to day management of most ortho cases. The Neuro cases always need a doc to manage, but many ortho cases don't. (mechanical LBP, neck pain, tennis elbow, patello-femoral syndrome, etc . . . ) If they don't fit the normal pattern or if they don't make progress as expected, they get referred anyway. I don't see how the involvement of a physiatrist in the treatment of a hamstring strain enhances the product. It is just one more step that the patient gets billed for. So, they skip it and go the the chiro and get their ultrasound, their back cracked and rack up 3 weeks worth of bills for worthless treatment that didn't have anything to do with their recovery.

I am in no way trying to say that I can do all that you do, I cannot.
But the things that you do in my area of expertise (unless you are a former athletic trainer or PT) I do much better (usually). If we stay in our scope of practice and refer out when the patient reaches the fringes of our scope, we PTs have a good track record of doing the right thing.
 

specepic

10+ Year Member
Feb 2, 2008
1,751
243
New England
Status
Attending Physician
True, but many times the referral doesn't happen unless the patient asks for it. No matter what happens with direct access for PT, the vast vast majority of referrals will come from physicians. I understand the difficulty of defining what PMand R docs do, because it is very similar to what PTs do (obviously just the physical stuff, MD/DOs do some things that are well outside PT scope of practice) However, in most areas, where PM and R has no presence, the PT is the professional that best deals with many of the things that they referenced in their advertisement.

Really, do you order MRI for every case of LBP? Of course not. you say to them, yup, you have low back pain. Go see the PT. Great, thanks for the referral, but we can do the same screening you can except without the imaging. There was a study a couple years ago where they compared the difference between FP, ortho, and PTs in what imaging they ordered (it was a military study) and the PT and orthos were nearly the same, both better than the FP. If we see something that doesn't fit, off they go to you.

Small town Minnesota, 5500 people, 9 family practice docs, two NPs, one orthopedist day per week, and 6 chiros. The three PTs are best suited to do the day to day management of most ortho cases. The Neuro cases always need a doc to manage, but many ortho cases don't. (mechanical LBP, neck pain, tennis elbow, patello-femoral syndrome, etc . . . ) If they don't fit the normal pattern or if they don't make progress as expected, they get referred anyway. I don't see how the involvement of a physiatrist in the treatment of a hamstring strain enhances the product. It is just one more step that the patient gets billed for. So, they skip it and go the the chiro and get their ultrasound, their back cracked and rack up 3 weeks worth of bills for worthless treatment that didn't have anything to do with their recovery.

I am in no way trying to say that I can do all that you do, I cannot.
But the things that you do in my area of expertise (unless you are a former athletic trainer or PT) I do much better (usually). If we stay in our scope of practice and refer out when the patient reaches the fringes of our scope, we PTs have a good track record of doing the right thing.

I think the key phrase here is 'manage' vs. evaluate. I'm only a resident, but I've seen a high percentage of pts in my cont. clinic who were 'managed' to death (not literally) :hardy: for lets say 'shoulder pain' by a PT for months, we see them and its clear its a radic. and that cuff program they were doing wasn't the ticket. I'm not slamming PTs, they know a ton of PT management programs in and out and better than me; what I am saying if there is no substitute for many years of training involved in getting your MD/DO and boarded in PM&R.

I think what people are taking issue with is PT asserting itself as the primary evaluators and substiting that for a speciality physician eval of an issue. Now, if the FP/IM has a clear diagnosis and is ready to procede directly to management and PT, then fine, why waste the resources on a PM&R or Orhto consult unless the pt doesn't improve?
 

truthseeker

Senior Member
10+ Year Member
Sep 2, 2004
1,001
311
Status
I understand that some PTs treat the shoulder pain for two months when it is really a radiculopathy. The thing is, there are plenty of MDs to miss that stuff too. Face it, there are residents in your residency class that you wouldn't want to evaluate your shoulder. There were people in my PT class who couldn't solve their way out of a paper bag, but they never got less than an A in any class in their life by simple brute force studying.

I don't believe that just because of a particular degree (PT vs ATC is a great example) you are better at a skill than the other profession when that particular skill falls within the scope of both professions. There are phenomenal pediatricians and there are the mediocre ones. There are superstar orthos and there are those that are not. Same with PT and PM&R. I submit that the PT that treated your shoulder patient was "not".

The many years of training are fantastic for learning a breadth of knowledge. Not neccesarily depth of knowledge. For example, I would bet that I took more anatomy than you did. You took biochem classes, I didn't. We both took physiology, mine was basic for the human physiology part, but much more in depth in the exercise physiology. In your medical rotations and residency, you have to use the basic physiology (and when I say that I don't mean simple, I just mean the non-exercise stuff) more. We probably took the same undergraduate classes. Your professional program is 2 years of classes, 2 years of rotations, and 3(?) years of residency. (correct me if I have this wrong) PT school is 3 years with one of that being clinicals. Your professional training covered assessment of seizures, dermatological disease, GI function, Liver function, mine barely touched upon that stuff. The classes that we took on those systems said basically this is how it is supposed to work, these are gross signs of system failure/disease and if you see these things, refer. Probably similar depth that medical school went into orthopedics.

What I am trying to say is, our professional training scope was limited. We can do what we do very well and recognize "other".
 

ampaphb

Interventional Spine
10+ Year Member
May 13, 2007
4,352
723
New Orleans, LA
Status
Attending Physician
It really depends upon the type of patient now, doesn't it. I wouldn't want a physiatrist doing my ACL reconstruction or rotator cuff rehab, I would want a good PT.

What I would want is a good PT following a plan of care established either by the arthroscopist who performed the surgery, or the fellowship-trained sports medicine MD who works with him.

I think there is a bit of territorialism here. PTs don't try to put themselves over as physicians. Why does that keep coming up?

It comes up precisely because DPTs want to be able to introduce themselves to patients as Doctor (your last name here), and blur the scope of practice lines.

As for teritorialism? It was the PTs of South Carolina who started that battle with their push for legislation which has prohibited physician ownership of physical therapy practices.
.
 

truthseeker

Senior Member
10+ Year Member
Sep 2, 2004
1,001
311
Status
Right, if you want your arthroscopist (whatever that is) to develop your rehab plan, you will be unhappy with the outcome. Surgeons do surgery, rehab specialists do rehab.

Physician owned physical therapy practice is as unethical as a physician owned imaging center. Too easy for physicians to line their pockets. "yes, mrs. Jones, you have LBP, I think you should get an MRI. No, not over there, right here in our MRI, it will be so much more convenient, and I know the quality of our MRI, its the best."

insert PT for MRI and you get my drift.

wow, the God complex is alive.

Furthermore, I have a DPT and would never think of introducing myself as dr anything for just the reason you stated, blurring the distinction between medical doctors and doctors of other persuasions. In fact, I have never met a DPT who introduced themselves as doctor, only PhDs which people don't seem to have a problem with. I just don't see it.
 

PMR 4 MSK

Large Member
10+ Year Member
5+ Year Member
Oct 1, 2007
4,182
30
Status
Attending Physician
Physician owned physical therapy practice is as unethical as a physician owned imaging center. Too easy for physicians to line their pockets.
...

In fact, I have never met a DPT who introduced themselves as doctor, only PhDs which people don't seem to have a problem with. I just don't see it.
Gotta jump in here.

So as a DPT, you will not want to have direct patient access (sans MD referral) as this could tempt you into "lining your pocket." Good thing Chiro's don't do this, huh? Direct patient access has never led to over-utilization on their part. Yep, only MD's. DPT's could never be party to such an abomination...

You will not employ other PT's, as you might make a profit off them. Might "line your pockets."

You will not employ most modalities in your practice, as the benefit to the patient is so limited in duration and questionable in efficacy as to not effectively justify their costs, i.e. your reimbursement that will "line your pockets."

You don't want to be employed by a doctor? Fine, make your own practice, recruit referrals or direct-patient access, whatever. But for those PT's who enjoy the multi-disciplinary approach and work well with docs, why screw them?

Basically, you're saying doctors should be completely outside of any possible financial motive for patient care. You'll really enjoy socialized medicine then. Until you learn that it won't pay you either.
...

We have a DPT here in town. All the patients know him as Dr. Green. Many think he's a physician.
 

Triathlon

Senior Member
10+ Year Member
5+ Year Member
Dec 19, 2005
129
1
Status
Resident [Any Field]
I must also jump in and state a very important and obvious yet not mentioned here. Differential diagnosis. We didn't go through 4 years of medical school and endure an internship for nothing. We have the training to recognize other medical problems that can contribute to or cause musculoskeletal symptoms. And that is where PT comes in after we decide that is what the patient needs vs. cardiologist or surgeon or internist etc. Anyway it doesn't and won't matter because there is that little thing called reality that will keep things in order. Enjoy. I assume this has been mentioned before in other threads but I am not interested enough to read any of them. Night shift in the ER is slow tonight but not that slow.
 

truthseeker

Senior Member
10+ Year Member
Sep 2, 2004
1,001
311
Status
Gotta jump in here.

So as a DPT, you will not want to have direct patient access (sans MD referral) as this could tempt you into "lining your pocket." Good thing Chiro's don't do this, huh? Direct patient access has never led to over-utilization on their part. Yep, only MD's. DPT's could never be party to such an abomination...

You will not employ other PT's, as you might make a profit off them. Might "line your pockets."

You will not employ most modalities in your practice, as the benefit to the patient is so limited in duration and questionable in efficacy as to not effectively justify their costs, i.e. your reimbursement that will "line your pockets."

You don't want to be employed by a doctor? Fine, make your own practice, recruit referrals or direct-patient access, whatever. But for those PT's who enjoy the multi-disciplinary approach and work well with docs, why screw them?

Basically, you're saying doctors should be completely outside of any possible financial motive for patient care. You'll really enjoy socialized medicine then. Until you learn that it won't pay you either.
...

We have a DPT here in town. All the patients know him as Dr. Green. Many think he's a physician.
Respectfully, the difference is that the docs have a bit more control over what the patient does. If someone needs an MRI, they give the patient a slip of paper that says they can get one. The patient sees where they are allowed to go and makes an appointment. Sometimes, the clinic will ask the patient where they want to go and will make the appointment with them. Your arguement of the PTs lining their pockets is a reach. yes there are unscrupulous providers of all stripes. The vast majority of docs whether they own their own practice or not are ethical. The reason for the opposition of POPTS is to protect our profession from exploitation.

I am not in favor of socialized medicine.

The differential diagnosis comment would be a valid one if the docs that refer to us went through a range of diagnostic tests before every referral. The simple fact is, they do not. The old, tired response is, how does a PT know if the patient's back pain is from a dissecting aortic aneurysm? The answer is, we don't and neither do you when they come in with back pain and you refer them to PT. We do a screening, tell you that it is not mechanical back pain and refer them back for more diagnostics.

I don't claim to be able to diagnose these things, but I do know, probably more thoroughly than most docs that refer to me how to do and interpret a clinical exam. If the patient does not fit what I expect to see, then they get referred. I have had to refer back people with testicular cancer, stress fractures of the pelvis and other diagnoses because they were referred for back pain and hip pain respectively. So don't tell me that you do exhaustive diagnostics on every patient that has pain, thats BS.

As far as comparing PTs with DCs . . . I don't think you really mean that, you were going on a rant, like I am. We are on your team and want it that way.
 

PMRMD2B

10+ Year Member
7+ Year Member
Mar 23, 2008
82
15
Status
Medical Student
Don't EVER compare chiros with PTs.. that is so degrading to Chiros.. JUST KIDDING GUYS...calm down.

Honestly, chiros do have direct access and have for years. Also have a "doctor" title, for around 100 years, and the scope is a lot more broad than PT. WE can do anything a PT can and more in some cases.

I see your point of PT Vs PMR. However.. you can also say the same thing about a NP vs. a FM doc.. The difference is, MD's have a lot more understanding of the underlying cause of disease and injury. I was one of the top students in my chiro class, I also have many other sports and rehab type certifications, etc. I thought I really knew my stuff... MD's didn't have anything on me.. NOT.. It was my FIRST semester in med school when I realized that it WAS different and MD DID learn everything in so much more depth. There is an understanding that is gained that is way beyond any class in chiro school or any seminar I have ever attended.
A few of my friends who are MD, do give me crap by saying that PMR docs are glorified PTs. I will agree that a lot of the practical work PMR and PT (and DCs in fact) perform, really does overlap. However...it is not always what you do that counts.. any monkey can "crack a back", or tell have someone stretch or apply stim pads. But.. do you know why you are doing it and exactly what is happening when you do it? I think that PMR docs are easily the top of the food chain when it comes to restoring normal physical function to patients with phyical injuries, no question. A paralegal may be able to do 90% of what an attorney does, but it is that 10% that the attorney knows from their education and experience that actually drives a case and understands the law. Same with PMR docs (sorry I compared to attornies..lol)
You have to also remember.. that a patient is more than just a knee rehab.. they could have other conditions, physical, chemical or emotional. MDs are trained to reconize and treat all of these. As a chiro.. I saw many patients with conditions that were out of my scope.. I had to refer.. many other chiros and PTs would simply miss simple diagnoses, because their training didn't cover those aspects. I have a friend in med school with me.. he is a DPT, also has a doctorate in electical diagnostic studies and a PhD (in something..lol)... but he wants to be a PMR doc, so he can be the BEST at what he does. He will even tell you.. he has learned more so far than he ever has as a DPT.
It is kind of like a mechanic.. you can take your BMW to the shade tree mechanic.. and as long as it is an oil change or something simple.. he will probably do a good job.. however.. if it is something more complex, that may need diagnostic testing and then extensive repair on complex systems.. you better take it to the dealership. PMR docs are the dealership here, of course. Just to note.. when you value your car (body) why even risk going to the shade tree mechanic?

As far as making money.. all physicians in the US that are paid for services are motivated by money.. unless you have a set salary. Even recommending a follow-up, lab work, prescribe a drug because the hot blonde bought your office lunch.. whatever it is.. there are plenty of financial incentives. I think most ethical physicians can draw the line when needed, whether it is a $20 lab fee or a $1,500 MRI. There is no reason you can't help people AND get paid for doing it. Think about funeral home directors.. they get paid very well.. to put you in a box and throw you in the dirt.

There is no reason to do away with POPTS. SC was wrong for that. PTs don't want to work for MDs.. but rely on them for scripts, so they can actually get paid for what they do. I hope most of the orthos that had PTs hire PMR docs and don't refer to the PTs that started that crap. Most of the PTs are now sorry they did that, since they can't get paid without the referral. However.. PTs can still work for chiros..HAHA that is too funny. Now all of them are asking chiros for jobs. Just to let you know.. I don't have anything against PTs.. or any healthcare providers.. I just think what they did was wrong and it is only hurting the patients' healthcare delivery.

PMR 4 MSK.. I have to say.. you always have the best posts and we are lucky to have a level headed, experienced physician in here to speak words of wisdom. Not trying to brown nose.. just saying what I feel.

I know my state is stringent on ALL "doctors", having to put what type they are in their advertising, cards, paperwork, etc. That line is getting more and more blurred since everyone wants to be called doctor. Even the attornies are getting into that now.
 

truthseeker

Senior Member
10+ Year Member
Sep 2, 2004
1,001
311
Status
The thing is, PTs do know why things are tight, why they need to be stretched, about neuro proprioceptive systems. Of course your DPT classmate learned a ton, they switched professions. I am guessing that they didn't learn more about the musculoskeletal system.

No DPT should introduce themselves as doctor in my opinion. It implies that they are physicians. I also believe that chiros (no offense intended) use that title (granted, you have a doctorate degree, but then again so do I) to imply a broader scope of knowledge than they really have. No more schooling than PTs have, but a different scope and a much more active political lobby (at least in the past).

when I call a friend of mine who is a chiro, his secretary answers "dr X's office" When people call me I answer, "Physical therapy, Joe speaking" We are not putting ourselves out as PM&R docs. Just don't dismiss our knowledge base and our area of expertise. I think, maybe, we know more than you give us credit for.
 

PMRMD2B

10+ Year Member
7+ Year Member
Mar 23, 2008
82
15
Status
Medical Student
I remembered in my second semester I called my friend who has been a MD for 15 years.. I said.. man.. school is hard..they really go fast and teach a lot in a short amount of time.. and then.. you have to take step 1.. the two years of rotations.. step 2, then.. you have to fight like heck for a residency.. and IF you get one.. you have another 4 years of working your butt off.. then step 3.. and that is just so you can practice.. not including getting boarded..
Then I said.. my hat goes off to ANYONE who even has a license to practice medicine.. because it is a long, hard road..

He then said.. why do you think we get so mad when you go to chiro school for 4 years and then come out saying "I am a doctor, just like you, I learned all the things you did, etc"..

I just said.. "I'm sorry"..

Medicine is way above chiro and pt.. simple truth.
 

Tenacious DO

Member
10+ Year Member
Nov 2, 2005
92
0
Status
Attending Physician
As a current PT --> DO --> Hopeful PMR, I thought I would offer the following.

Re: the doctor of PT issue...I am not sure that is the greatest path for the PT profession.

Simply look at the percentage of referrals from a MD/DO --> PT vs MD/DO --> Chiros
(don't give me limited case study reports of Physician referrals to Chiros...for the most part Chiros are out hustling for patients, PT's could be heading toward a similar hustle) = PT’s have a good thing going. Don't Bite the Hand that Feeds You.

Not that I fear PT's as competition, but I just don't want to see a good PT act as a poor doctor....I also don't appreciate the opposite....the term "Doctor" has really got watered down anyway. I just got my car fixed at the "Brake Doctor"

I would have preferred to see more promotion of the PT fellowships or specialty certifications (SCS, OCS and the like)....Experience + Credentials should be the path to PT career advancement, instead of 6 more months in grad school. As a future Physician, I would be more willing to fill the schedule of a good PT with advanced credentials in Sports, Ortho, Neuro over just a DPT.

It is interesting to me to hear what comes out of the mouth of PT students that have shadowed me recently. These schools are really filling them full of the idea that they need to prepare to think & act like a Physician...There are still a lot of missing pieces.

My brief 2 years in med school has greatly improved the way I approach a patient as a practicing physical therapist....I for one did NOT know what I DIDN’T know.

My 2 Cents.
 

truthseeker

Senior Member
10+ Year Member
Sep 2, 2004
1,001
311
Status
I remembered in my second semester I called my friend who has been a MD for 15 years.. I said.. man.. school is hard..they really go fast and teach a lot in a short amount of time.. and then.. you have to take step 1.. the two years of rotations.. step 2, then.. you have to fight like heck for a residency.. and IF you get one.. you have another 4 years of working your butt off.. then step 3.. and that is just so you can practice.. not including getting boarded..
Then I said.. my hat goes off to ANYONE who even has a license to practice medicine.. because it is a long, hard road..

He then said.. why do you think we get so mad when you go to chiro school for 4 years and then come out saying "I am a doctor, just like you, I learned all the things you did, etc"..

I just said.. "I'm sorry"..

Medicine is way above chiro and pt.. simple truth.
I don't disagree with a single thing you said. The difference between a DC or DPT or PhD, or PharmD, or OD, or DDS and an MD or DO is gigantic. I have no argument with the difference. My point has been that in general, a good PT will know more about the neuromuscular system than most FPs. One of the responses to the original poster suggested that PTs were challenging the PM&R docs position, then one of the PM&R residents jumped in and said tha PTs "product was inferior" I disagreed.

They are different products.

Medicine is way above PT and chiro is not how I would have put it but I understand what you are saying. Yes, you know more about systemic disease, physiology, and pharmacology. PTs know more about how people move, position sense, performance enhancement, and in general, exercise. Advice to new docs, recognize when you are not the expert and say " I don't know", and refer to the people that do.

That applies to all people in any profession. I know that I practice what I preach.
 

PMRMD2B

10+ Year Member
7+ Year Member
Mar 23, 2008
82
15
Status
Medical Student
I agree with you...chiros and PTs know a lot more about neuro-MSK than 90% of FM or IM docs. They don't concentrate on the same things. That is why I got so many referrals from them.... they didn't understand basic biomechanics of the spine or other joints. I was suprised to be honest on how little they were trained in these areas. I used to turn x-rays upside down and ask them.. does this look normal to you.. they would 99% of the time look at it and say.. yeap.. looks normal to me..LOL
However.. let's be fair and reconize that they are very well trained in the areas they practice everyday.. they know more about other diseases and treatments that I could imagine (at this point).

I guess that is why we have different fields.. you just can't know it all.
 

truthseeker

Senior Member
10+ Year Member
Sep 2, 2004
1,001
311
Status
I agree with you...chiros and PTs know a lot more about neuro-MSK than 90% of FM or IM docs. They don't concentrate on the same things. That is why I got so many referrals from them.... they didn't understand basic biomechanics of the spine or other joints. I was suprised to be honest on how little they were trained in these areas. I used to turn x-rays upside down and ask them.. does this look normal to you.. they would 99% of the time look at it and say.. yeap.. looks normal to me..LOL
However.. let's be fair and reconize that they are very well trained in the areas they practice everyday.. they know more about other diseases and treatments that I could imagine (at this point).

I guess that is why we have different fields.. you just can't know it all.

I do recognize that and have said so in earlier posts. I just get sick of the dismissive tone that some medical students and residents use when discussing PT.
 

TRAMD

Señor Member
10+ Year Member
5+ Year Member
Mar 10, 2007
1,525
3
Status
Attending Physician
There is fine line between "here is some other threads on this topic" to be helpful and "nobody will say anything new on this topic so just read what has already been said" to be condescending and make an attempt to insult our knowledge of the forum search function.

I always find posts that lean (as this one seems to) towards the latter to be most annoying. Perhaps SOME of the joy of a forum is discussing issues and the back of forth of spirited debate, not simply reading the opinions of others.

If you go to a party and people are discussing politics/religion/marriage/economics/environment/etc. do you let them know that these have all been discussed to death in the past and then tell them about books and articles that they can read on the topic? I bet that people would really appreciate that.

If you meant this post to merely be helpful and I have somehow misjudged it then I apologize profusely but keep my standpoint of being annoyed with posts that are in fact what I perceived yours to be.
 

TRAMD

Señor Member
10+ Year Member
5+ Year Member
Mar 10, 2007
1,525
3
Status
Attending Physician
As a current PT --> DO --> Hopeful PMR, I thought I would offer the following.

Re: the doctor of PT issue...I am not sure that is the greatest path for the PT profession.

Simply look at the percentage of referrals from a MD/DO --> PT vs MD/DO --> Chiros
(don't give me limited case study reports of Physician referrals to Chiros...for the most part Chiros are out hustling for patients, PT's could be heading toward a similar hustle) = PT’s have a good thing going. Don't Bite the Hand that Feeds You.

Not that I fear PT's as competition, but I just don't want to see a good PT act as a poor doctor....I also don't appreciate the opposite....the term "Doctor" has really got watered down anyway. I just got my car fixed at the "Brake Doctor"

I would have preferred to see more promotion of the PT fellowships or specialty certifications (SCS, OCS and the like)....Experience + Credentials should be the path to PT career advancement, instead of 6 more months in grad school. As a future Physician, I would be more willing to fill the schedule of a good PT with advanced credentials in Sports, Ortho, Neuro over just a DPT.

It is interesting to me to hear what comes out of the mouth of PT students that have shadowed me recently. These schools are really filling them full of the idea that they need to prepare to think & act like a Physician...There are still a lot of missing pieces.

My brief 2 years in med school has greatly improved the way I approach a patient as a practicing physical therapist....I for one did NOT know what I DIDN’T know.

My 2 Cents.
"The Hand That Feeds" is a great Nine Inch Nails song. I should burn some copies and send them to these PTs.
 

TRAMD

Señor Member
10+ Year Member
5+ Year Member
Mar 10, 2007
1,525
3
Status
Attending Physician
I agree with you...chiros and PTs know a lot more about neuro-MSK than 90% of FM or IM docs. They don't concentrate on the same things. That is why I got so many referrals from them.... they didn't understand basic biomechanics of the spine or other joints.
I would say this goes a little less for DOs that concentrate more on MSK than MDs.

I was suprised to be honest on how little they were trained in these areas. I used to turn x-rays upside down and ask them.. does this look normal to you.. they would 99% of the time look at it and say.. yeap.. looks normal to me..LOL
However.. let's be fair and reconize that they are very well trained in the areas they practice everyday.. they know more about other diseases and treatments that I could imagine (at this point).

I guess that is why we have different fields.. you just can't know it all.
Hmm, making others look foolish is your thing . . . awesome. Try this one: Ask another doc what the most common kind of cancer is in men over 50. When 95% of them say "prostate" respond "basal cell carcinoma of the skin you doofus." Hilarious. every. time.

. . . Wow, I am a little squirrelly tonight. Probably because I am on call.
 

Taus

.
Moderator
10+ Year Member
Feb 1, 2005
3,893
487
Philly
Status
Attending Physician
There is fine line between "here is some other threads on this topic" to be helpful and "nobody will say anything new on this topic so just read what has already been said" to be condescending and make an attempt to insult our knowledge of the forum search function.
probably a little bit of each

I always find posts that lean (as this one seems to) towards the latter to be most annoying. Perhaps SOME of the joy of a forum is discussing issues and the back of forth of spirited debate, not simply reading the opinions of others.

If you go to a party and people are discussing politics/religion/marriage/economics/environment/etc. do you let them know that these have all been discussed to death in the past and then tell them about books and articles that they can read on the topic? I bet that people would really appreciate that.
I would probably just excuse myself to go get another beer...

If you meant this post to merely be helpful and I have somehow misjudged it then I apologize profusely but keep my standpoint of being annoyed with posts that are in fact what I perceived yours to be.
 

TRAMD

Señor Member
10+ Year Member
5+ Year Member
Mar 10, 2007
1,525
3
Status
Attending Physician
probably a little bit of each
I can respect that.

I would probably just excuse myself to go get another beer...
Hmm . . . maybe you mean wine or cocktail? At parties that I have been to with beer the discussion tends to lean more in the range of sports to "there was this one time that I was so trashed . . . "
 

freddydpt

15+ Year Member
Apr 1, 2004
842
140
Pennsylvania
Status
Attending Physician, DPT / OTD, Physical Therapist
I think the key phrase here is 'manage' vs. evaluate. I'm only a resident, but I've seen a high percentage of pts in my cont. clinic who were 'managed' to death (not literally) :hardy: for lets say 'shoulder pain' by a PT for months, we see them and its clear its a radic. and that cuff program they were doing wasn't the ticket. I'm not slamming PTs, they know a ton of PT management programs in and out and better than me; what I am saying if there is no substitute for many years of training involved in getting your MD/DO and boarded in PM&R.

I think what people are taking issue with is PT asserting itself as the primary evaluators and substiting that for a speciality physician eval of an issue. Now, if the FP/IM has a clear diagnosis and is ready to procede directly to management and PT, then fine, why waste the resources on a PM&R or Orhto consult unless the pt doesn't improve?
Agree with above, except, if the PT didn't pick up the radiculopathy, then that's a poor exam which could be done by an FP or even a bad PM&R doc. As a PT, I feel like radics were drilled into us as much as basic anatomy.

I completely agree with the last paragraph.