PT as “primary care provider”

[deleted959484]

Saw a friend that is currently in PT school post this on social media... I definitely think that PTs have a role but seems like this is overreaching it. Thoughts?

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[deleted87716]

Yeah, that’s BS. Cut that $h*t off at the knees.

 

[TableMD]

Overreaching

 

[Moose A Moose]

Negative, ghost rider

 

[Sheldon]

Curious as to why you all don't think a PT can 1) screen for referral and red flags in an OP PT setting 2) Manage MSK pain and refer/contact PCP or specialist as necessary 3) and aren't already doing this in a) the military and b) most states with direct access. It's not like we are ordering unnecessary imaging and prescribing opiods for CLBP.

If your issue is with the term "primary care provider," I understand that. If, however, your issue is that you don't want PTs to be the first healthcare professional to see a patient with MSK-related issues without first having been to a "gatekeeper" first, then I disagree given the above statements/questions in the first paragraph. PTs are doing it, doing it well and safely, and referring when necessary.

 

[deleted87716]

Are PTs trained to diagnose? Yes or no. That answers the question.

 

[Link0358]

Curious as to why you all don't think a PT can 1) screen for referral and red flags in an OP PT setting 2) Manage MSK pain and refer/contact PCP or specialist as necessary 3) and aren't already doing this in a) the military and b) most states with direct access. It's not like we are ordering unnecessary imaging and prescribing opiods for CLBP.

If your issue is with the term "primary care provider," I understand that. If, however, your issue is that you don't want PTs to be the first healthcare professional to see a patient with MSK-related issues without first having been to a "gatekeeper" first, then I disagree given the above statements/questions in the first paragraph. PTs are doing it, doing it well and safely, and referring when necessary.

Because that leg pain might be leukemia, or PVD, or a myositis, or pseudogout, or shingles, or DVT, or lupus, or a tumor etc etc.

 

[Sheldon]

Are PTs trained to diagnose? Yes or no. That answers the question.

Yes, PTs are trained in making a PT diagnosis. And we are taught to kindly suggest possibilities ("signs/symptoms consistent _____ with best assessed by a physician") when referring out or referring back.

Because that leg pain might be leukemia, or PVD, or a myositis, or pseudogout, or shingles, or DVT, or lupus, or a tumor etc etc.

"Might be." You are correct.....but it's LIKELY not. Here's the thing - if a pt comes in with a primary complaint of leg pain, and I cannot reproduce, exacerbate, or diminish his/her familiar complaint with movement or modification of movement, does not fit with any MSK pattern, and/or does not improve as expected, that patient is referred out or back. The flip of your "point" is that odds are it's not, but do you really want to tell me that you are going to do whatever lab/image/diagnostic test to r/o each of the above EVERY TIME a pt with leg pain comes in? Or, are you going to do a physical exam and go from there?

I trust we are more similar than different in how we approach the standard of care in our respective fields- I have my wheelhouse and you have yours. PT is direct access in most states already, so the ship above you are "wanting to cut off at the knees" has already sailed. PTs are safe, effective, and cost-effective; we don't need to prove that time and time again to physicians that are worried about keeping the gate to good conservative MSK care to themselves. Our time is better spent working together without silos and egos that drive up cost and frustrate the consumer. PTs aren't pretending to be physicians, but in the realm of conservative MSK care, we aren't your subordinate either.

 

[VA Hopeful Dr]

Yes, PTs are trained in making a PT diagnosis. And we are taught to kindly suggest possibilities ("signs/symptoms consistent _____ with best assessed by a physician") when referring out or referring back.

"Might be." You are correct.....but it's LIKELY not. Here's the thing - if a pt comes in with a primary complaint of leg pain, and I cannot reproduce, exacerbate, or diminish his/her familiar complaint with movement or modification of movement, does not fit with any MSK pattern, and/or does not improve as expected, that patient is referred out or back. The flip of your "point" is that odds are it's not, but do you really want to tell me that you are going to do whatever lab/image/diagnostic test to r/o each of the above EVERY TIME a pt with leg pain comes in? Or, are you going to do a physical exam and go from there?

I trust we are more similar than different in how we approach the standard of care in our respective fields- I have my wheelhouse and you have yours. PT is direct access in most states already, so the ship above you are "wanting to cut off at the knees" has already sailed. PTs are safe, effective, and cost-effective; we don't need to prove that time and time again to physicians that are worried about keeping the gate to good conservative MSK care to themselves. Our time is better spent working together without silos and egos that drive up cost and frustrate the consumer. PTs aren't pretending to be physicians, but in the realm of conservative MSK care, we aren't your subordinate either.

The thing you're missing is that if a patient comes to us, we can determine the etiology and start the work up that's needed. If its not MSK, you have to send them to us for additional work up. Its an extra step that costs the patient time/money.

Now you can make the argument that the same is true for MSK problems if we refer to you, but the initial visit is in part to investigate for more serious pathology.

 

[j4pac]

Yes, PTs are trained in making a PT diagnosis. And we are taught to kindly suggest possibilities ("signs/symptoms consistent _____ with best assessed by a physician") when referring out or referring back.

"Might be." You are correct.....but it's LIKELY not. Here's the thing - if a pt comes in with a primary complaint of leg pain, and I cannot reproduce, exacerbate, or diminish his/her familiar complaint with movement or modification of movement, does not fit with any MSK pattern, and/or does not improve as expected, that patient is referred out or back. The flip of your "point" is that odds are it's not, but do you really want to tell me that you are going to do whatever lab/image/diagnostic test to r/o each of the above EVERY TIME a pt with leg pain comes in? Or, are you going to do a physical exam and go from there?

I trust we are more similar than different in how we approach the standard of care in our respective fields- I have my wheelhouse and you have yours. PT is direct access in most states already, so the ship above you are "wanting to cut off at the knees" has already sailed. PTs are safe, effective, and cost-effective; we don't need to prove that time and time again to physicians that are worried about keeping the gate to good conservative MSK care to themselves. Our time is better spent working together without silos and egos that drive up cost and frustrate the consumer. PTs aren't pretending to be physicians, but in the realm of conservative MSK care, we aren't your subordinate either.

You don’t have to get an ultrasound every time...but it is considered clinically every time.

PTs do a good job with MSK issues. But MSK issues usually don’t kill people. More often than not MSK complaints are due to MSK etiologies but definitely not always.

 

[Bostonspine]

Curious as to why you all don't think a PT can 1) screen for referral and red flags in an OP PT setting 2) Manage MSK pain and refer/contact PCP or specialist as necessary 3) and aren't already doing this in a) the military and b) most states with direct access. It's not like we are ordering unnecessary imaging and prescribing opiods for CLBP.

If your issue is with the term "primary care provider," I understand that. If, however, your issue is that you don't want PTs to be the first healthcare professional to see a patient with MSK-related issues without first having been to a "gatekeeper" first, then I disagree given the above statements/questions in the first paragraph. PTs are doing it, doing it well and safely, and referring when necessary.

My reservation are the large and small PT corporation that give stim/manual for 30 session and refer when they run out of session. Everyone gets the same protocol

 

[Link0358]

"Might be." You are correct.....but it's LIKELY not. Here's the thing - if a pt comes in with a primary complaint of leg pain, and I cannot reproduce, exacerbate, or diminish his/her familiar complaint with movement or modification of movement, does not fit with any MSK pattern, and/or does not improve as expected, that patient is referred out or back. The flip of your "point" is that odds are it's not, but do you really want to tell me that you are going to do whatever lab/image/diagnostic test to r/o each of the above EVERY TIME a pt with leg pain comes in? Or, are you going to do a physical exam and go from there?

Physicians are trained when to suspect certain diagnoses based off the clinical history. It’s why we go to school for so long. The fact that you don’t seem to be aware that many scary things can mimic MSK complaints proves the point that PTs should not be seeing undifferentiated patients.